Never mind that many hospitals aren’t providing counseling or other resources to help assaulted nurses cope with the distress that lingers after an attack, including insomnia, flashbacks, anxiety, and other symptoms of post-traumatic stress disorder. In nearly three-quarters of assaults against ER nurses, hospital management never even responds to queries from nurses who are attacked (according to those nurses). “They want the nurses to ignore it, partly because they don’t want the liability, but mostly because people outside of nursing just assume since the patient is elderly or mentally ill, they don’t know any better. Right. Let me sit here and get my ass kicked because ‘she doesn’t know what she’s doing and doesn’t mean it,’ ” Molly said. In hospitals, the shrug-it-off culture forces nurses to endure treatment that would not be tolerated in any other profession.

More assaults occur at acute-care hospitals than any other workplace, according to the Bureau of Labor Statistics, and the majority of these healthcare assaults target nurses. Yet many hospitals don’t train nurses how to manage violent people. As an Emergency Department chairman told me, “My residents get more training than my nurses do,” even though nurses are assaulted more frequently than doctors because they are more often at the bedside.

Hospital administrators aren’t the only people dismissing the victim. In 2012, Tennessee state senators debated a bill to strengthen penalties for people who assault healthcare workers. Senator Ophelia Ford gave an odd, rambling statement in which she complained about “mean and hateful” nurses during her own medical care and not getting a private room. She concluded, “To come before this committee and ask for this kind of thing is ludicrous.” The bill passed the committee anyway with a five-to-four vote, but attacking a nurse is still only a misdemeanor in Tennessee and twenty other states.

When workplaces put measures in place to protect their staff, the results can be impressive. The Veterans Administration Medical Center in Portland, Oregon, installed a computerized database to identify patients with a history of violence, so that staff members would know to take additional safety measures, according to the National Institute for Occupational Safety and Health. The program helped to decrease the number of violent attacks by an astounding 91.6 percent.

The prejudice against nurses is alarming and dangerous. In 2006, Brenda Coney, a patient in Jacksonville, Florida, pulled a knife on another patient. The hospital called the sheriff’s office, which filed a police report. Two months later, when Coney slapped a nurse twice in the face, the hospital ignored the incident. Later that same month, Coney returned to the hospital, where she shot and killed a pharmacist.

If nurses are ignored, blamed, or laid off when patients assault them, what happens to other hospital staff members? Consider the case of Paul Matera, who worked in Washington, DC. A trauma patient who had been stabbed punched Matera in the back of the neck, rupturing several discs. Matera, who continued treating the patient almost immediately, needed three surgeries (covered by workers’ compensation insurance) to repair his own injuries. He didn’t press charges because, he said, “He was a young guy under the influence of alcohol and cocaine and under duress from his own trauma, so I felt he likely did not know what he was doing.” But Matera wasn’t a nurse. He was an ER doctor. So his hospital didn’t fire him or fault him for the attack. Instead, Dr. Matera received an entirely different sort of response: The American Medical Association gave him the rarely awarded Medal of Valor for “courage under extraordinary circumstances in nonwartime situations.”

SAM

  CITYCENTER HOSPITAL, October

Now in her third month as a nurse, Sam was certainly more confident than she’d been back in August. She enjoyed the work, even if Citycenter’s ER was crazy. The patient load was enormous, but as a result, she had treated so many people that she no longer felt like a brand-new nurse. She relished learning something interesting every shift.

By focusing on the work rather than the environment, Sam could even put up with the spontaneously high-kicking CeeCee, whose personality continued to grate on her. Sam tried giving her the benefit of the doubt, because CeeCee was the type of nurse who jumped in to help without being asked (and even if her help wasn’t actually needed). Yet the way CeeCee went about helping made it seem as if she were doing so not to alleviate another nurse’s workload or to improve patient care but because she wanted her fellow nurses’ gratitude and adoration.

That was okay. Sam could let that go. One thing about being an introvert—because you avoided drama, it was easy to let petty matters go. And the other nurses were mostly gracious and willing to teach her. On rare occasions, Sam was lucky enough to share a shift with Shirley, a well-respected nurse practitioner who cheerfully answered any questions Sam had about being an NP. Shirley told Sam that she could do nearly anything in the hospital that ER residents did.

William, in particular, seemed to get a kick out of Sam. “You’re so funny, Sam,” he told her once. “You’re so quiet and then suddenly you speak up—‘Screw this!’ It’s like, tell me how you really feel.” Sam was enjoying getting to know him, too. They had several mutual interests outside of medicine, like biking and swimming, and he was easy to talk to.

But Sam was still disheartened by how difficult it was for nurses to find respect at Citycenter. “Nurses are really looked down on by residents. Some residents are amazing, but others you just want to drop-kick,” she said.

Dr. Spiros, who pulled ER night duty about every three weeks, continued to fall into the latter category for her, which was frustrating because everyone else seemed to love him. Sam’s style of speaking was casual, but Dr. Spiros’s was not. So when Sam asked, for example, her cheeks flushing, “Hey, Dr. Spiros, do you mind if I get some morphine for Mr. Neberz?” he was short with her. Half the time, he didn’t even look at her. Granted, she tended to run into him when both of them were stressed or tired. And her attempts at nonchalance probably didn’t mask how awkward she felt approaching the busy senior resident.

One night, a nurse mentioned that Dr. Spiros had helped her out of a tight spot with a seriously ill patient.

Sam scoffed. “He wasn’t an ass?”

The nurse looked at Sam quizzically. “Oh, no, no, no! He’s a nice guy who did right by my patient.” The nurse told her that Dr. Spiros had gone through a sad divorce the year before. “When he told me about it, he got all teary-eyed and said he just wanted to find the right person,” she said, shaking her head sympathetically.

“Really? I just find him pompous,” Sam said.

“Oh, but he’s so nice. Seriously, he’s Mr. Nice Guy.”

Sam doubted that. An hour later, when Sam went to the minor care nurses station to document patient information, Dr. Spiros was telling another nurse about his recent trip to Greece. The other nurse brought Sam into the conversation before she left.

“I’d love to go there someday,” Sam said.

Dr. Spiros pointed to the surname on her badge. “Where’s that name from?”

“I’m Greek, can’t you tell?” Sam answered.

“That can’t be right,” he said.

“My grandparents lived closer to Italy.”

Beneath his tousled hair, Dr. Spiros fixed his deep brown eyes on Sam as if she were the only person in the room. “Oh, really. So you’re supposed to be pretty fiery . . . ” He grinned at her. “And ‘Sam’? Not short for Samantha?”

“Salome.”

“Salome! It means ‘peace.’ Fitting.” He raised an eyebrow. “So, Sam. Why are you so quiet?”

Sam adjusted her glasses for a moment to avoid the intense gaze of this hunky doctor. Why was she quiet? There were several reasons. She liked to observe her surroundings, to soak them in, rather than to insert herself clumsily into them. Somehow the words in her head rarely exited her mouth as elegantly as she had hoped. She preferred to “feel things out” rather than charge headlong into a situation. And she didn’t believe in jabbering only to fill a silence; silence could be beautiful, and illuminating.