This week, a visitor opened fire at Legacy Good Samaritan Medical Center in Portland, killing a security guard and injuring a nurse.
Following increases in both aggression towards nurses and mass shootings, stakeholders are debating whether new tech or old solutions can make a difference.
Texas-based University Medical Center announced this month that it has deployed an AI-based gun detection system. Protesting nurses in Colorado, meanwhile, say protections against guns are far lower on their safety to-do list, below things like improved nurse-to-patient ratios.
Sharda Fornnarino, president of the nurses union and nurse at Rocky Mountain Veterans Affairs Hospital, said most incidents are from patients who do not have guns but have experienced delayed care.
“Guns are not the only issue,” Fornnarino said. “Patients that are in pain that have been waiting a very long time for a chair can escalate quite a bit. Pain is a big contributing factor or getting the runaround. One person comes in, a second person comes in or they're waiting a long time. All these things contribute.”
Fornnarino has worked for the Department of Veterans Affairs for 23 years. She is also a veteran herself. As a member of the union National Nurses United (NNU), she has been protesting outside the hospital in recent weeks, demanding more from management. A spokesperson for the hospital told Fierce Healthcare that the administration takes workplace violence seriously and communicates with nurses daily.
“When nurses expressed recent safety concerns stemming from a specific unit, we developed a safety plan, and that plan is continuously monitored and adjusted as needed,” said a spokesperson for the VA. “We will continue to work with frontline employees, nursing leadership and union partners to make sure that employees feel safe as they deliver world-class health care to the Veterans we serve.”
NNU wants the hospital to increase staffing and supporting nurses who speak out. Fornnarino mentioned the addition of physical barriers to nursing stations.
“I'm asking for management to give us some safety plans, which they haven't been able to do,” Fornnarino said. “We want it to be developed with nurses that have boots on the ground that are subject matter experts in these areas. Management can't be isolated when they're making these proposals.”
Colorado passed a law in 2015 making violence against emergency room staff a felony. Fornnarino said the law made little difference. She urges lawmakers to look at a federal bill titled the Workplace Violence Prevention for Health Care and Social Service Workers Act, which would create universal workplace safety standards including staffing for patient care and security.
Parsing out degrees of hospital violence with few data
Workplace violence in healthcare facilities is five to six times higher than in any other private workplace, according to the U.S. Bureau of Labor Statistics. But that widely-cited statistic is from 2018 and does not differentiate gun violence from other forms of physical aggression.
Even before the pandemic, incidence rates nearly doubled between 2011 to 2018. Healthcare workers accounted for 73% of all nonfatal workplace injuries due to violence in 2018.
From 2011 to 2018, the bureau counted 156 workplace homicides of healthcare workers. The most common assailant was a relative or domestic partner. Patients made up just over 20% of assailants.
Judy Arnetz has studied violence in hospitals long before recent upticks. She is a professor at Wayne State University of Medicine and has seen violence take many forms within hospitals.
“Violence towards nurses is by no means new,” Arnetz told Fierce Healthcare. “Nurses are well accustomed, unfortunately, to experiencing aggression and violence from patients.”
Cognitive impairment and substance abuse are also large predictors for violence against nurses, according to Arnetz. Violence towards nurses is far higher in psychiatric and substance abuse hospitals. While she thinks gun violence is a point of concern, she agrees with Fornnarino that safety in hospitals goes far beyond firearm mitigation.
“I have heard of situations where patients were able to use things other than guns,” Arnetz told Fierce Healthcare. “They weren't brandishing weapons, but they took apart their IV pole and used it as a weapon, or they picked up a chair and threw it. Unfortunately, as we see gun violence increase in the US, we're also going to see more and more weapons finding their way inside hospitals.”
Nurses aren't alone in facing physical threats in the hospital. In a 2022 survey, 55% of emergency physicians say they have been assaulted in the ED while 79% say they have witnessed another assault. Those numbers were up from a similar poll in 2018 and were accompanied by feelings of burnout and increased feelings of emotional trauma and anxiety.
Firearms and violence against hospital staff: Two crises meet
University Medical Center (UMC) implemented ZeroEyes AI gun detection software earlier this month. Jeff Hill is senior vice president of support services and government relations at the Texas hospital. He said that after a long acceleration of violence against healthcare workers and the nearby school shooting in Uvalde, hospital management felt firearms deterrence was a priority.
ZeroEyes is integrated into hospital security cameras. If an illegally brandished weapon is detected, the company’s own security team is alerted as well as the hospital itself. UMC has its own police department along with security guards that could respond to an active shooter situation.
Hill told Fierce Healthcare that UMC decided to publicize use of the security tool to engender trust with staff who he said have been concerned for their safety.
“I think something more overt like metal detectors could create fear and anxiety,” Hill said. “We don't want to create that fear or anxiety. We want folks to feel safe and to be able to come and go as they choose.”
While concealed carry is legal in Texas, firearms cannot be brought into what Hill calls “soft targets,” including schools and hospitals.
ZeroEyes co-founder and CRO Sam Alaimo confirmed that UMC is not the first hospital the company has partnered with but is their first hospital partner in Texas. He could not reveal the names of the other hospitals. Some hospitals choose to keep the detection private to avoid redirecting a would-be assailant to a “softer” target, he said.
When it comes to violence in hospitals, Alaimo is with the rest of the country—uncertain about why it happens in the first place and what will happen next.
“People are arguing gun laws, and they should be arguing gun laws," he said. "People are talking about mental health, and they should be talking about mental health. People are offering thoughts and prayers, and they should be offering thoughts and prayers.
"But we want to do something right now. And we have a solution that could identify a gun right now that’s outside of a hospital. I wish we had an answer to the why. But we're focusing on a solution right now, not necessarily the question.”