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and a traumatic brain injury, all of which required two eye surgeries, one nose surgery, physical therapy, and chiropractic treatments. And the psychological wounds ran deep. "I had counseling for about two years. I didn't want to leave my house," says Holder. Acupuncture and weekly cognitive behavioral therapy worked to curb residual trauma, but Holder still had linger- ing double vision, ringing in her ears, difficulty lifting, and post- traumatic stress disorder. She was unable to return to ER nursing. Her workers' comp payments, a fraction of her original salary, even- tually ran out, and she was essentially forced, for lack of funds, to move to Florida to live with one of her daughters and her family. Now, still experiencing vision and hearing issues as well as "a signifi- cant number of headaches every week," she has returned to school at age 59 in an attempt to qualify for an office job. "I am keeping a positive attitude and refuse to allow this to define me going forward," said Holder. "But this has been life-changing, and I feel let down by the system." No job comes without some degree of risk. But for registered nurses, the dangers of being hurt by workplace violence while doing their jobs have not only reached unprecedentedly high levels, but are also now much more frequent. The U.S. Bureau of Labor Statistics reports that violence against hospital workers is almost five times greater than the average worker in all other industries combined, and the rates appear to be rising. For too long, nurses have simply put up with the violence. Or, worse yet, they actually assimilated and normalized the violence as a routine part of their jobs. Hospitals must be held accountable for having violence preven- tion plans and for practices, such as unsafe staffing levels, that directly contribute to the inability to stave off violent incidents, say RNs. They must also be prepared to deal with increasingly mentally unstable patients, and even their family members, due to the aban- donment of psychological services across both the public and private health sectors. The healthcare industry's plans to maximize profits by shifting the burden of care onto the patient's family members at home may also be putting undue stress on both patients and rela- tives. By having a plan to prevent violence, employers will not only be protecting RN and other healthcare staff, but also other patients, families, and visitors. Across the country, RNs are now demanding that hospitals and clinics take responsibility for creating and maintaining safe work environments—as employers across all sectors are required to do. Nurses in California in 2014 passed a law directing their state Occu- pational Health and Safety Administration to draft tougher work- place violence rules for hospitals and spell out what is required of them. Nurses in Minnesota, Florida, Texas, and Massachusetts are also trying to pass legislation requiring similar safeguards. Holder said RNs understand that with the confusion and fear brought on by illness, medication, old age, and mental illness, there is some amount of risk that a patient will occasionally become agi- tated or lash out. She's been bitten, hit, and scratched by "little old ladies," but the scenarios RNs face now are wholly different. Today, nurses are constantly put in risky situations that should have been avoided in the first place had the hospital had better protections and policies in place. No staff should have been left alone with a boxer suspected to suffer from a head injury. "We feel like we're putting our life on the line for no reason," said Holder. "Now I have a permanent injury. As far as having any kind of light at the end of the tunnel after all this, or [the hospital saying], 'Here, we're going to make up for your lost wages.' There have been no phone calls [from administration], no card. They forget about you." Ask a convention hall packed full of thou- sands of registered nurses, "Who has suffered violence at work?" and almost all will raise their hands. Violence comes in many forms, whether physical, verbal, or psychological, and can be committed by patients, their friends and family members, and even doctors, hospi- tal management, and administrators. "We've always considered workplace violence a critical issue," said Karen Higgins, a Massachusetts RN and a copresident of National Nurs- es United. "Now, the concern is that the violence seems to be escalating." According to the Bureau of Labor statistics, violence against healthcare workers is, indeed, on the rise. In 2013, thirteen percent of the injuries and illnesses requiring health care and social assis- tance workers to miss workdays were the result of violence. That's an increase, for the second year in a row, of 16.2 cases per 10,000 work- ers, up from 15.1 in 2012, according to the BLS. Again, these rates are almost five times greater than typical workers. And those are just the recorded figures. According to the U.S. Department of Justice, Federal Bureau of Investigation, actual sta- tistics regarding violence committed against healthcare workers may be even higher, due to a "likely under-reporting of violence and a persistent perception within the healthcare industry that assaults are part of the job. Under-reporting may reflect a lack of institution- al reporting policies, employee beliefs that reporting will not benefit them, or employee fears that employers may deem assaults the result of employee negligence or poor job performance." In her 40 years as a nurse, Kathy Britten, RN, of Sanford Thief River Falls Medical Center, in Thief River Falls, Minn., has seen vio- lence go unreported, due, she believes, to factors such as worries about getting fired and not wanting to be reprimanded. "I keep telling my younger coworkers, you need to fill things out," she said, stressing that it's critical to report and document violence in order to establish patterns and hold management accountable. 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J A N U A R Y | F E B R U A R Y 2 0 1 5 "We feel like we're putting our life on the line for no reason. Now I have a permanent injury. As far as having any kind of light at the end of the tunnel after all this, or [the hospital saying], 'Here, we're going to make up for your lost wages.' There have been no phone calls [from administration], no card. They forget about you."