Penn’s hit-and-run shows it’s time for violence against ER nurses and doctors to stop

In the early hours of Saturday morning Oct. 12, three ER nurses in Philadelphia were injured, one critically, in a hit-and-run assault at Penn Presbyterian Medical Center. These nurses were attempting to rescue a shooting victim from a car just outside the ER entrance when the driver sped away, striking the nurses who were attempting to save a life.

These events don’t just scar the nurses who were injured but leave marks on the entire health-care worker community.

» READ MORE: Three Penn nurses injured in hit-and-run highlight problem of violence against health-care workers

The hit-and-run at Penn Medicine’s main trauma center in University City highlighted the violence faced by health-care workers. In particular, dangers in ERs are increasing across Philadelphia and the nation. Emergency nurses and physicians are disproportionately exposed to violence compared to workers in any other industry, as well as those in any other part of health care.

Over 50% of ER nurses reported experiencing violence from a patient in the past 30 days in a survey conducted this year by a professional society. Every hour, two nurses in the U.S. are punched, spit on, or verbally assaulted — and that’s likely an underestimate, a 2022 analysis of industry data showed. Health-care workers in the ER — like those working at Penn Presbyterian that Saturday — are the first touchpoint to hospital care for millions of us every year (1 in 5 adults uses an ER annually).

As emergency medicine clinicians and researchers ourselves, we have been victims of violence; we have supported our colleagues through the aftermath of violence; and we have surveyed hundreds of nurses and physicians to study their workplace, job safety, and well-being.

Our research underscores all the reasons why violence against all health-care clinicians must stop.

We have found that 53% of emergency nurses and 29% of physicians report high burnout — with violence in the workplace a major driving factor. ERs are the epicenter of a burnout problem afflicting health-care workers that contributes to turnover, mental health strain, and has led to an exodus of experienced doctors and nurses. Workplace violence is a top reason why emergency nurses would not recommend their hospital to other clinicians as a good place to work.

Working in an ER has long been an intense and stressful experience. For many of us, that intensity attracts us to the work. But as workplace violence worsens, where is the line drawn between tolerating mistreatment and protecting our safety? Many of us have brushed off verbal attacks, and perhaps even the physical ones, but now we cannot stand by as our colleagues are being struck by cars.

Nurses and physicians shouldn’t have to accept violence in order to care for patients.

The airline industry and the Federal Aviation Administration have led the way, having successfully implemented zero-tolerance policies for unruly passengers on flights. Now a zero-tolerance policy is needed universally within all health-care settings to protect clinicians.

» READ MORE: At Philly hospitals, health-care workers face routine violence

Two federal bills — the Workplace Violence Prevention for Health Care and Social Service Workers Act and the Safety from Violence for Healthcare Employees (SAVE) Act — introduced by members of Congress would establish zero-tolerance policies, standards for addressing violence in our workplaces, and enforce penalties for assaults on health-care workers.

We also need stronger reporting and follow-up requirements, given that 88% of workplace violence incidents go unreported by clinicians. To further support health-care workers, we need time off for recovery, prosecution when appropriate, and better access to mental health care.

Safe staffing levels at work are also needed, given the association between high patient-to-nurse staffing ratios, poor hospital safety, and high nurse burnout. As an emergency nurse and physician, we know that when there aren’t enough nurses staffed on a shift, wait times extend, frustrations rise, and everyone’s safety is at risk. The Patient Safety Act, which is currently awaiting a vote with the Pennsylvania Senate, would ensure that hospitals have enough nurses working on shifts for patients to receive timely and effective care. We fear this legislation will not pass without vocal support from the public.

The 24/7 health, safety, and emergency preparedness of our communities depends on health-care workers being able to safely do their jobs. We must invest in safe health-care settings for our teams, otherwise we will lose these vital individuals, and who would blame them?

K. Jane Muir is a nurse and assistant professor at Penn Nursing in the Center for Health Outcomes and Policy Research and a senior fellow at the Leonard Davis Institute of Health Care Economics.

Anish K Agarwal is a physician and assistant professor of emergency medicine at the University of Pennsylvania and Penn Presbyterian Medical Center. He is also a senior fellow at the Leonard Davis Institute of Health Care Economics.