Violence in Unexpected Places

Last week I wrote about the gunman who appeared on my unit when I worked the night shift in a large urban hospital. The nurse who first confronted the gunman advised him that guns were not allowed on the floor.

Now that might not seem the smartest comment in the circumstances but nurses aren’t trained in law enforcement. Violence in hospitals had not yet become an issue discussed by management and part of employee training.

Also, the day before the gunman incident, a family had complained to the unit staff that their dad said he was threatened regularly by Arabs with guns. The father had Alzheimer’s disease and thought his call light was a nuclear weapon. The nurse who responded to the family’s complaint stated, with more sarcasm than sympathy, that visitors were expected to check their weapons at the security desk downstairs. Little did we know.

I’m not sure why it took so long for violence to become a hospital issue. Hospital employees are beaten up by demented patients and patients under the influence of alcohol or drugs.

Nurses used to keep the keys to narcotics on a cord around their necks. I knew of at least one nurse who had the cord ripped off her neck. If a drug thief was suspected of being on a unit, security would lock down that unit as well as the floors above and below it. The nurses were locked in with the suspected drug thief.

Before the danger to staff of needle sticks became an issue, used needles were pushed into a container with a mesh top. Sometimes the containers became very full. After they were replaced, the old containers were stored in the dirty utility room where anything contaminated was kept. Before it was common knowledge that HIV could be spread by contaminated needles, these containers were sometimes stolen for the many used needles they held.

How did the thieves enter the hospital? The basement of the hospital had several entrances at that time, and they weren’t all alarmed or watched. The night pharmacy was in the basement. If we ran out of a particular narcotic during the night, a nurse would descend to the basement pharmacy, present her identification badge and receive the narcotic in a plain brown bag. I wondered whether potential thieves would believe I was carrying my lunch rather than narcotics.

One time, although nurses always had to present identification and couldn’t go past any locked pharmacy door, a man who claimed to be delivering flowers to a pharmacy employee was granted access during daylight hours. He had a gun and forced a pharmacist to open the narcotic safe. A pharmacy employee managed to send out an email and a security officer happened to be checking his email.

Unit staff quickly becomes acquainted with regular visitors and employees from other hospital disciplines. They would report anyone who seemed suspicious. Still, it’s surprising more threats of violence don’t occur in hospital settings. If a person arrives in the ER clutching his chest, the ER staff doesn’t assume he’s faking it and using the symptom as a ploy to steal narcotics.

There have been stories and TV shows about angry patients or relatives showing up with a gun at a hospital. I can think of a whole lot of other scenarios in which hospital staff could be caught off guard. It’s probably not the prisoner who arrives with his own police escort who presents the biggest threat.

How to create a story that hasn’t been done? I think I could come up with ways to sneak onto a unit with evil intent but do I want to give someone ideas?