Security in Healthcare Today - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Several weeks ago, I attended the American Academy of Nursing meeting in Washington, DC. The growing problem of physical assaults and violence on healthcare staff was discussed with a focus on gun control. Not surprisingly, the murder of a nurse and social worker at Methodist Hospital Dallas was top of mind for many attendees.

Between sessions, I spoke with a security officer in the hotel. I will call him Max because he asked that I not use his real name. Max shared that he had been a senior police officer at St. Elizabeth’s hospital in Washington, DC, for 30 years. St. Elizabeth’s Hospital is a psychiatric hospital in Southeast Washington, D.C. operated by the District of Columbia Department of Behavioral Health. It opened in 1855 under the name Government Hospital for the Insane. John Hinckley, who attempted to assassinate Ronald Reagan in 1981, was one of their more well-known forensic patients. Today operations are significantly scaled back, but treatment is still aimed at patients with behavioral health issues.

We talked about what had happened in Dallas. Max shook his head and said – “security in hospitals today is like me moving into a high crime area and then being shocked when your house is robbed- you can’t be in denial about what is out there.” I asked Max for his thoughts and recommendations (based on years of experience) about the security issues in healthcare today. He shared the lessons he had learned from his own experience:

Hurt people hurt people – Max told me that healthcare professionals sometimes have magical thinking that people will walk into their environment, behave and be respectful. Many people today have experienced trauma and in turn, will hurt others when they don’t get what they need or want. Max said he realized at St. Elizabeths that patients lashed out at professionals even when they trusted them. Patients or family members can quickly turn into assailants.
Hospital security needs to be managed by experts – Max noted that too many hospitals today underinvest in security and outsource these services to security companies who send a changing cast of characters into hospitals. To tighten security, he observed, the security team needs to be part of the healthcare team. They need to know the staff and know patient behaviors.
Situational awareness is critical – Max feels that many healthcare staff are not situationally aware. He noted that in his own experience, some had exam rooms set up in a way that would make it hard to leave the room. Hospitals should conduct yearly drills on active shooter protocols like schools do today.
Hospitals are not hotels – Max observed that too many health systems are using the hotel model versus the airport security model. Hospitals are not hotels; given what is happening, bag searches and walk-through security systems must be part of the picture. He noted federal legislation making it a crime to bring a gun on healthcare property was probably required.
It takes a village to provide security – Many neighborhoods have crime watch volunteers. Max feels we must train every hospital staff member to watch for suspicious behavior or conversations. Shows of force are sometimes needed when a situation is out of control.
Professionals need training in both physical and verbal de-escalation techniques – Max noted that being skilled in verbal de-escalation is an essential skill most healthcare professionals don’t have. He observed they often make things worse by saying the wrong thing. Yearly crisis prevention training with take-down skills is as vital as BLS training.

We know that physical and verbal threats are increasing in healthcare today and are top of mind for professionals. Max is a security expert and professional whose advice should be heeded. I think Max is right in many ways, particularly his observation that we should view ourselves more as airports and less as hotels. It is past time to rethink our paradigm about security.

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