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After recovering from a life-altering assault at work, Patricia Moon-Updike worries not enough has changed about workplace safety within health care settings.
Back in 2015, Moon-Updike worked as a registered nurse in Milwaukee County at a facility for juveniles with behavioral health issues.
Two weeks into her time there, while being shadowed by a nurse new to the unit, Moon-Updike rushed to help secure an aggressive patient. Two security guards arrived, and the four tried to restrain the patient. In the process, the patient spun around and kicked Moon-Updike squarely in the throat.
She grabbed her neck, thinking her trachea had collapsed.
“I thought I was going to die,” she said.
A November 2022 report from the American Federation of Teachers, or AFT, paints a stark picture of workplace safety for staff in health care settings. The AFT was founded in 1916 and represents a range of workforces, including those in education, government and health care.
Moon-Updike was rushed to the nearby trauma center for emergency surgery, during which the surgeon discovered her trachea was intact. The assault did, however, cause major tissue damage, so she was admitted to the intensive care unit and intubated.
“My face was completely swollen. I didn’t even want to look at myself at that point,” Moon-Updike said.
Health care and social services workers experience 76% of all the reported instances of workplace violence, according to the AFT report. Over the past two decades, the rate of reported assaults grew by 144% in hospitals and 63% in home health agencies. Reported assaults grew by 95% in two different types of private sector facilities – psychiatric and substance abuse, according to the report.
The road to recovery
After three days, Moon-Updike was released from the hospital, and her recovery began and, in several ways, continues. Now, Moon-Updike is motivated to speak out about what she believes led to her injury and what should be done about it.
She has written about this experience and even testified before Congress about it. She is unequivocal when she says her injury was caused by insufficient staffing.
Instead of four guards arriving to help restrain the patient, as was protocol in emergency situations at the facility, only two guards came. There “absolutely should have been more security.”
“And that young man should’ve had a one-on-one sitter,” she said.
The AFT report similarly cites staffing issues of many types plaguing health care settings throughout the country, leading to real harm to staff.
The AFT report described the precise sort of situation in which Moon-Updike was injured: “When there are too few workers available to safely restrain violent patients or when staff work in isolation, the risk of serious injury increases.”
Patricia Raes, president of Service Employees International Union Healthcare Wisconsin, said understaffing creates a constant and ongoing risk to staff.
“When you are understaffed … you don’t have the time to get to know people or make the connections,” she said.
Without these connections, she added, “people are going to swing. They’re going to kick. … I’ve been attacked with a box of Kleenex by more than one patient.”
The pandemic certainly added to the problem, but it was a problem many years in the making, according to a fact sheet by the American Hospital Association:
By 2033, the U.S. will face a shortage of up to 124,000 physicians and will also have to hire 200,000 nurses every year to keep up with demand and replace the nurses who are retiring.
The fact sheet also stated there are “critical shortages of allied health and behavioral health professionals, especially in historically marginalized rural and urban communities.”
The U.S. Government Accountability Office published a study in 2016, relying on three different sets of federal data, that concluded the rate of violence against employees in health care workplaces is five to 12 times higher than the average rate of violence in U.S. workplaces.
As the pandemic worsened the existing staffing crisis, it also worsened the existing violence associated with it. The rate of violence in hospitals alone went up by 25% from 2019 to 2020, according to the AFT report.
There are four hospital systems in Milwaukee County: Ascension Wisconsin; Advocate Aurora Health; Children’s Wisconsin and Froedtert & the Medical College of Wisconsin.
Andy Brodzeller, spokesperson for Children’s Wisconsin, said Children’s has recognized the national trend of workplace violence and developed a program called SAFER in response.
SAFER stands for Staff and Family Expectations and Responsibilities. It states that verbal abuse and physical violence will not be tolerated at its facilities.
“Expectations are shared with staff, families and visitors on posters and banners in our locations,” Brodzeller said.
The other three health systems declined to comment about the trend of increased violence in health care settings. The county itself, which employs health care workers in various settings, also declined to comment on the trend.
What now?
Immediately after the attack, Moon-Updike experienced post-traumatic stress disorder and required frequent appointments with a psychologist and a psychiatrist. She fought for disability benefits, as she could not return to work as a nurse because of the severe anxiety and panic she experienced.
Several years later, Moon-Updike was asked to testify before Congress in February 2019 on behalf of the Workplace Violence Prevention for Health Care and Social Service Workers Act.
The House of Representatives bill called for, among other things, more personnel to reduce the risk of violence in health care settings. Although the bill passed in the House, it stalled in the U.S. Senate.
Closer to home, while Wisconsin does not have laws governing safe staffing ratios in health care settings, Gov. Tony Evers did sign a bill into law in 2021 that makes it a felony to threaten or assault health care workers.
Despite the legislative stalemate, testifying before Congress was an experience that inspired Moon-Updike to return to nursing.
“If I can do that,” she told herself, “I can be a nurse again.”
Moon-Updike was a hospice nurse from 2019 to 2021 and now works as a triage nurse. She is still adamant that more needs to be done to protect workers and patients.
Jamie Lucas, executive director of Wisconsin Federation of Nurses and Health Care Professionals, the union that represented Moon-Updike at the time of the injury, said the union “is still fighting … still fighting to make sure facilities give health care workers enough staff to care for their patients and remain safe themselves … and still fighting for more accountability at the state and federal level.”
Happy to hear a law was passed making it a felony to assault or threaten medical staff but more needs to be done. The medical staff is a life saving asset we can’t afford to lose more of. Medical people need to be regarded as heros and treated with nothing but respect at all times.
AMEN TO THAT