Amy Schmidt isn't sure what would have prevented a brutal attack at St. John's Hospital in Maplewood last fall, when a 68-year-old patient swinging a metal rod chased nurses out of their unit and injured four workers.
Schmidt, who was the charge nurse on the Nov. 1-2 overnight shift, fled when the rod crashed onto her nursing station. She tried to close the unit's door to block the attacker, but a co-worker was still escaping, so Schmidt left the door cracked and hid.
"We need help on P1," she whispered into her communication badge.
The high-profile attack, which ended with the patient dying after a scuffle with police, is creating momentum at the Capitol for legislation to improve hospital safety, with two bills set to receive hearings Wednesday.
"Violence against health care workers … happens every day," said Sen. Charles Wiger, DFL-Maplewood, lead author of a bill supported by the Minnesota Nurses Association. "The incidents range from spitting and biting to kicking and punching to the use of anything within reach as a weapon against a health care worker."
The bill seeks a state reporting system to track violent injuries, along with state Health Department recommendations on hospital safety and minimum training standards for workers on violence prevention and de-escalation. The union also wants nurses protected against retribution if they report injuries or request more staffing when they feel it is needed to address threats.
The Minnesota Hospital Association supports a different bill, which would give prosecutors the option of tougher penalties against attackers in hospitals.
"The hospital environment needs to be one of safety and healing," said Wendy Burt, a hospital association spokeswoman, noting that Minnesota has "safe zone" laws that increase criminal penalties for attacks in schools and other public places.
Advocates say the risk of hospital violence is rising because today's patients are sicker and more prone to delirium and dementia — conditions that can result in impaired and rash judgment. Minnesota saw a record 69 workers' compensation claims filed in 2014 by nurses intentionally injured on the job. That exceeded the total for 2012 and 2013 combined, which was 68.
Many injuries aren't reported, Schmidt said. "I don't know a health care worker out there who hasn't been hit or pinched. At the time, you blow it off. It's part of the job."
St. John's has good protections, she said, including a "code green" system workers can use to call for help.
Schmidt isn't sure the November attack could have been stopped by anything short of a security guard outside the patient's door. Signs of trouble were apparent, though, as the attacker, Charles Logan, was admitted due to his "altered mental status" and had called an attorney at the hospital about separating from his wife and giving his assets away. Police later found bizarre writings on a board in his room, including, "When people fear you, they control you. I fear no one."
As Schmidt fled the attacker, a nurse behind her tripped and received two swift blows from the metal rod, which normally is attached bedside for IV pumps and other devices. After calling for help, Schmidt heard screams and found a nursing assistant bleeding from the head.
"We were all in a daze," said Schmidt, who helped injured colleagues to the ER and then completed her shift.
A Ramsey County death investigation, completed Feb. 24 and released Tuesday, found Logan likely died from "excited delirium" and medical complications after he charged at police officers outside the hospital and was wrestled to the ground. The county attorney did not seek charges against the officers, because their use of nonlethal force was "justified" and wasn't necessarily the cause of death.
The nursing union opposes the hospitals' proposal to increase criminal penalties for such attacks. Nurses might be less apt to report injuries if it could get patients in deep trouble, said Jon Tollefson, a government affairs specialist for the union. "If an elderly patient [who injures a nurse] is suffering from dementia or reacting to a medication, is criminal prosecution the best way to address that? It's certainly not a way to prevent that."
But hospital officials don't see how the union idea of state reporting will prevent injuries. Nurses can already report lapses in hospital safety to the state's Office of Health Facility Complaints, Burt said.
She suspects the union's proposal is a way for nurses to complain to the Health Department about the need for more staffing, and to build support for mandated nurse-to-patient ratios, which hospitals view as unnecessary and costly.
Since the incident, St. John's has made changes, Schmidt said, including removing the bedside metal rods that could be used as weapons.
Schmidt, 38, is a former accounting administrator who stayed at home until her kids were school-aged and chose nursing as a second career.
The attack has not dissuaded her, or diminished her compassion for patients. But she is more cautious, she said. "It made me aware of the fact that things can happen quickly. [Patient instability] is always something you're watching for. It's part of your assessment."