Melissa’s Story, Continued

Twenty years ago, narcotics were locked up and the key passed from shift-to-shift, nurse-to-nurse, pocket-to-pocket. That night, “I just happened to be the lucky one who had the narcotics key,” she said.

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After trying to dissuade him, Melissa walked the man into the medicine room and showed him injectable morphine, but she said she couldn’t give it all to him because she had some patients who needed it.

“He was very nervous and very jumpy, and I just wasn’t sure if he was going to shoot me because he was crazy or if he was going to shoot me after he got what he wanted. I had no idea. And then he asked for something to bring him down,” she said.

She gave him some sleeping pills, “and then he just took off.”

The nurses hid under desks until security arrived. Police eventually found the man outside the hospital, injecting himself with morphine, and they arrested him.

The hospital offered Melissa counseling and antianxiety medication, which she accepted. She took 1 night off, “petrified” to return, and was urged to return the second night—and she did. “I was a nervous mess, constantly thinking that someone was going to jump on the unit and hurt me. It was just a very terrible feeling.”

Melissa was called to testify before a grand jury. “Did he have the gun in his left hand? His right hand? What color were his eyes? I just didn’t remember,” she said.

The hospital didn’t change any of its security measures or protocols, which she found upsetting.

Melissa stayed a year or so after that and then went to work at a larger facility in New York City. This institution, she believes, is committed to ensuring the safety of its employees. Still—even today—Melissa says she remains hyperaware of her surroundings: “You think that you are safe, especially at work—and then you’re not.”

So What Can Be Done?

Dr Phillips suggested that first, “we need accurate baseline statistics to ascertain the true extent of the problem.”1 Only 26% of physicians and 30% of nurses report episodes of workplace violence.

“Underreporting is due in part to a health care culture that is resistant to the belief that providers are at risk for patient-initiated violence and to a complacency in thinking that violence is ‘part of the job,’” he said.

Other concerns include an uncertainty as to what constitutes violence, the belief that perpetrators are not in control of their actions, and fear of retribution. In addition, “the current intense focus on customer service in health care serves as a deterrent to reporting workplace violence, since the concept of customer service results in the mentality that ‘the customer is always right,’” he stated.

Next, policy changes such as national guidelines and individualized and customized prevention programs must be implemented that address “a multifaceted, multidisciplinary approach to violence reduction.” Flagging a patient’s chart if previously violent has reduced recurrence of violence in the Veterans Affairs system, but there is no evidence that metal detectors, for example, actually mitigate violence.

“Statistically significant, universal applicable methods of risk reductions” have yet to be discovered, Dr Phillips stated.

In addition, “with the exception of laws regarding workplace violence in a few states, health care organizations are not required to have highly specific prevention strategies in place.” The Occupational Safety and Health Administration provides voluntary guidelines, while the Joint Commission has vague policy requirements regarding workplace violence, which are open to interpretation. When contacted, the American Society of Clinical Oncology replied that it “has no existing policy or data on this issue.”

Finally, health care employers must ensure safe working environments for their employees.

“Like all other workers, health care employees have a right to be safe on the job,” Dr Phillips concluded.


  1. Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;374(17):1661-1669.