After a series of fatal incidents, questions are being raised about the use of firearms in hospitals. Currently, there is no federal law barring guns from hospitals. Laws in health systems vary by state, with some states, including Texas, designating hospitals as gun-free zones. Such bans, however, may not stop criminals from shooting in healthcare settings, only preventing people at the hospitals from defending themselves. Some medical staff are concerned that guns in hospitals would add an unnecessary risk to an already high-risk setting.

The rate of violence against healthcare staff is significant, particularly in emergency and mental health settings. In January 2015, a man walked into the main entrance of Brigham and Women's Hospital in Boston, MA, proceeded to a cardiology clinic and fatally shot his late mother's doctor, Michael Davidson, MD. The man was reportedly unhappy with his mother's care. According to the Bureau of Labor Statistics, workers in healthcare and social assistance settings are five times more likely to be victims of nonfatal assaults or violent acts than the average worker in all other occupations.

For nurses in emergency departments, the risk of workplace violence is high – more than 55% of nurses report physical violence, verbal violence, or both, according to an Emergency Nurses Association study in 2010. In addition, there is a well-established tendency for workers in healthcare settings to underreport incidents. The same study showed that 66% of victims of physical violence do not file a formal report, and neither do the large majority (86%) of victims of verbal abuse. The authors write, "Higher commitment to violence mitigation from hospital administration and emergency department management and the presence of reporting policies (especially zero-tolerance policies), were associated with a lower odds of physical violence and verbal abuse."

Physicians too face a risk of being threatened, abused, or physically harmed by one of their patients. Such aggression and violence are costly on a number of levels. Financial costs include losses to the institution as a result of medical expenditures, time away from the job, psychological counselling, and workers' compensation claims. The cost to the individual extends beyond the immediate physical injury to possible anger, fear, anxiety, self-blame, and loss of confidence.

Reasons for the high level of violence are many and varied but can include long wait times, unrestricted movement of the public around clinics and hospitals with no security measures (I think that’s what she means but “checks” sounds too informal), fewer inpatient mental health beds for high-acuity patients; a general increase in patient acuity upon arrival; and an increasing use of hospitals by police and the criminal justice system for the care of acutely disturbed, violent people, or as an alternative to overcrowded jails.

Several major medical associations are taking steps to discourage violence in hospitals. The American Medical Association's (AMA) policy on guns in hospitals calls on hospitals "…to incorporate, within their security policies, specific provisions on the presence of firearms".  The AMA points out that such policies "…must be developed with the cooperation and collaboration of the medical staff, the hospital security staff, the hospital administration, other hospital staff representatives, legal counsel, and local law enforcement officials".

These policies should begin with a careful needs assessment, the AMA policy states, and should, at a minimum, address the following issues: identification for all staff and visitors; restrictions on access; changes in the physical layout to improve security; possible use of metal detectors; monitoring equipment such as closed circuit television; an emergency signalling system; procedures once a weapon is discovered; and a means of securing or controlling weapons that may be brought into the facility. Training should then be provided to all members of staff, adds the AMA.

The Occupational Safety and Health Administration (OSHA) has also published guidance on workplace violence, making similar recommendations. The guidance points out, "A written program for workplace violence prevention, incorporated into an organization’s overall safety and health program, offers an effective approach to reduce or eliminate the risk of violence in the workplace."

Although not a common point of view, some lawmakers are open to the idea of allowing guns in healthcare settings (is this sentence referenced?). In any case, every healthcare organization should take action on establishing appropriate security programs with the aim of cutting assault rates.

References:

Bureau of Labor Statistics. NONFATAL OCCUPATIONAL INJURIES AND ILLNESSES REQUIRING DAYS AWAY FROM WORK, 2013.
http://www.bls.gov/news.release/pdf/osh2.pdf

Emergency Nurses Association. Emergency Department Violence Surveillance Study, November 2011.
https://www.ena.org/practice-research/research/Documents/ENAEDVSReportNovember2011.pdf

American Medical Association Policy H-215.977 Guns in Hospitals.
https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/resources/html/PolicyFinder/policyfiles/HnE/H-215.977.HTM

U.S. Department of Labor Occupational Safety and Health Administration. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers
https://www.osha.gov/Publications/osha3148.pdf

 

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