Maine Medical Center has agreed to beef up staffing to help emergency room nurses deal with assaultive patients, hospital officials said Friday.
The decision follows criticism from nurses, some of whom demonstrated outside the hospital Thursday. Representatives of the nurses union at the hospital say Maine Med’s management has not provided adequate help to deal with aggressive patients in the ER.
Both the nurses and hospital officials agreed that Maine Med staff is having to deal with an increased number of psychiatric patients in the ER, including some who can be abusive or violent. While they also agreed that years of state cutbacks in psychiatric care and services is to blame, the nurses called on the hospital to do more to prevent violence.
A spokeswoman for MaineHealth, Maine Med’s parent, said some psychiatric patients go to the ER because the state’s health care system provides no other options for them, a situation nurses say makes their jobs more difficult and dangerous.
“It’s hard to come to work every day and be assaulted or be afraid of being assaulted,” said Lucy Dawson, who works in the ER and has been a nurse for 20 years.
Until Thursday, Dawson said, ER nurses’ complaints to Maine Med management seemed to go unheard. She said the hospital’s decision to agree to two of the union’s demands was at least a step in the right direction. The hospital said it would have at least two nurses deal with patients who have a history of violence against health care workers and make sure at least two security guards are always on duty to help with violent patients.
But Dawson also said Maine Med is “continuing to do what is not working. Things are not fine. They are very, very far from fine.”
The nurses said Maine Med management told them it is considering two other steps they say are needed to make nurses safer, but has not yet decided whether to implement them. One would be to isolate patients who have a history of assaultive behavior and the other would allow nurses to volunteer for duty in the acute psychiatric unit with the hospital paying bonuses for taking on those shifts because of an increased need for nurses in the unit.
Maine Med put out a statement Thursday saying it supports nurses speaking out against violence in the ER and other hospital units.
“Violence against health care workers is unacceptable and we hope these concerns are heard loud and clear,” the statement said.
The hospital set up a workplace violence prevention committee, Maine Med’s statement said, and has implemented several measures including safety training, peer support programs, stricter access controls, an easy system to report instances of violence, a metal detector in the emergency room and a visitor screening and badge program at check-in.
Maine Med also said it is implementing the two measures nurses had asked for and would shift employees as needed to increase staffing when dealing with patients who have a history of assaulting workers.
“Unfortunately, solutions created by care team members and leadership cannot address system issues outside the hospital,” the statement concluded.
Nurses who have been victims of assaults by patients said the problem seems to be growing.
Jen Conover said nurses in the acute psychiatric unit at Maine Med were already dealing with one patient with a history of violence last week when her patient passed her a note asking to be discharged.
When she went to talk to the patient about it, Conover said, “out of nowhere, he just punched me.”
Conover said she hit her head on the nursing station window and then the floor, suffering a concussion.
She pressed charges and the man was arrested, Conover said, but was back in the unit the next day.
“We’ve all just been very, very anxious coming to work,” she said. “It’s just a very tough situation.”
Conover said the same man has since assaulted another nurse at the hospital in a similar way, and she thinks Maine Med’s management knows the incidents are going to happen again and should be doing more to address the problem.
Derik Allain, an emergency room nurse, said an assault on him last month, like Conover’s, was unexpected, even though the patient he was dealing with had a history of being aggressive.
The patient had been put in an isolation room when he became aggressive, Allain said, but seemed to calm down and asked to call a relative, which typically calms the man down. But instead, when Allain went to tell him that his relative was on the line, “he went for my neck.”
With the help of security guards, Allain said, the man was put back in an isolation room.
Allain, who is serving on a Maine Med workplace violence prevention committee, said he wants the hospital to take more steps to stop the assaults.
The increased staffing agreed to Thursday “are reactive measures and we have proactive things that we’re talking about,” he said.
On the same day that the nurses demonstrated and hospital administrators agreed to increase staffing, Gov. Janet Mills’ administration said that starting next week, it will begin distributing $9.3 million in MaineCare payments to mental health and substance abuse disorder service providers to beef up community behavioral health care efforts.
Maine Med issued a statement saying that the additional funding is “welcome news and a good step,” but the state needs to do more to build a strong mental health care system.
Katie Fullam Harris, MaineHealth’s chief government affairs officer, said the poor state of Maine’s behavioral health system means hospitals are taking on roles they are not designed for.
She said one patient has been at the hospital for months and “essentially, homeless individuals, because of their disabilities, are living in our emergency department.”
Harris said that Maine Med has suggested that the state build a secure residential treatment area for children and specific care facilities for homeless people who have behavioral health issues.
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