Rising anger toward healthcare workers hampering patient care

Increasing anger and even violence toward healthcare workers in South Dakota and across the U.S. is adding great stress on practitioners who are already enduring the pain and hardship of providing care during the deadly COVID-19 pandemic.

Healthcare workers in South Dakota have been called offensive names, faced threats at work or at home, had things thrown at them, and occasionally have endured direct physical violence. The aggression is being displayed by both patients and family members.

In the short term, dealing with inappropriate behavior takes the focus of doctors, nurses and aides away from patients who need help. In the long term, the outbursts are driving some healthcare professionals out of the field, worsening a worker shortage that threatens to reduce overall patient care and efficiency of the American medical system.

Ashley Kingdon-Reese of Huron, is an independent nurse who provides at-home care and runs a nursing consultancy. Preventing violence and anger against nurses and other healthcare workers has been a topic of concern for several years, but especially since the pandemic began.

Kingdon-Reese recently experienced violence firsthand while providing nursing care to a woman with behavioral problems who had a potential infection and needed to be taken from her home to a clinic.

The patient grew frustrated and angry after being forced to wear a mask at the clinic, Kingdon-Reese said.

“She jumped out of bed, pushed me against the wall and bit me in my thigh and I had to do what I could to get her off me,” recalled Kingdon-Reese, who serves as the government relations committee chair for the South Dakota Nurses Association. “Part of it was obviously behavioral health, but the other part was she didn’t want to wear a mask and she was very big into social media that said, ‘You can’t tell me what to do.’”

Kingdon-Reese and others are asking medical patients and the public to reduce their tension level before entering a healthcare facility. “We’re not asking for your devotion or appreciation, we’re just asking for decency,” she said.

Dr. Kara Dahl, a physician in the emergency room at the Sanford Aberdeen Medical Center, said incidents of inappropriate, threatening or violent behavior toward healthcare workers has been on the rise during the pandemic. 

“You can almost guarantee that you’re going to be name-called or disrespected in some capacity at least once a week,” said Dahl, president of the South Dakota Medical Association. “The frequency of getting to the magnitude of calling security is rising at such an alarming rate, it’s no longer just an occasional thing.”

The anger displayed toward healthcare workers has multiplied the stresses of dealing with a deadly pandemic in an industry already beset by worker shortages. The moment anger or violence arises, patient care overall is immediately damaged, not only for the patient involved but for all patients, Dahl said.

“If we are pulled from a more critical situation to have to deal with a behavioral issue, that is definitely impacting patient care,” she said. 

Many healthcare practitioners see the rise in anger as an outcome of the political polarization surrounding prevention and treatment of COVID-19, and the rise of misinformation campaigns by conservative television and radio commentators and on social media. 

Whatever the cause of the rising tension, the result is that the healthcare industry is seeing workers getting burned out and enduring stress that hampers their effectiveness — with some prompted to leave the field completely.

The long-range result may be that as medical professionals leave the industry, hospitals and clinics will see a worsening of the ongoing shortage of nurses, aides, technicians and physicians, said Dr. Jeremy Cauwels, chief physician of Sanford Health in Sioux Falls.

“I think it’s reasonable to say that there are people leaving health care because of this, because for many people there are easier ways to make a living than being verbally or sometimes physically assaulted,” Cauwels said.

Officials and healthcare providers at Monument Health in Rapid City have been the target of a recent protest campaign by the wife of a man who has been receiving treatment in the COVID-19 ward at the hospital.

The woman has criticized the care her husband has received in numerous online videos and postings. She has held signs outside the hospital, posted the name and phone number of the Monument Health patient liaison, and urged people to call and complain on her behalf. The woman’s social media posts call the coronavirus a “bio-weapon” launched against Americans, refers to the pandemic as a “scamdemic” and insists that Monument employees receive financial bonuses for each patient assigned to the COVID ward and for each person who dies of COVID-19 at the hospital.

In response, someone started a Gofundme account to raise money to buy takeout meals for Monument emergency room staff. So far, the effort has raised $2,150 from 106 donors and meals have been provided to hospital staff, according to the Gofundme page.

Kingdon-Reese has begun to worry that unless the anger, disrespect and violence against healthcare workers abates, health care may become dominated by less experienced or less well-trained workers.

In 2018, former Gov. Dennis Daugaard signed into law a bill that increased the penalty from a misdemeanor to a felony for anyone who assaults a healthcare worker who is providing patient care.

Research into the escalating anger and violence toward healthcare workers has picked up in pace and intensity in recent years.

The U.S. Bureau of Labor Statistics found that workplace violence against American healthcare workers nearly doubled in frequency from 2011 to 2018. Violence was found at five times the rate in healthcare compared with all other industries, and healthcare workers made up 73% of all nonfatal workplace injuries due to violence in the country in 2018.

Monument Health officials would not discuss the situation with the protesting woman due to privacy concerns and because the situation is ongoing, spokesman Dan Daly said.

But the West River hospital group is far from unique in facing backlash from patients or family members who are upset or

angry, said Nicole Kerkenbush, director of nursing at Monument Health.

Monument has taken a proactive approach to reducing unhelpful or tense interactions between people in its hospitals, Kerkenbush said.

Monument has a Workplace Violence Committee that meets monthly or more frequently if needed to discuss recent incidents but mostly to develop strategies to reduce tension or potential violence.

The hospital group has provided training for nurses, physicians and others in de-escalation techniques and on how to react respectfully and safely when tension arises. 

The hospital has erected a series of posters that urge people to “Please take responsibility for the energy you bring into this space.” The posters also note that, “Your words matter. Your behaviors matter. Our patients and teams matter. Take a slow, deep breath and make sure your energy is in check before entering.”

Kerkenbush doesn’t rule out that misinformation or binary political views on the pandemic are driving some of the inappropriate behavior toward medical professionals. However, she said her belief is that the rise in tense or angry incidents among patients and family members is being driven mostly by the overall tension caused by the COVID-19 pandemic. Many people have had disruptions in their workplaces, at schools, in access to shopping or leisure activities, or have lost a loved one, she noted.

Cauwels said that the politicization and misinformation surrounding COVID-19 have created distrust in the medical community that is unprecedented and unwarranted.

“With cancer or pneumonia, you don’t try to pick your own treatments; instead you defer to the expertise of the expert in the room,” he said. 

Lori Popkes, head of nursing at Avera Health, said Avera has seen an increase in healthcare workers asking for mental health assistance or entering into employee assistance programs due to stress.

Popkes said she has seen a shift over the past couple of years in how medical professionals are viewed by the public, almost “from heroes to zeros,” she said.