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Medscape
a day ago
- Health
- Medscape
Violence Against Nurses, Not Part of the Job Description
Terry Bartmus, DNP, had been bitten, hit, choked, and threatened since she started working in the emergency department in Las Vegas in 2009. Worse, there's been no improvement in the violence. 'I noticed a significant change during COVID, especially when we were on lockdown, of people…lashing out at [hospital] staff,' said Bartmus, a nurse practitioner in the emergency department and assistant professor at Touro University Nevada in Henderson, Nevada. 'I definitely have seen more [workplace violence] in the last 5 years.' Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, A Medscape Nurse Practitioner Burnout & Depression report found that 60% of burntout and depressed nurse practitioners reported job stress was a critical factor. One quarter of nurse practitioners reported a lack of respect from patients. More than half felt their employers didn't recognize their stress levels. The latest data from National Nurses United showed that 8 in 10 nurses have experienced at least one incident of workplace violence, and 45% reported an increase in workplace violence on their unit in the past year. The violence registered nurses (RNs) experience includes verbal and physical threats of being pinched, scratched, slapped, punched, and kicked. 'It's sad to me that the violence has [become] just a part of the career,' Bartmus said. 'There are just some facilities that don't take it seriously.' Underreporting Violence Is Common The perpetrators of violence against nurses can range from patients who are under the influence of drugs or alcohol or experiencing mental health issues to grieving families. The hospital experience, including long wait times, unmet expectations, and feelings of anger and powerlessness, can also contribute to violence. Regardless of the cause, workplace violence takes a toll on nurses. As a result of rising rates of workplace violence, nurses often experience increased job stress, absenteeism, burnout, fear, and posttraumatic stress disorder. Workplace violence has become such an epidemic in healthcare that 26% of nurses are considering leaving the profession. The issue has even been highlighted on primetime television. In the medical drama The Pitt , a patient frustrated with long wait times in the emergency department of the fictional Pennsylvania hospital in Pittsburgh violently punches a charge nurse in the face, knocking her to the ground. The nurse goes home after that shift, knowing she likely won't return. Despite the toll that workplace violence takes on nurses, incidents often go unreported. The American Nurses Association cites issues that include poor or nonexistent hospital policies and procedures, complex reporting procedures, and beliefs that patients cannot be held accountable for their actions as reasons that up to 80% of workplace violence against nurses is never documented. Bartmus pointed to a 'lack of consequences' for patients as another reason that nurses are often reluctant to report violent incidents. 'In aviation, even a verbal threat is grounds for being removed from a plane, being reported, and oftentimes the police are called,' she told Medscape Medical News . 'That's not necessarily the case in the hospital.' In fact, the Emergency Medical Treatment and Labor Act mandates that healthcare providers screen all patients who come into the emergency department and provide stabilizing treatment. The legislation expects that hospitals will have protocols in place to manage violent patients and can enact those protocols while following the legal requirement to provide screening and treatment. Bartmus admitted that she once didn't report a violent incident that happened while she was working the night shift because she didn't want to call her nurse manager or deal with the paperwork; she has also heard from peers who decided not to press charges because of the hassle of a court hearing or an unwillingness to bog down the police department. Gordon L. Gillespie, PhD, DNP, adjunct professor at the University of Cincinnati College of Nursing, Cincinnati, and chief program officer for the National League for Nursing, Washington, DC, was often the target of violence when he worked in the emergency department of a community-based hospital from 1998 to 2012. Even nurses who don't want to file reports with law enforcement should still report physical violence, verbal aggression, and threats internally. 'Institutions should make it required,' he said. 'Increased reporting [provides] measurable data that you can act on.' Internal reporting would make it possible to document violent incidents in the electronic health record, triggering a risk flag that would alert nurses to a higher risk for violence the next time the patient seeks care. Curbing Workplace Violence Unfortunately, many hospitals fall short when it comes to addressing workplace violence. A recent healthcare workplace report found that 43% of nurses said hospitals ignored their complaint of workplace violence and 12% said that administrators sided with the perpetrators. Moreover, 74% of healthcare organizations fall below the benchmark for a safe work environment and have 'notable gaps' in workplace safety and preparedness, putting nurses at risk. 'We get annual inspections by local departments of health and the fire marshal, but we don't have…comprehensive safety assessments,' said Nora Warshawsky, PhD, RN, nurse scientist at Press Ganey in Chicago. 'We talk about zero harm for our patients…but we also need to have a zero-harm culture for our staff.' Implementing violence prevention programs, investing in de-escalation training, and enhancing security measures can help create safer work environments, she added. Warshawsky also believes that technologies like wearable panic buttons, video monitoring, and weapons screening could help nurses feel more secure and lead to faster incident response. Legislation could help address the issue. The bipartisan Workplace Violence Prevention for Health Care and Social Service Workers Act was reintroduced in both the Senate and House in April 2025, and it would require healthcare organizations to implement comprehensive workplace violence prevention plans. It will also establish a set of minimum standards that all healthcare organizations must follow, ensuring there is continuity in violence prevention even when there is staff or leadership turnover. A previous version of the bill introduced in 2023 did not pass. Gillespie is hopeful that the reintroduced legislation will pass, but regardless of the outcome, he encourages nurses to report workplace violence. 'Violence is not in your job description; violence is not 'other duties as assigned,'' he said. 'Violence is a problem of a troubled community and a healthcare system that needs to evolve, and one of the first steps to doing that is to report 100% of those problem behaviors because that puts the healthcare system on notice that they must act.'
Yahoo
10-06-2025
- Health
- Yahoo
Common Childhood Virus Linked to Alzheimer's Development in Old Age
A study published 30 years ago is striking up new conversation about the potential connection between the common cold sore and Alzheimer's disease. Published in The Lancet in 1997, researchers compared DNA extracted from the brains of elderly people with and without Alzheimer's, and in some of them, found herpes simplex virus 1 (HSV-1)—an infection often contracted in childhood—dormant in the nerves. Ultimately, researchers predicted that those with HSV-1 and a specific gene, called the ApoE-e4 gene, had a higher risk of developing Alzheimer's. Meet the Experts: David Hunter, M.D., an assistant professor and neurologist with UTHealth Houston, Linda Yancey, M.D., an infectious disease doctor at Memorial Hermann Health System; and Mark Santos, Ph.D., an assistant professor of microbiology and immunology at Touro University Nevada. Study co-author Ruth Itzhaki, Ph.D., summarized her team's findings in a recent article for The Conversation and noted that, over the years, additional work has surfaced to support hers. But what does it all mean, exactly? If a cold sore pops up, should you be concerned about dementia? We reached out to experts who explained everything. 'HSV-1 is a common virus to which almost everyone is exposed early in life,' says David Hunter, M.D., an assistant professor and neurologist with UTHealth Houston. 'It is best known for causing cold sores and is closely related to chicken pox and mononucleosis.' What these viruses have in common is that they are neurotropic, meaning they linger in the nervous system long after the initial illness, explains Linda Yancey, M.D., an infectious disease doctor at Memorial Hermann Health System, and can be reactivated by stress or lowered immunity. That's how, for instance, chicken pox can manifest later in life as shingles, adds Dr. Hunter. The virus's ability to infiltrate the nerves is believed to get it past the blood-brain barrier, a membrane that shields the organ from infection via the bloodstream. Thanks to that entry point, Dr. Hunter says, HSV-1 is the most common cause of viral brain inflammation in the United States. 'There is no vaccine for HSV and almost everyone will get it by adulthood,' Dr. Hunter adds. Cold sores are a mild case of it, and symptoms can be treated with antiviral drugs. Dormant HSV-1 may be reactivated by illness and reach the brain, explains Mark Santos, Ph.D., an assistant professor of microbiology and immunology at Touro University Nevada. This can trigger brain inflammation over time, known as herpes encephalitis,and in people with genetic risk factors, like the ApoE-4 gene, contribute to Alzheimer's development, he adds. 'We don't entirely know why ApoE-4 is a risk factor for Alzheimer's,' adds Dr. Hunter. 'The link to HSV could be that ApoE-4 impacts the blood-brain barrier and makes it easier for HSV to enter.' And the inflammation caused by that entry may heighten Alzheimer's risk. 'It is now universally accepted that inflammation in the brain is a key step in the development of Alzheimer's,' Dr. Hunter reiterates. In the three decades since the original study, doctors and researchers have learned much more about Alzheimer's disease and its connection to viral inflammation. For instance, several studies have found that being immunized for any disease (like COVID-19 or the flu) reduces Alzheimer's risk, says Dr. Hunter. 'Several other studies have shown that reducing inflammation in the brain helps prevent Alzheimer's,' he adds. Santos concurs. 'Since 1996, additional studies have found HSV-1 DNA in the brains of individuals with Alzheimer's. Lab studies have also shown that HSV-1 infection can trigger the buildup of amyloid-beta and tau—proteins strongly associated with Alzheimer's pathology,' he explains. However, there are a few disclaimers to note. Firstly, the posed risk is associated with people who contract HSV-1 in early life, giving it time to progressively cause inflammation. The risk may be lower in adults, says Santos. 'That said, if someone has other risk factors (like a weakened immune system or APOE-e4), adult-onset HSV-1 could still have long-term consequences,' he adds. Still, neurotropic viruses are extremely common, Dr. Yancey reiterates. 'This makes it difficult to tease out whether they are causing neurologic problems or are simply common in the general population, including people with neurologic problems,' she adds. In other words, because most people end up with HSV-1 doesn't necessarily mean that most people will get Alzheimer's. 'Most cold sores aren't a cause for concern,' Santos adds. 'They're common and usually well-controlled by the immune system. But for people with frequent outbreaks, weakened immunity, or APOE-e4, it may be worth discussing with a healthcare provider. The concern is not a single cold sore, but long-term viral activity in the brain.' More research, including long-term studies, is needed to make any solid associations, Santos and Dr. Yancey conclude. 'The current data is based on population-level surveys. There is no way to predict on an individual patient's level whether this has a meaningful impact,' says Dr. Yancey. Future research will, hopefully, at least help experts understand how antiviral treatment affects Alzheimer's risk, as well as identify better ways to detect when HSV-1 is active in the brain. 'The hope is that understanding how infections contribute to Alzheimer's will open up new ways to prevent or treat it—especially before symptoms start,' says Santos. Being vaccinated, exercising, engaging in mental stimulation, and maintaining a heart-healthy diet are all known ways to lower dementia risk, our experts say. Avoiding smoking or nicotine use of any kind can also 'drastically' reduce the risk, says Dr. Yancey. All of these habits and choices work together to support both immune and brain health. You Might Also Like Can Apple Cider Vinegar Lead to Weight Loss? Bobbi Brown Shares Her Top Face-Transforming Makeup Tips for Women Over 50
