RALEIGH, N.C. (WTVD) -- The Duke Raleigh Hospital was the best place Rebecca ever worked, it was also the place where she said she almost lost her life.
"Closed fists. I felt the initial impact and that was it," she said. "It was this side of my face and I don't remember what happened after that.
After 17 years of working in the hospital's emergency department, Rebecca was violently attacked by a patient in July. Rebecca asked for her last name to be excluded to protect her privacy from the man who attacked her.
"Somebody dropped the ball," she said recalling the moments that allowed the incident to escalate.
Her attack happened at the end of July around 3 a.m. Rebecca remembered it was one of the first days that Duke was trying a new program that involved continuing to "fast-track" patients in the waiting room in the late night hours.
One patient in the emergency room that night showed signs of potentially being aggressive.
"If the attitude is a little bit aggressive or you know, they think it might be a danger for the patients and employees. We always have security come in. And the way it works is security is basically just a presence to be. They act as a deterrent. And the way it's never just one officer, it's at least four or whoever is free sometimes it's five or six," she said.
But that night in July, she remembered just one security guard answering their call; a female guard who was smaller than Rebecca.
The patient refused to answer questions related to his health and shortly after punched Rebecca hard in the face. The punch led to Rebecca being life-flighted. She suffered a concussion, broken nose, a fracture at the floor of her left eye socket, which resulted in her eyeball sagging. She had to have reconstructive surgery.
"The way they described it was I was in a fetal position in a pool of my own blood," she said.
Months past the assault Rebecca said she continues to suffer. Her symptoms range from vision impairment to inability to drive to acute PTSD.
"I had no life," she said. "For the past five months, I've been basically homebound."
Rebecca's attacker, Stanley Scarboro was charged with multiple felony charges including assault on emergency personnel and communicating threats. Court records show Scarboro had a long history of charges, including disorderly conduct, assault on a government official, assault on a female and assault with a deadly weapon.
Rebecca's attack gained local media attention. Duke Health officials told ABC11 in the days after that they were redoubling their security measures and placing signage around the hospitals to alert patients that "aggressive behavior will not be tolerated."
Rebecca doesn't believe signs will make a difference.
"If a patient is going to be violent, he's not going to stop and read this and say, 'Oh, sorry, can't do it,'" she said.
Rebecca believes her attacker lashed out due to a lack of security.
"They were just nonexistent," she said.
She has started taking legal action against Duke claiming the system failed to provide a consistent protocol for its staff and a failure to provide security has caused staff to feel like no one is looking out for them. A formal lawsuit has not been filed yet.
A spokesperson for Duke Health did not comment on the specifics of Rebecca's case but said in a statement, "We support our team members who have witnessed or experienced violent incidents and commend them for sharing their personal experiences. We hope that increased awareness of this issue will help spur change."
The hospital system also reiterated that security is one of its top priorities. It is committed to "doing all we can to protect everyone in our facilities from violence incidents."
In addition to the signage, Duke Health is optimizing and organizing strategic security presence, providing additional emergency alert resources and support, and creating site-specific plans and training.
Despite these efforts, this month the ABC11 I-Team anonymously received a copy of a feedback card that nurses fill out at the end of the shift. The Duke Raleigh Hospital employee stated five staff members were physically assaulted in one week. On the feedback card, the employee wrote, "Workplace violence remains an issue and there have been no perceivable changes occurring,"
A spokesperson for Duke Health declined to comment on the card and referred to their original statement regarding security.
Duke would not share details on the specifics of its security requirements. The I-Team reached out to other local hospital systems. Many hospital systems declined to share specific data and roles related to their security personnel citing security reasons.
UNC Hospitals did share it only has security at its Neurosciences Hospital. At that location, one security officer is at the entrance of the Emergency Department, and others are assigned throughout it. In the last year, UNC created teams to provide extra security and support to its inpatient psych floors and in the Emergency Department.
WakeMed's campus police provide 24/7 coverage and perform regular rounds throughout its hospitals. WakeMed also has a team that reviews safety and security incidents to ensure the hospitals are best protecting patients and staff.
Cape Fear Valley Medical Center also has an officer at the entrance and at least one officer in the four different areas of its center at all times. Since 2019 the center has added more armed officers every year. In the last two years, it has also added more lighting in parking lots, and cameras. The hospital system also now has an app for employees that provides virtual escorts and a panic button.
David McDonald, the president-elect of the North Carolina Emergency Nurses Association (NCENA) said he knows many hospitals are increasing security, and that is a good thing but believes more needs to be done.
"I think there's the secondary factor of prevention that I think we really need to be exploring a lot deeper, and that's looking at a comprehensive workplace violence plan, which is not just the response once an incident happens, but working to prevent those incidents from happening," McDonald said.
He alongside NCENA is pushing for federal lawmakers to pass the Workplace Violence Prevention for Health Care and Social Service Workers Act.
McDonald said right now there is no healthcare-specific guidance, which leads to some hospitals taking an approach to safety that isn't always sufficient.
"So if everyone else is deficient, we can all be deficient. So what this act will do, it will require OSHA to require the hospitals to come up with a comprehensive workplace violence solution to vote resources to fix their specific threats, and charge them to keep the nurses safe. And I think that's super important," McDonald explained.
The bill has been passed by the House but McDonald said regularly fails to make it through the Senate. Many worry that without federal laws requiring some hospitals to step up, these violent attacks will keep happening.
"I don't think any of us would want to stay in a workplace where we think that our safety has been put in jeopardy and that's, unfortunately, the circumstance. A lot of our Emergency Department nurses and their other assistive healthcare personnel are experiencing this on a daily basis," McDonald said.
Rebecca said ER is her passion but she's considering not returning.
"Being in the ER is my passion. I love it. We're busy but it's a comfortable busy, but now it has me questioning, is it even worth it?" she said.
Rebecca believes all hospitals need to take this spike in violence more seriously.
"We take a risk, whether it be the pandemic or people throwing urine on us, or hitting us or whatever and all of this is true. We do this because we want to give back or this is what we love or it's our calling for whatever reason. But the changes are making people more reluctant to come into the field," Rebecca said.
The North Carolina Nurses Association released a survey last month where nearly 80% reported a current shortage at their facility, with 37.5% indicating that the shortage was "severe."
Nearly half of the nurses surveyed said they have personally witnessed violence in the last two years. The increase in violence is a major factor leading to burnout and then shortages across the industry.
"That ratio between patients and nurses, particularly in that waiting area can be quite onerous, and it can really lead to some of these escalating situations where additional staff may have been able to kind of calm that down," McDonald said.
Rebecca said she's seen the cycle of short staffing leading to more agitated incidents, which leads to more outbursts, which then leads to more burn out and the cycle starts over.
"We're flapping. We're just hoping and praying," she said. "So something needs to be addressed or else you're going to we're going to continue to have this shortage."
McDonald said one way to start fixing this is by increasing funding in nursing schools and training.
"Every year we have about overall close to 100,000 nurses that are qualified nursing students that are qualified to go to nursing school, but don't have spots due to it no nursing faculty, no nursing faculty clinical teaching sites, school capacities, and so we turn away 100,000 potential nurses a year from our industry," he said.
NCENA is pushing for Congress to pass the FAAN Act to provide grants for nursing schools across the United States.
While the industry waits for federal assistance, Rebecca hopes local hospital systems continue and increase their commitment to proactively taking action to protect their workers.
"I have to worry about if I'm going home to my family because we have families too. We give up our safety," she said.