Injuries quickly became part of the job for Paul Messina. He got into health care to help others but didn't realize the daily dangers he would face.
Five days into being an EMT he was punched in the face by a patient and said he was advised not to press charges.
When he transitioned into nursing, the threat of assaults only grew.
"It has gone something that is not just anticipated, but almost expected at the beginning of your shifts," Messina said calling the violence in hospitals an 'epidemic.'
He said over the past four years, he's experienced workplace violence weekly.
"It's our job. We take care of people but again, it's not something that we signed on for," he said.
The worst incident occurred in July 2021 while he was working at the Betsey Johnson Hospital in Dunn, NC.
Messina remembered he was working as the charge nurse in the emergency department when a patient started having an outburst and physically assaulting staff.
"He picked up one woman who was elderly and threw her across the room, about 15 feet," he remembered. "He had been tased twice by security and had no effect."
Messina said around 10 staff members were injured from the incident and he had three partial tears in his rotator cuff.
"Myself and then other security officer got involved and he at one point bit the security officer's arm to where the bite was not just superficial but had broken the skin and gotten down into the muscle," he said.
The attack left him questioning if he should stay in nursing and is still something he is concerned will be repeated.
"That is absolutely my worst fear," Messina admitted.
National Nurses United surveyed more than 2,500 nurses across the nation and found that 48% reported an increase in workplace violence.
Federal data show health care workers report the highest rates of injuries from workplace violence, a rate that has increased by nearly 50% between 2015-2019. In fact, workers in the health care sector make up around 50% of all victims of workplace assault in the nation, according to data from the Emergency Nurses Association.
David McDonald with the North Carolina Emergency Nurses Association said he knows of nurses in every major hospital system in the state who have been physically assaulted. While it is a widespread problem, he pointed to elevated violence occurring in communities that are more prone to violence outside of the hospital.
The American Hospital Association pointed to studies that found 44% of nurses in the U.S. experienced physical violence and 68% experienced verbal abuse.
"It's traumatizing. It's degrading, and it's heartbreaking," said Mission Hospital nurse Elle Kruta. She called the last few years 'scary'.
Kruta said she has also experienced firsthand the uptick in violence against health care workers.
"I had to step in between a nurse who was being felt like she was being physically assaulted by a patient, they were coming up to her, they were screaming at her, they were yelling at her, and we had to remove her from the situation," she remembered.
Health care attacks in the Triangle and Sandhills
Locally, Cape Fear Valley Medical Center reported it has had 122 physical assaults reported over the past three years with around half occurring in 2020.
A spokesperson for the hospital system said Cape Fear Valley has a "no tolerance" policy for assaults. The center has metal detectors at Emergency Department entrances, armed officers and cameras.
Over the past few years, the hospital system has increased the number of security officers, tightened the number of entrances, improved lighting and added cameras.
Duke Health refused to share the number of incidents that have occurred within its hospitals but said cases have been trending down this year due to some of the added security measures the system has put in place.
"We are deeply concerned about these escalating incidents of violence in health care settings. In recent months, we have redoubled ongoing efforts to address workplace safety, and are actively reviewing additional, more aggressive measures," a Duke Health spokesperson wrote.
Some of these measures have included limiting visitors' entrances, increasing security/police presence, increasing resources to teams handling patients with behavioral health concerns and creating site-specific plans and scenario training in our ambulatory setting.
An employee was physically assaulted by a patient at Duke Regional Hospital in July.
The I-Team requested data from WakeMed but has not heard back.
UNC Health reported 136 assaults on 65 staff members over the last two years at its UNC hospitals in Chapel Hill; around 43% of those attacks occurred in 2022.
A spokesperson for UNC Health said a task force is developing strategies to reduce incidents and enhance support. The health system plans to increase training to help staff "recognize and react to potential security issues before they escalate into violence."
"UNC Health is very aware of increased incidents of violence targeting hospital staff in our own facilities and across the country. One of our top priorities is our teammates' safety and well-being, and violence in hospitals is a serious issue - and one that's getting worse. We strongly support federal legislation that would help protect health workers and reduce workplace violence.
What's behind the uptick in violence?
Jean Ross, a registered nurse and the president of National Nurses United, said staffing is one of the biggest issues contributing to these incidents.
National Nurses United's survey found that 69% reported staffing has gotten worse, a significant increase from surveys conducted last year.
"Let's say you're just standing in line at a store, waiting for a clerk to help you, it's frustrating and the longer you stand there, the more frustrated you are," Ross said. "Now, pretend you're a patient, maybe you're in pain. You've got your light on, the nurse can't come there aren't enough nurses."
Ross also said the attacks are also contributing to staff shortages as some workers decide they've had enough.
Nationwide, National Nurses United is encouraging management to maintain sufficient staffing ratios and is encouraging the public to help by signing petitions.
Kruta said one of their nursing assistants left the field after getting slapped. She also had to step in to stop a patient from physically attacking another staff member.
"It was all about because we were so short-staffed on the medical-surgical unit," Kruta said. "Where the nurses normally take five patients they're having six or seven patients. Where they normally have three nursing assistants, sometimes they're lucky if they have one."
Messina said in North Carolina, another factor that he believes is increasing these incidents is a lack of facilities and resources for patients with behavioral health needs.
"On any given day at one of my facilities in North Carolina, out of my 24 beds in the emergency department, I'd have up to 11 beds that were dedicated to emergency department psychiatric holds that were pending placement at other facilities," he said. "At one point, one patient stayed for over two months."
While ED nurses are trained to handle a lot, they often don't have specialized training to deal with psych patients and this can leave them ill-equipped to handle situations that arise.
A path towards change
"I need to be able to keep you safe. How can I keep you safe if I can't keep myself safe?" Kruta stressed.
While data shows incidents are increasing, health care professionals say the incidents are still underreported. Health care professionals said the management at some facilities discourages reporting.
"It's horribly underreported, and there are nurses, especially those who don't have a union contract who are afraid to come forward because of retaliation or possible loss of their job, or it gets turned around on them," Ross said.
Health care professionals pointed to management at facilities as a starting point to create safer environments.
"I think it comes down from facility management. And also it comes down from whether or not local law enforcement takes this seriously," Messina said.
Messina also said keeping electronic health records would help facilities flag patients who have had a violent encounters with staff in the past. He believes increasing training for nurses and increasing awareness around the risk.
"One of the biggest things that can be done in facilities is to raise awareness that while our profession is a helping profession, it's not a 100% safe profession," Messina said.
Nationally, a federal law that many health care workers believe would make a difference is stalled in the U.S. Senate.
The Workplace Violence Prevention for Health Care and Social Service Workers Act would allow OSHA to require employers to develop workplace violence prevention plans, similar to how they do for other sources of workplace injury like falls and hazardous waste.
"We encourage all of our emergency nurses and their advocates to contact their US Senators to support and pass this bill," a spokesperson for the North Carolina Emergency Nurses Association stated.
"Health care violence affects everybody and if it doesn't get passed to become a federal law, it's just gonna keep happening because, I mean, there's nothing we can really do," Kruta said.