BEND — Just three months into her new career, Kathryn Darling, a certified nursing assistant in the intensive care unit at St. Charles Bend, was assaulted by a patient.

It was on the morning of Feb. 25. Darling was at a desk when she heard the patient thrashing about and throwing a plastic cup on the floor.

She went into the patient’s room and was followed by two security officers.

The three of them tried to stop the patient from ripping out intravenous lines and getting out of bed. The security guards were able to forcibly hold the patient on the bed, but his head was dangling.

Darling said she was worried about the patient’s head and neck. As she bent down to provide support, the patient’s leg lifted and delivered a blow to the left side of Darling’s head.

She hit the floor and lost consciousness.

Two months later, the Deschutes County district attorney filed charges against the patient, Cody Ray Reynolds, for allegedly assaulting Darling and the two security officers, according to court documents. A plea hearing is scheduled Sept. 19 on charges that include fourth degree assault and fourth degree attempted assault.

“I like what I do,” said Darling, a 29-year-old Bend resident. “My goal in talking about this is to make people aware that violence does happen in a hospital and in health care settings. It’s a problem and it’s a crime.”

Every day, 57 nurses are assaulted across the county by patients, and only 20% to 60% of the assaults are actually reported, according to the American Nurses Association, which used data from a 2021 report. One in four nurses are assaulted, the report found, including two nurses every hour in acute care settings.

“This under-reported epidemic has devastating results on the healthcare industry,” the association said on its website.

Bend isn’t the only Oregon city with hospital violence. In July, a hospital employee was injured and a security officer killed during a shooting at the Legacy Good Samaritan Medical Center in Portland. While the gunman was later killed by police, there were signs that the he had threatened hospital staff days before the shooting.

The number of nurse assaults is higher than police and fire injuries, said Kevin Mealy, Oregon Nurses Association spokesman.

“Culturally, nurses run to an emergency, but police and fire take self-defense steps to protect themselves,” Mealy said. “That’s not always the case in a hospital setting. In many cases the violence is assault.”

At St. Charles Health System, the four-hospital system serving Central Oregon, 44 healthcare professionals were attacked by patients in 2022, compared to 132 in 2019. While the number is not available for this year, Darling knows how a patient-inflicted injury can affect life outside of the hospital.

Darling was out of work for about two weeks and then came back on limited duty, only returning to her full-time position just six weeks ago.

Still months after her concussion, she has difficulty focusing, difficulty finding the right words when she speaks and is slower to process new information.

“My vocabulary was pretty rich before this,” Darling said. “I have always been intentional about my words. Since my injury, I noticed that words elude me.

“I think it’s linked to stress and a lot of things going on in my head.”

Another side effect of her injury is she’s more cautious and forgets things easily, she said. She doesn’t rush into patient rooms any more. And she’s more nervous and anxious than she used to be, as well, even though patients are generally kind.

Brain injuries take time to heal, said Darling’s physician, Dr. Michael Conner, a Bend psychologist who specializes in trauma. Combined with a heightened sense of danger, Darling is more vigilant, which is natural after an attack, Conner said.

“Your body remembers, even if you don’t,” Conner said. “Her forgetfulness leads to worry and worry leads to fear.”

Hospital policy

St. Charles Health System wants to create an environment free from violence, said hospital spokeswoman Alandra Johnson. There are five-foot high signs around hospital entrances, reminding patients and visitors to not harm caregivers. Soon, the same signs will appear at the entrances of clinics as well, Johnson said.

“Do no harm, make no threats,” state the signs. “Our caregivers are here to help you. Help them by being kind with your words and actions. Please treat our caregivers with the same respect you would expect to receive.”

Metal detectors were also installed recently at the entrance to the St. Charles Bend emergency department, Johnson said.

Should patients or visitors yell, curse or use hate speech, they could be removed from the premises and possibly have charges levied against them, she said.

“St. Charles maintains a strong relationship with local law enforcement agencies to this end,” Johnson said. “Safety is one of the key priorities and core values at St. Charles and we are committed to continuing to build a culture of safety across our health system.”

Changes ahead

Oregon lawmakers also saw that protections were needed for healthcare workers and nurses and in 2019 approved the Oregon Health Care Worker Protection Act. The act requires transparency, security plans and team-based solutions and protects a worker’s right to report violent incidents without fear of retaliation.

At St. Charles, the health system created a Workplace Violence committee that started this year and meets twice a month, Johnson said.

“Workplace violence is under reported because many healthcare workers don’t regularly report minor injuries or instances of violence,” said Mealy, nurses association spokesman. “It’s a large part of the culture. But in the last decade or so, we are changing that culture so that people feel comfortable reporting threats and feel supported.”

The assault on nurses and caregivers is made worse by the staffing shortage, Mealy said. More staff means more care for patients. De-escalation training also would help and information about a patient’s behavior or prior incidents needs to be shared, he said.

“You need that information before entering a patient’s room,” Mealy said. “The job is a hands on job. You can’t check a heart beat from across the room. Patients are sometimes experiencing the worst days of their life and they’re hearing the worst information ever.”

Code gray

At St. Charles, when a patient or visitor is combative or abusive, a code gray is issued, triggering a response from nurses and others in the health system.

Bend psychologist Conner, who is treating Darling for post traumatic stress and helping her understand the side effects from the concussion, said more attention needs to be paid to these incidents.

“It’s an assault and the hospital has to believe it’s a crime,” Conner said. “Healthcare workers, in my opinion, don’t recognize assault as a crime. They excuse the behavior. If you’re afraid and fear that you’ll be injured, you need to back away. But many don’t recognize the danger.

“Caregivers shouldn’t risk their family, careers or livelihood for someone who assaults them.”

Darling agrees. She would like to see the culture in healthcare facilities changed so healthcare professionals can learn to disengage from a potentially harmful situation. Since the incident, she doesn’t enter a room after a code has been issued. She waits for security.

“Nurses are warriors for each other. They’re selfless,” Darling said. “They exhaust themselves with how much they care.”

The Oregon Nurses Association, which represents about 16,000 nurses, supports St. Charles’s actions and also suggests:

• Hiring enough security personnel so that all units across the hospital campus are staffed and trained in de-escalation training.
• Establishing a zero tolerance policy for verbal threats of violence with stated consequences for individuals who engage in workplace violence.
• Allowing caregivers who have been assaulted by a patient/family or visitor to not be required to continue working the same assignment without prior consent.
• Paying the caregiver after an incident and not requiring a completed shift following an incident.
• Streamlining an incident reporting system for caregivers and informing others in the hospital system of an incident. 
• Providing training in de-escalation, trauma-informed care and crisis intervention, safe gun training, personal self-defense classes and other continuing education to support the healthcare staff.

Source: Oregon Nurses Association