‘I went home with blood all over me’: At Philly hospitals, health-care workers face routine violence

Early on an October morning last year, a “code pink” alert sounded over the intercom at Jefferson Einstein Medical Center: Someone was trying to kidnap a baby.

In the NICU, a mother who had lost custody of her infant had decided to take the child home anyway. At the ward’s entrance, a nurse tried to stop her — and the mother threatened her with a knife.

Staff on duty were able to talk the woman into handing over her baby, recalled Carla LeCoin, a longtime nurse on the neonatal intensive care unit. Then security officers tackled the woman to the floor, wresting the knife from her hands.

The alarming episode illustrates the day-to-day dangers that nurses face from a concerning rise in violence against hospital workers across the state and nation. In Philadelphia, police regularly respond to reports of assaults on health-care workers at the city’s four trauma centers, police reports show. And nurses at several of the city’s most prominent hospitals say far more go unreported.

To understand the dangers that nurses face, The Inquirer requested information from city police on the number of assaults against hospital workers reported in the last two years at the four Philadelphia hospitals with Level 1 trauma centers, which treat the most severely injured patients and tend to have busy emergency departments.

In interviews, nurses in union leadership positions at the Pennsylvania Association of Staff Nurses and Allied Professionals spoke about their experiences with violence on the job. The nurses shared that how hospital leaders deal with the issue impacts morale and perceptions of safety. They also provided details on episodes, such as the Einstein “code pink,” that could not be obtained from police due to ongoing investigations.

At Temple University Hospital, for example, PASNAP leaders believe that they have made significant progress addressing violence with hospital leadership in the last year, meeting regularly to discuss how to protect health-care workers at the facility.

But in PASNAP’s Einstein chapter, leaders say staff feel unsafe, even though fewer instances of violence have been reported to police in the last two years than at other hospitals. Many fault the Einstein administration for not enacting security measures they have been requesting.

In the aftermath of the attempted kidnapping in the Einstein NICU, shaken staff members tried to comfort each other, according to LeCoin, who was working that day. The mother who pulled the knife on nurses had struggled with mental health and substance use issues, and staff knew she was likely acting out of desperation and grief, LeCoin said.

A weapons detector at the entrance to the building housing the maternity ward might have detected the knife before the woman brought it into the NICU, something that union nurses at PASNAP requested after the episode, but that hasn’t been put into place. (Such security measures are in place at buildings across Penn Medicine’s campus, which includes Penn Presbyterian Medical Center, staff there say.)

At the very least, the Einstein nurses wanted leaders at the hospital or its corporate owner, Jefferson Health, to meet with witnesses to the attempted kidnapping to hear their concerns.

Instead, staff were sent information on external mental health programs they could access. And leadership threw them a pizza party, to build morale, the union said.

Jefferson Health declined to comment on the episode, saying in a statement that the “safety and security of our staff, patients and visitors is a top priority.”

Jefferson is “committed to supporting our employees” and to working to strengthen security, said the statement from spokesperson Damien Woods. It noted the health system has expanded safety efforts in recent years, including adding more officers to the Jefferson police force and having security officers circulate regularly in patient care areas.

In Philadelphia, nurses routinely experience on-the-job violence.

According to Philadelphia police, Einstein saw 18 reported assaults involving staffers between January 2022 and early December 2023.

Thomas Jefferson University Hospital, which is separate from Einstein but also owned by Jefferson Health, reported 32 such assaults during this time. Temple University Hospital reported 31 assaults involving workers.

Penn Presbyterian Medical Center reported four staff-involved assaults in the same time period.

The preliminary data, culled from police reports, have limitations: As police conduct their investigations, they may categorize episodes differently, leading to discrepancies over time in the number of reported assaults at each hospital. They may also go back and update reports as new information surfaces.

The number of episodes that police respond to is also likely a fraction of the true number of assaults on health-care workers at hospitals, because incidents that do not rise to the level of a crime may not be reported.

According to the 2021 Pennsylvania Workers’ Compensation and Workplace Safety Annual Report, some hospital jobs are nearly as dangerous as working in a coal mine or metal manufacturing plant, and the most common injury among health-care workers is being struck.

In Pennsylvania, hospital staff and executives alike are pushing for federal legislation that they say would protect more hospital staffers from violence. The proposed Safety from Violence for Healthcare Employees Act would make intentionally assaulting a hospital worker a federal crime, and provide grant funding to hospitals to improve security at their facilities.

Unionized nurses in Philadelphia’s major hospitals say that regular communication with hospital leadership helps to improve safety and morale for staff.

Last year, the Temple nurses’ union signed a new contract that requires hospital officials to regularly debrief staff who witnessed or experienced violent episodes. Temple nurses say that provision has made staff feel safer and given them a say in how their workplace addresses such episodes.

“The debriefings are really helpful — we watch videos, talk about what we could have done better, what the hospital could have done better. It creates closure for people who are victims,” said Mary Adamson, an ICU nurse and the head of Temple’s nursing union. “Bringing it out in the open is what needs to be done.”

Union leaders at Temple still believe that the hospital could move faster on some initiatives now in place, such as installing weapons detectors at hospital entrances and cameras to deter thefts from nurses’ cars in the hospital parking garages.

Temple officials declined to comment when asked about workplace violence at the hospital and leadership’s communication with staff.

At Penn Presbyterian Hospital, which had the lowest reported number of assaults on health-care workers of any major trauma center in the city, nursing officials say their health system, Penn Medicine, has trained staff on tactics to de-escalate tense encounters with patients and other visitors. Penn also distributed distress buttons that staff can wear and press to alert hospital security if they feel threatened.

Penn also invested $28 million to place weapons detecting equipment at 16 locations around its medical facilities.

Hospital officials debrief with staff who have experienced violence on the job within 24 hours of an episode, said Lisa Triantos, the clinical director at Presbyterian.

“We are closing the loop on 100% of those events that are brought to our attention,” she said.

Einstein nurses say leadership at the hospital is not responding quickly enough to their concerns. In their most recent union negotiations, efforts to get hospital leaders to commit to hiring more security officers to protect nurses in especially dangerous roles were unsuccessful.

“They said it wasn’t within the purview of the nursing contract,” said Danielle Wright, a nurse who works in the hospital’s crisis response center for psychiatric patients.

Last summer, Wright said, she witnessed a patient in the crisis response center hit a staffer in the face without warning, then the patient chased the staffer down the hallway to the nursing station and rained punches on her. The staffer suffered multiple fractures to her facial bones.

Security officers eventually subdued the patient, Wright said, but had to run to the station from several rooms away, wasting crucial seconds. Wright believes that if security officers had been in the nursing station at the time of the attack, they could have stopped it sooner.

Instead, Wright comforted her stricken coworker and helped her to the emergency room.

“I went home that day with her blood all over me,” she said.

The staffer was treated at the hospital but was on medical leave for several months, Wright said, and only recently returned to work.

Jefferson officials declined to comment on the episode.

Philadelphia police declined to provide the details of assaults on hospital workers to The Inquirer, including this episode described in interviews. The data police provided to the paper showed six assaults involving staffers reported at Einstein in the summer of 2023.

Einstein nurses say they were encouraged when a second security officer was recently added to the crisis response center. The hospital still needs to hire additional officers and station them in more areas of the hospital, such as nursing stations, to enable them to respond more quickly to violence, Wright said.

Union leaders said they’d also like security to screen for weapons at other entrances to the hospital, not just the emergency department, which is currently the only place patients are searched for weapons.

“People say safety regulations are written in blood,” said LeCoin, the nurse who witnessed the attempted kidnapping in Einstein’s NICU. “I don’t want to bleed. I don’t want to be the person that ultimately moves Einstein to do what they should do.”