In one of the most violent incidents ever recorded in healthcare, an ED doctor was gunned down in a parking lot at Mercy Hospital & Medical Center in Chicago in 2018 while a van full of nursing home patients watched in horror.
Three other people were killed in that incident, including a security guard, a first-year pharmacy resident and a Chicago police officer. What made it particularly disturbing is that the perpetrator was identified as the former fiancée of the ED doctor killed in the shooting. The shooter asked her for his engagement ring to be returned and fired his gun six times as she tried to run back to the hospital to alert security.
Sadly, this is not the first time a domestic incident has spilled into a healthcare worker’s professional life. In 2002, another medical center nurse was killed by a staff member’s husband after returning from her lunch break. Twenty years ago, workplace shootings were far less common than they are today. Intimate partner violence has substantially increased over the last two decades. According to the Centers for Disease Control and Prevention, data from U.S. crime reports suggest that about 1 in 5 homicide victims are killed by an intimate partner. The reports also found that over half of female homicide victims in the U.S. are killed by a current or former male intimate partner.
Many of these women work in the healthcare system, and violence in their personal lives often follows them into the workplace. In January 2022, workplace violence standards went into effect for all Joint Commission-accredited hospitals and critical access hospitals. (Please see sidebar on Page 46 for details on these standard requirements.)
Identifying Intimate Partner Violence
Also, in January of this year, The Joint Commission published Quick Safety, Issue 63: Addressing Intimate Partner Violence and Helping to Protect Patients. This issue was thrust into the spotlight after medical professionals began voicing concerns about unreported child abuse, domestic abuse and intimate partner violence during the COVID-19 pandemic.
Accredited organizations are required in standard PC 01.02.09 to use written criteria to identify patients who may be victims of:
- Physical assault.
- Sexual assault.
- Sexual molestation.
- Domestic abuse.
- Elder or child abuse and neglect.
Some of the same tactics used to identify patients who may be victims of intimate partner violence can also be applicable for colleagues and staff. A simple statement like, “I care, and I am concerned about your safety and the safety of your child/children. I can help connect you with counseling and support, legal resources and shelter. Would you be interested?” can go a long way.
Many organizations have a “go-to person” for intimate partner violence, and this individual can also work with staff experiencing domestic issues. It’s important to keep all staff informed of what’s in your organization’s policies surrounding intimate partner violence and make sure the contact information for subject matter experts in the area is kept current.
Not every organization has a workplace violence subject-matter expert on staff, and some employees may actually be more comfortable reaching out to a stranger about issues with a partner. Share the local 24/7 emergency domestic violence hotline number with staff. If there isn’t a local intimate partner violence provider, use the National Domestic Violence Hotline, 1-800-799-7233, which also provides excellent language translation services.
Partner With Human Resources
No department manager should be working in a silo when there is a potential for violence toward staff or patients. This is a situation that requires a great deal of diplomacy because victims are often embarrassed or worry that the suggestion of victimhood will negatively impact their career.
It’s critical to keep accurate documentation on threats and potential threats. Employees who have taken out a restraining order should inform the organization’s human resources department and security department to explore possible security changes. This may be the last thing on the mind of an individual being abused, so the responsibility for sharing restraining orders often lies with supervisors or concerned colleagues. Human resources and security often request a copy of the restraining order and a photo of the individual for security purposes.
Another key role of human resources is connecting the employee with the organization’s employee assistance program, a natural fit given the correlation of intimate partner violence with staff and patient safety. EAP services usually include:
- Policy development.
- Delivery of training and seminars.
- Delivery of educational/awareness-raising activities.
- Provision of management/security staff consultation.
- Counseling to the affected employee.
- Oftentimes the most impactful changes can come from the employee’s manager, who can arrange to change schedules, re-allocate the staffer to a different patient area or make other arrangements such as secure parking.
Security Considerations
Forewarning about the potential for a staff member’s partner to create violence in the workplace is the key to preventing a deadly event. Security staff would benefit from having a photo behind the desk of anyone who could potentially present a threat.
Security could also increase their rounding in areas with potential for violence and arrange car escorts for any staff member who could be in danger. The escorts to the car are a huge deterrent for criminals, as many attackers try to find the victim alone or away from hospital security when initiating violence.
It’s considerably easier for larger organizations with more resources to implement security precautions. Smaller or more rural organizations can still partner with local law enforcement or even facilities and maintenance staff.
Underreported Epidemic
The healthcare industry has learned a great deal from these violent incidents over the years, and the resulting security precautions have been extraordinarily effective. However, because intimate partner violence is so underreported among healthcare workers, organizations don’t always have the opportunity to put their well-honed plans into place.
Much of the underreporting is attributed to the persistent (but false) notion that problems like intimate partner violence “don’t happen in communities like ours.” We’ll never forget surveying in a hospital located in an affluent area when a nursing student approached the administration about posting flyers with tear-away telephone numbers for a domestic abuse hotline. The administration supported the request but thought it was unnecessary in their demographic. Administrators were later shocked to hear that every single phone number from the tear-away flyer was removed in a few days.
Even tight-knit staffing units that may suspect a colleague is being abused often neglect to report these apprehensions to human resources or security. The only way to really resolve this issue is through further all-staff education on intimate partner violence. This is happening at the early stages with the CDC and the World Health Organization publishing statements on intimate partner violence, but now is the time to take it to the next level.
Intimate partner violence can happen to anyone, including healthcare workers. This issue needs to be treated as one connected to safety culture. Employees need to feel comfortable reporting potential violence in their own homes, and that will happen only when leadership creates a safe space to do so. Only then can we be confident that incidents like the death of the ED physician in Mercy Hospital's parking lot are something that will never be repeated.
Lisa DiBlasi-Moorehead, EdD, RN, is associate nurse executive (ldiblasimoorehead@jointcommission.org), The Joint Commission, and Jim Kendig, is field director (jkendig@jointcommission.org), The Joint Commission.
New Workplace Violence Prevention Requirements
The Joint Commission’s new workplace violence prevention requirements went into effect on Jan. 1, 2022. These requirements include three new elements of performance and two revised elements of performance. These are explained thoroughly in R3 Report Issue 30: New Workplace Violence Prevention Standards and are designed to provide an accountability piece for hospitals and support reporting of violence. Highlights include:
- An annual worksite analysis that could capture additional data confidentially.
- Taking action to mitigate or abate issues as a result of the worksite analysis.
- Collecting information about safety and security incidents involving patients, staff or others, including those related to workplace violence.
- Investigating issues gathered through safety and security incidents or worksite analysis.
- Staff training and education at time of hire, annually and whenever a change occurs related to workplace violence (hospital determines training based upon staff’s roles and responsibilities).
- Training required to address prevention, recognition, response and reporting.
- A program led by a designated individual and developed by a multidisciplinary team.
- Reporting to the governing body.