“Yeah, for patients or for our nursing license,” another nurse muttered.

“I talked to Victoria about the patient ratio,” Renée said. “She told me she didn’t understand what all the grumbling is about.”

“I don’t understand how the hospital can completely ignore repeated safety concerns from staff!” Molly said.

“We’ve all been submitting complaints to The Joint Commission. You should do one, too,” Renée suggested. TJC accreditation was required for hospitals to receive federal funds and Medicare/Medicaid reimbursement. To get the accreditation, hospitals had to recertify every three years. Supposedly, TJC inspectors could show up at any time to investigate whether a hospital maintained TJC standards.

At home, Molly reviewed The Joint Commission website: “Joint Commission standards focus on safety and quality of care.” Everything I complain about involves safety and quality of care! she thought. She clicked to a page where she could register a complaint. The website made it easy: She had only to select a few categories from drop-down menus and fill out a short comment box. “Citycenter’s ER is unsafe based on workload,” she wrote. “I’m expected to care for nine patients at a time when the standard is four to five. When my partner goes to lunch, I’m required to take care of double that number, even if it’s eighteen patients. And minor care consistently has one nurse to twenty patients.” She wondered whether the authorities would step in.

Academy Hospital

Molly was working triage at Academy when a fellow ER nurse, upset and disheveled, came in for treatment. She told Molly she was trying to get a patient settled in bed when the patient jumped up and walked out of the room. The nurse called for security, but the officer only watched. “Wait!” the nurse had shouted as the patient continued toward the elevator. The nurse hurried after her. “If you want to leave, I’ll take out your IV and get you ready to go!”

The elevator door opened. “Come back!” the nurse said, leaning in the doorway. The patient lunged, grabbing her neck and scratching her multiple times before the security officer finally stepped in.

“You should file charges,” Molly told the nurse.

“It’s too much trouble. Administration wouldn’t like it.”

Molly exhaled loudly. This incident had hit too close to home. “If you worked at Macy’s and someone grabbed you by the neck and scratched you up, would you do nothing?”

“It’s different in healthcare.”

“No!” Molly yelled. “Too many people have that attitude! It is not okay to assault healthcare workers. If a nurse thinks that, how can we possibly get anyone else to change their mind? You need to get mad!”

The previous week, a Citycenter patient had thrown her urine sample into a nurse’s face. Management had pleaded with the nurse not to report the incident; when she did, the police said the report probably wouldn’t go anywhere because “the patient is mentally ill.”

Molly was livid. “I can’t believe even the cops gave her a hard time,” she told a friend. “There’s no other career where you can be hit, scratched, spat on, verbally assaulted, have people threaten your life, and you just go about your business like it never happened.”

It had happened to Molly two years before. Daryl was a frequent visitor to the ER. In his forties, he lived in a shelter, and when he wanted free meals and time to himself, he came to Pines, claiming to be suicidal. He would refuse all treatment, medication, and therapy, but the hospital kept him for three to five days. He had done this countless times. One day Molly entered his room in the ER’s psychiatric area and prepared to take his blood pressure. Within a matter of seconds, Daryl punched her in the eye, yanked her long hair, and scratched her arms and neck. He grabbed Molly’s shirt and began to pull her onto the bed. As Molly struggled with him, Daryl bit her arm, breaking the skin. Molly tore herself away and rushed out of the room. Daryl fell to the floor, unharmed.

While Molly washed the bite with soap and water, the psych tech, who was assigned to observe patients from behind a glass window, told her that security wasn’t answering her call. Molly could hear the security department’s emergency line still ringing. When an officer finally arrived, he escorted another nurse into Daryl’s room to take over his care. Molly found out later that Daryl’s first words were “I should have bitten her fucking face off.”

Because Molly equated going home with “letting Daryl win,” she returned to work after Employee Health had documented her injuries. Back in the ER, a doctor recommended she go to a specialized medical clinic for monitoring: Daryl had hepatitis C. She would have to return to the clinic at 6:30 a.m. weekly, then biweekly for a year for blood draws to make sure she hadn’t contracted the disease.

That day, Molly filed charges against Daryl. Priscilla supported her, but the Pines Memorial lawyers and risk management team told Molly that if she wanted to pursue a case against the patient, she was on her own. Fortunately, the state took the case. Police issued a warrant for Daryl’s arrest.

More than a month after the incident, Daryl filed a restraining order, claiming that Molly had assaulted and intimidated him. An officer came to the ER to give Molly a court summons. Suddenly Pines’ risk management department wanted to get involved. Molly would never forget the conversation with the hospital administrator.

“He’s making some very serious allegations against you,” the risk management director told Molly. “When were you planning on telling us about it?”

“This was given to me this morning. My court date is on Tuesday,” Molly said.

“We’re getting you an attorney and changing your court date.”

“I don’t want to change the date. I’m ready.”

“It’s not about you anymore. You don’t have a choice in this,” the administrator said.

“It absolutely is about me! It’s a case against me!”

“Well, you represent the hospital and we’re going to get it changed.”

“The hospital had nothing to say about it when I filed my charge, but now risk management wants to get involved? I’m not changing the date.” Ultimately, the hospital had no right to reschedule the hearing. But Molly was left feeling devalued because Pines’ administrators didn’t support her until they believed the hospital’s reputation was at risk.

When Molly asked the head of security for a copy of the tape from the video cameras in the psych area, he told her that the cameras didn’t actually work.

At court, the judge immediately dismissed the charges against Molly because the statute of limitations for Daryl’s claim had passed. Nevertheless, for two more months, the state’s judicial website—a collection of public records—listed the restraining order against her.

For the case against Daryl, the judge sided with Molly. He sentenced Daryl to one year in jail, as much time as Molly would have to worry about her health. When Daryl was released, one of his terms of parole would be continued mental health treatment.

Not long after he got out of jail, Daryl was back in the Pines ER, enjoying free meals and refusing treatment once again, without consequences. And by the time Molly quit, Pines Memorial still had not fixed the security cameras in the ward.

The Third Most Dangerous Profession

DeAnne Dansby was a travel ER nurse in Sacramento when she experienced the worst patient assault of her career. Medics brought in a hypothermic, unresponsive homeless man whom Dansby and a student nurse were able to revive. Dansby left the patient with the student for a moment. When she returned, the patient had backed the student into a corner. Dansby rushed to protect the girl, holding out her arm so the student could get behind her. The man ripped out his IV and lunged at Dansby, tackling her so hard that when they fell through the doorway, her head banged hard onto the floor. Feeling an excruciating snap in her neck, Dansby screamed. The man pulled her scrub pants down, bit her inner thighs, and was about to attempt to rape her before several of Dansby’s coworkers were able to wrestle him off her.