Workplace injuries from hospital violence increase in Minnesota

Minnesota hospital workers are suffering more disabling injuries from violence in the workplace, according to new federal data, and health care leaders don't expect the problem to disappear with the end of the pandemic.

About 630 employees missed work from 2021 through 2022 to recover from violence-related injuries in the state's nonprofit and private hospitals, according to estimates last week by the U.S. Bureau of Labor Statistics. That compares with 200 a decade earlier. Most injuries came from assaults by patients and visitors — while the intent in other violent incidents remained undetermined.

Fenis Mogere missed months of work with back and shoulder problems after a patient in an acute mental health crisis lunged over an intake desk, attacked her and threw a mug of hot coffee at her. Despite her family's worries, she went back to work at Mercy Hospital's Unity campus in Fridley because disability payments equaled just 60% of her salary.

"That isn't going to take care of your mortgage," said the 50-year-old registered nurse. "So you have to come back. You have to force yourself to come back."

Nonfatal injuries are only reported by federal authorities if they result in missed work or reduced activities, so they represent a fraction of what hospital workers endure. Mogere said she had been assaulted twice before as a nurse over 15 years, including the past six years in Unity's mental health unit.

Clashes over COVID-19 treatment during the pandemic increased tension in hospitals, but patients and relatives have also grown agitated over delays caused by worker shortages and a lack of bed space. Hospital leaders said it is a top priority to reduce workplace violence, a problem that could feed on itself if it pushes more workers out of hospital care and exacerbates shortages.

"Post-pandemic, we're continuing to see levels of violence be a problem in our hospitals and health systems," said Jenny Schoenecker, associate vice president of improvement for the Minnesota Hospital Association. "We need to continue all of our efforts to prevent any incident of violence and keep our employees and patients safe."

The hospital association's violence prevention committee met Thursday to discuss the implementation of legislation last spring to increase safety. Hospital workers have long received training on how to assess and de-escalate risks for violence in working with patients, but now that training must be completed before they work alone.

Hospitals also must offer a documented process by which workers can express safety concerns about a shift and request support to prevent harm.

An unstable patient shoved Carrie Zimmerman's head into a computer, causing the clinical patient safety attendant to miss work at her west metro hospital while she recovered from a concussion. Zimmerman, 60, returned but said she felt anxious and unprotected in her emergency room. She cut back, picking up occasional shifts at the hospital but mostly worked a separate job as a veterinary technician.

"There's a guy there now who tried to choke a nurse," she said.

Hospitals have responded with physical changes such as limiting access to entrances, but they have the dual challenge of maintaining a therapeutic and healing environment that doesn't look like a militarized zone.

Mogere said she requested a glass screen to protect her intake station but was told that it would disrupt the therapeutic bond with patients. Coworkers gave her the intake desk closest to the medication room, which she would use as an emergency exit.

"Otherwise, I can't stop looking at the (front) door," she said.

Despite residual fears, Mogere said she wants to stay with her job until retirement. She said she loves advocating for patients with mental illness and seeing them get healthy, and has learned from them about how to parent her own child who has autism.

Hennepin Healthcare responded to incidents this year at its emergency department intake unit in downtown Minneapolis with a security guard, but the solution is problematic, said Josh Gramling, the health system's director of occupational health and wellness. The presence subdued some people but agitated others, he said.

The hospital has added a screening system, pioneered at Regions Hospital in St. Paul, to identify potentially violent patients, Gramling said, but solutions often vary by department.

Assaults at clinics and pharmacies often involve people with addictions who are seeking drugs. Those that take place at emergency departments often have to do with interminable wait times for care. Attacks in intensive care often involved patients coming out of medicated comas, but Gramling said care teams are reducing them by assessing patients and strategizing how to keep them calm as they emerge from sedation.

"So much of this is about the patients not feeling safe," he said. "They lash out, because they don't feel like their needs are met. … To them, they're being violent because they think that's what they need to do."

Gramling said he hoped to see worker assaults decline in 2023, but he said the numbers so far have been "relatively stable, in not-a-good way."

Statewide, workers compensation claims by hospital staff with violence-related injuries appear to have plateaued. Claims increased in private and state-run hospitals from 178 in 2019 to 274 in 2022, but are on pace to be below that total in 2023.

Workers compensation claims involve injuries resulting in more than three days of disability. The federal data includes injuries that caused workers to miss a single day.

Nonfatal workplace injuries related to violence have increased overall in Minnesota, according to the data, though the numbers have remained flat in other health care sectors such as nursing homes.

Hospital leaders said there are larger challenges beyond security that could reduce violent events. A decline in post-hospital nursing homes and rehab centers has left hospitals stuck with patients — and with resulting backlogs in their emergency departments and waiting areas.

"There isn't room for them to go on to the next place, so they are having to stay in the hospital or ED longer than necessary," Schoenecker said. "That is certainly causing agitation and frustration."