By Karen Coughlin, RN 

My son was 14 years old when he asked me if anyone had tried to kill me at work. He is grown now, so it is hard to remember whether, on that specific day, someone had pulled a weapon, punched me, or used some other means to try to end my life. But I wouldn't bet against it.

I was a bedside registered nurse for 34 years. I was punched, bit, kicked, spit on, nearly knifed, and once threatened with a handmade weapon resembling a straight-edge razor. Once, in 2005, a furious 6-foot 4-inch, 275-pound patient struck another patient, bit a health aide, and twice tried to grab me while threatening my life. The patient was restrained, but the fear was traumatizing.

I tried not to talk about these things with my family. I did not want to bring the fear, anxiety, and trauma my co-workers and I were experiencing into my home. Despite my caution, my son had overheard a conversation with my husband. His question struck me to my core. No child should ever have to question their parents' safety at their workplace, right? I'm a nurse; I didn't sign up for this.

I began to speak out. Working with my union, the Massachusetts Nurses Association (MNA), I joined with other nurses and advocates to call for new laws to prevent violence. We banged on doors at the State House, and shared our stories in newspapers, on television, and on the radio. Many times, I have sat in front of a panel of lawmakers and detailed gruesome tales of healthcare violence. A co-worker was thrown down and her head was repeatedly slammed against the floor. She is one of three staff I used to work with who suffered traumatic brain injuries. We bore witness to workers who came into work healthy and left with a broken collarbone, a whiplash injury from being whipped by the hair, a near-death strangulation, or a kick to the chest causing back spasms and broken ribs. A colleague permanently lost peripheral vision in one eye while another's jaw was broken.

These are just examples from my facility. But the violence is everywhere. The Massachusetts Health & Hospital Association reports that every 38 minutes in a Massachusetts healthcare facility, someone -- most likely a clinician or employee -- is either physically assaulted, endures verbal abuse, or is threatened. This is a marked increase since 2020 when it was every 57 minutes -- not that this statistic is so great, either. In June, a nurse at Heywood Hospital in Gardner was attacked by a patient on hospice care. The patient barely missed her carotid artery with a pocketknife. In July 2021, a Lowell General Hospital nurse was sitting at the nurses' station when a patient came up from behind and smashed her head twice with a fire extinguisher. She suffered a brain bleed. I'm sure both continue to deal with the psychological trauma of those assaults.

Yet people ask, why are nurses leaving the bedside? The exploitation of nurses, as exhibited by years of hospital corporations understaffing their facilities to boost their profits, and their refusal to seriously address the epidemic of healthcare violence, is at the root of our current hospital staffing crisis. Experienced nurses can no longer bear the weight of exhaustion along with constant fear for their own safety. Newer nurses are coming into the field, mission-driven to provide quality patient care, and quickly deciding the work is unsustainable.

In Massachusetts, 63% of nurses believe workplace violence and abuse is a serious problem, up from 42% in 2021, according to the 2023 State of Nursing in Massachusetts survey. Among those nurses surveyed this year, 70% experienced at least one incidence of violence over the last 2 years, up from 57% in 2021. A national survey of nurses found a 119% increase in reports of violence from nurses between March 2021 and March 2022.

Attacks and threats like those I have described are why I support legislation to prevent healthcare workplace violence. Several bills championed by frontline nurses and other healthcare workers can make meaningful, measurable, and enforceable improvements by:

-Requiring healthcare employers to perform an annual safety risk assessment and, based on those findings, develop and implement programs to minimize the danger of workplace violence to employees and patients.

-Providing time off for healthcare workers assaulted on the job to address legal issues.

-Allowing nurses and healthcare professionals to use their healthcare facility address instead of their home address to handle legal issues related to an assault.

-Requiring semiannual reporting of assaults on healthcare employees to district attorneys.

-Increasing the penalties for assaulting nurses and other healthcare workers from a misdemeanor to a felony punishable by up to 5 years in state prison.

-Requiring homecare safety plans, including assessments of the mental status of patients and others present, criminal history, and the presence of any weapons.

-I retired earlier than I would have liked due to the risk of injury from violent assault, and I no longer bring that anxiety into my home the way I did years ago. I plan on continuing to speak out.

If we want to truly address our staffing crisis, we must give caregivers the tools and support they need to feel safe at the bedside. Our nurses at the bedside, those following in our footsteps, and the patients we take care of, deserve it.

Karen Coughlin, RN, is a Massachusetts registered nurse who retired after more than 34 years with the Massachusetts Department of Mental Health at Taunton State Hospital.