Increase in workplace violence at Alexandria Hospital reported during COVID-19
ALEXANDRIA, Va. -- In 2020, the number of reported workplace violence incidents at Inova Alexandria Hospital was 136 -- doubled compared to 2019, said Lisa Hawksworth, senior director of operations at Alexandria Hospital.
Dr. Zachary Wotherspoon, senior director of emergency services at Alexandria Hospital, said workplace violence comes in two forms -- verbal and physical violence. Verbal abuse is the most common form and can be harder to control.
Inova Alexandria ER entrance. Photo submitted by Dr. Zachary Wotherspoon.
Wotherspoon noticed an uptick of workplace violence incidents beginning in November 2020, along with an increase in patients being treated for psychiatric diagnoses of depression and anxiety. Community mental health resources were limited at a time when more were needed.
“Patients with depression and anxiety are also increasingly being hospitalized,” Wotherspoon said. “This leads to less available behavioral health beds creating a problem for patients needing inpatient care.”
Since COVID-19, Alexandria Hospital experienced an increase in patients needing emergency care for alcoholism and drug related psychoses. Individuals with alcoholism and substance misuse disorders have a greater chance of becoming violent and require longer hospital stays, Wotherspoon said. This is more difficult when the hospital is working with limited beds and resources, said Wotherspoon.
“These patients often return a few days later,” Wotherspoon said. “They’ve gone back home and used again because we weren’t able to treat their unresolved psychiatric-related needs.”
Lisa Hawksworth, MSN, RN, senior director of operations at Inova Alexandria. Photo submitted by Lisa Hawksworth.
Hawksworth, the chairperson for the Alexandria Hospital workplace violence committee, was instrumental in developing a more robust system for workplace violence reporting. When staff access the incident reporting system, five workplace violence categories are available to choose from -- behavioral events, intentional blood or body fluid exposures, physical trauma, professionalism/staff inappropriate behavior and workplace violence. Hawksworth hoped that better data would lead to identifying causes and prevention strategies for violence.
“Our numbers have gone up but compared to other hospitals in the Inova Health System, the number of cases being reported are on par with hospitals of the same bed size,” Hawksworth said.
By making reporting easier and straightforward, Hawksworth said more specific information was available, but no causal relationship could be found between COVID-19 and workplace violence.
Alexandria Hospitals offers emergency department staff an industry standard, crisis intervention prevention program, Wotherspoon said. Staff learn evidence-based de-escalation techniques. Hawksworth encouraged staff members outside of the ED to attend the training. When staff members recognize early warning signs and triggers for violence, the whole hospital benefits, Hawkworth noted.
“Training like this could help staff members reduce the number of patient-related violence events taking place,” Hawksworth said.
Dr. Thomas Foreman, a clinical ethicist at Alexandria Hospital, said the root cause of violence between patients and staff members needs to be understood. Patients suffering from dementia and Alzheimer’s disease must be viewed differently from patients who become violent because they do not want to follow rules. Foreman described this as purposeful versus non-purposeful violence. Dementia patients will not understand that their violent actions are not okay, but any other patient should understand they cannot hit or speak inappropriately to staff members, Foreman said.
Like Hawksworth, Foreman agreed that there is no direct cause as to why violence has increased. Foreman said two factors could be at play. Many hospitalized patients are without direct support systems because visitation policies across the country are limited, due to Centers for Disease Control and Prevention recommendations. Also, individuals in the community are faced with extra stress and pressure caused by the pandemic. Both are potential triggers for the increased violence taking place, Foreman said.
Safer hospital environments are important in preventing patient self-harm and promoting safer working conditions for all staff. The current increase in workplace violence is shaping how Alexandria Hospital is planning to build their new hospital, scheduled to open in 2028, Wotherspoon said.
Until then, Alexandria Hospital plans to build upon their collaborative relationship with the Alexandria Police Department and community service boards. Starting in July, plans are underway to initiate more frequent community outreach check-ins for individuals needing mental health support to prevent returns to the ED in crisis, said Wotherspoon.