Born with a natural curiosity for how the body worked, Patricia Moon-Updike says she had wanted to be a nurse since she was nine years old — and she achieved that goal when she landed her first nursing job in 2007 after 10 long years in nursing school. But what was once a life-long dream eventually warped into recurring nightmares and crippling anxiety when a violent incident with a patient in 2015 left her with post-traumatic stress disorder and nearly ended her career.
“There is a deep loss when you used to make a difference in the lives of people…” Moon-Updike wrote in a Medium post. “Now that space is filled with extreme sadness and fear through no fault of my own.”
Spurred into action by her own traumatic experience — as well as the death of a Wisconsin nurse named Carlie Beaudin in January — the 49-year-old flew to Capitol Hill in February tell her story and urge congressmen to pass the Workplace Violence Prevention for Health Care and Social Service Workers Act, a sweeping bill aimed at holding health care and social work organizations accountable for protecting their workers.
On Thursday, Moon-Updike and the masses of America’s broken and battered health care workers were finally heard. After countless social and health care workers marched on Capitol Hill to support the bill passed in the House with a majority, bipartisan vote.
The legislation, which was sponsored by Rep. Joe Courtney, will “mandate that the federal Occupational Safety and Health Administration (OSHA) create a national standard requiring health care and social service employers to develop and implement a comprehensive workplace violence prevention plan,” according to National Nurses United, a union that helped advocate for the bill. Sen. Tammy Baldwin, who offered support for the legislation, is co-sponsoring an identical Senate companion bill.
“Workplace assaults against nurses, health care professionals, and social service workers occur more often than in any other profession,” Rep. Courtney said at a press conference following the bipartisan victory in the House. “These are some of the same people we depend on to take care of us when we need it most, and they shouldn’t have to fear for their own lives while they’re at work trying to save ours.”
For Moon-Updike, the decision to fight back was crucial.
“I decided it was time to get off my rear end and do something and try to make sure that that didn’t happen again and that someone was held accountable for Carlie dying because there’s a sisterhood and a brotherhood of nurses. And we put ourselves out there to help people,” Moon-Updike emotionally testified on Feb. 27, 2019.
On the frontlines of health care
The House vote comes just days after the release of a survey of 20,000 registered nurses by AMN Health Care — a large healthcare workforce company — which found that 41 percent of nurses have been victims of “bullying, incivility or other forms of workplace violence.”
The survey, and the vote, both shed light on an issue that nurses have been told is simply “part of the job.” But for the 3.8 million nurses in the United States, it’s more than just an abstract concept. As the bulk of America’s health care system, they have more direct contact with patients than any other medical workers, making them the most vulnerable to assault.
Despite the fact that the Occupational Safety and Health Administration (OSHA) recognizes workplace violence as a chronic hazard of the health care industry, 63 percent of nurses reported their employers have not done well in addressing specific instances of workplace violence. While nurses working in emergency or psychiatric departments are more vulnerable to assault, nurses report that workplace violence has increased across the board.
“Hospitals and health systems are considered safe places for healing, caring, compassion and recovery. We should be very clear that violence against health care providers is unacceptable in any form. It is not a part of the job,” Cole Edmonson, DNP, Chief Clinical Officer of AMN Health Care, tells Yahoo Lifestyle.
“If we don’t protect nurses, the health care system as we know it will be severely affected in its ability to provide care to all those who seek it. It will also have direct impacts on the nation’s health because nurses are critical to total wellness.”
According to the AMN survey, nurses and other health care workers who are victims of assault may suffer from post-traumatic stress disorder, leading to a range of difficult symptoms, decreased productivity and high job turnover — with some leaving the profession entirely.
“It’s combat medicine”
Ironically, nurses and other health care workers fear the most violence from the very individuals they are trying to heal: their patients. In interviews with Yahoo Lifestyle, nurses tell Yahoo Lifestyle that walking into the hospital for work every day can feel like entering a war zone — one rife with abusive language, threats and physical violence.
“It's the unknown. It's not knowing if you walk into a room if you're safe or not. You don't know if this patient has weapons on them, you don't know if this patient wants to hurt you,” Randee Litten a California emergency room nurse, tells Yahoo Lifestyle. “Nurses are definitely on the front lines of that abuse. It’s combat medicine.”
Litten recalls a patient punched her so hard she was left with a black eye for two weeks. Another nurse from Cleveland, Susan Harper, says a patient repeatedly beat her head, leaving her with a concussion and out of work for a month. A third, Ashley Webb, who works as a cardiovascular ICU nurse in Oklahoma, relays how she was punched, slapped, kicked, threatened, bullied and then followed to her car in her two-and-a-half years as a nurse.
Moon-Updike’s own story — which she shared on the floor of Congress — dates back to June 2015 when she was working as a psychiatric nurse at the Behavioral Health Division of Milwaukee County in the Child and Adolescent Treatment Unit. After a patient with a track record of being aggressive began screaming, thrashing and bucking, she called the four security guards on duty. But when only two arrived, she was left with no choice but to help take the patient to a padded seclusion room.
Just when the staff thought they had safely escorted the patient into the room, she says the patient quickly “spun around” and kicked her throat. “All of sudden, I feel a pop in my neck and I can't breathe. And it just kind of goes kind of dark and I just feel my head flip back,” Moon-Updike recalls to Yahoo Lifestyle. “I grabbed my throat so hard and I wouldn't let go because I was afraid that if I let go, I would stop breathing. I thought he had crushed my trachea.”
Moon-Updike was immediately taken to a trauma center where she felt certain she was going to die. “All I could think of is … I don’t get to say goodbye to my kids.” Fortunately, she later woke up in the ICU with her trachea intact and breathing on her own. But while the bruises from the kick eventually faded away, the trauma from the incident remains with her to this day — and may for the rest of her life.
Immediately following the incident, Moon-Updike says her “brain would not let it go,” experiencing uncontrolled flashes of the incident both asleep and awake. She still has nightmares of being intubated through her nose and can sometimes feel what she describes as a “pair of scissors [going] up her entire body” from when the nurses cut her out of her scrubs.
Moon-Updike was diagnosed with moderate to severe PTSD, anxiety, insomnia, depressive disorder and social phobia related to the incident. Unable to continue in a profession that felt intertwined in her identity, Moon-Updike says she fell into a deep depression and even contemplated suicide. “I felt like less of a human being. I didn't even know what I was anymore,” Moon-Updike says. “People would say, ‘Well, you're still a nurse.’ And I'm like, ‘No, I'm not. Because I don't do that anymore.’”
Beyond suffering from the debilitating side-effects, the single violent incident took away her livelihood. As a registered nurse, the former single mom took home $62,000 a year for her four children. On Social Security Disability after deductions for Medicare, she brought home $12,720 a year.
“I lost a career that I loved,” Moon-Updike told House representatives in February.
Silent No More
Moon-Updike told the story of her assault, and subsequent departure from the nursing field, on the floor of Congress this February — explaining how she went from making a difference in her patients’ lives to feeling “tortured” by the violent incident with a patient that upended her life. She’s not the only one who wants more protection for nurses.
While states including California, New York, New Jersey, Oregon, Washington, and Maryland have enacted laws to prevent violence against health care and social workers, Litten says California’s workplace violence prevention in healthcare regulations aren’t doing enough to actively protect health care workers. “Oftentimes when we are hit, we retreat and we don't fight back. They have implemented a self-defense training course, but … you can't protect yourself at all times,” Litten explains.
Beyond refusing to address systemic workplace violence, many nurses say that hospitals are exacerbating the rates of violence by not providing adequate, safe staffing, especially for mental health and security. After her assault, she finished the rest of her seven-hour shift and even treated the patient after the incident because the hospital was understaffed that day — and most days, for that matter.
“Right now organizations are cutting staffing for profit and we're having to work as if we're two nurses as opposed to one. And we're constantly being assaulted and berated and threatened by our clientele, So safety is a huge aspect of what we need to look at going forward to make it a better environment for us to provide good care,” says Litten. In her testimony, Moon-Updike says her attack could have been completely prevented had there been more security guards and staff in her unit.
For too long nurses have accepted and justified violence as part of their jobs — but not anymore. As the violence increases to a near-daily basis, Litten says that nurses are “done taking the abuse.” Hundreds of nurses across the country have begun sharing anecdotes and pictures of battered limbs and bruised eyes on the Facebook page of the Silent No More Foundation, a non-profit whose mission is to protect health care workers “before, during and after an assault.”
“We're done being silent. We're done taking the abuse. We go to work every day wanting to care for people and to provide a safe, healing place for all walks of life,” says Litten. “But now we're finding that [the fear of violence] is becoming a part of a daily basis and it's not sustainable,” Litten tells Yahoo.
The American Federation of Teachers, National Nurses United and other social and health care worker unions and advocacy groups have been working with federal legislators to develop and pass this legislation that will make mandate reporting on incidents of violence, require health care facilities to have a plan to prevent violence and ensure protections for front-line whistleblowers who may fear retaliation for speaking out.
“Every single worker in this country should have the right to a safe and welcoming workplace, no matter what job they do,” Randi Weingarten said in a press release following the passing of the bill in the House. “Yet our nurses, healthcare professionals and social service workers — the people who take care of us when we need them, who have devoted their careers to looking after the aging, the sick and the injured — have no specific federal protections at work. As such, these workers face potential violence every day without [an] adequate remedy.”
The legislation — which has been seven years in the making — comes at a tipping point for America’s struggling health care system. Beyond ensuring the safety and well-being of health care workers, it is critical now more than ever to keep trained, registered nurses in the profession. As Baby Boomers age and the need for health care grows, experts project that the U.S. will experience a shortage of registered nurses, which could have a detrimental impact on the care given and the future of the American health care system.
As Rep. Courtney handed the torch to Sen. Tammy Baldwin to pass the Senate companion bill, advocates “urge legislators to recognize that workplace safety is not a partisan issue but rather a human right."
Moon-Updike says nurses right now are “hemorrhaging” and that they need the government to step up to protect the individuals that maintain the physical and mental health of the country.
“We take care of everyone you know: we take care of your friends and family. And it's expected that when they need us we are there for them— and we will do that willingly,” Moon-Updike tells Yahoo Lifestyle. “There needs to be some accountability.”
Moon-Updike echoed these thoughts in an impassioned speech on the House floor. “We help your mothers, your brothers, your daughters, your sons, your wives, your husbands — we do that,” she said. “And who is helping us? That’s why I am here.”
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