A Path Forward

The murder of home care nurse Joyce Grayson in October 2023 put a spotlight on the crisis of workplace violence for health professionals in Connecticut—a growing problem that union activists have been sounding the alarm about for decades. In the wake of this tragedy, healthcare workers and legislators came together to pass landmark workplace violence protections. To learn more about the problem of workplace violence and what this new law means for healthcare professionals in Connecticut, we spoke with Sherri Dayton, AFT Connecticut divisional vice president for healthcare and president of the Backus Federation of Nurses, AFT Local 5149, and Martha Marx, former president of the Visiting Nurse Association of Southeastern Connecticut, AFT Local 5119, and state senator for Connecticut’s 20th district.

–EDITORS

EDITORS: What brought you into nursing, and how have your work and your activism shifted over the years?

SHERRI DAYTON: I was in and out of the hospital for the first couple of years of my life, and I had such kind healthcare professionals and nurses taking care of me. When my preschool teacher asked me what I wanted to be when I grew up, I immediately knew the answer: I wanted to be a nurse.

I started as a certified nursing assistant; after working as a home health aide, I became a patient care technician. In 2006, I got my associate degree as a nurse. Eventually I got my BSN online, and last year I finished a master’s degree so I can work as an advanced practice registered nurse. I practice at a primary care facility now, but I’ve stayed on with the Backus Federation of Nurses as a retiree so I can continue as president and train the next generation.

Over my career, I’ve seen terrible changes in healthcare, mostly related to the increasing pressure healthcare corporations put on health professionals to care for more patients with fewer resources. We’re chronically understaffed, and we have more patients as baby boomers age but fewer places to put them because healthcare organizations continue to close “unprofitable” departments and facilities. We’re already seeing people on their worst days, and longer wait times and stressful conditions for both patients and healthcare professionals push tensions higher and higher—and eventually people crack. That’s how we got to where we are today, with jaw-dropping rates of workplace violence for healthcare workers.¹

MARTHA MARX: I’ve been a nurse for almost 40 years. My mother died when I was a senior in high school, after a long sickness. I did a lot of her caregiving, and it made me feel good to be able to help. That’s why I went into nursing, and if I had to do it all over again, I would make the same choice. I just love what I do.

After I got my BSN, I started in pediatric oncology, and then hospice care. I transitioned to contract-based home healthcare in 1998 because my kids were school age and I wanted as much flexibility as possible. I joined the union, the Visiting Nurse Association of Southeastern Connecticut, as soon as I could. A few months later, when there was an opening, I agreed to run for president.

I loved being union president, but working in home care is what eventually pushed me into politics. I saw how health policies weren’t working for patients or workers, and I wanted to fix it. For example, the state wants to keep elderly people out of nursing homes because it’s cheaper, but we’re doing it on the backs of homemakers and companions—mostly women of color—who are providing in-home nonmedical care for next to nothing.

I first ran for City Council in 2015, and I won. Since then, I’ve lost a lot of elections—including council reelection and state Senate twice—but I didn’t let those losses stop me. In 2021, I won my council seat back, and in 2022, I won my Senate seat.

EDITORS: Workplace violence is on the rise. What have you seen and experienced?

MARTHA: I’ve been talking about workplace violence for 20 years as a home care nurse and as a union president. The norms of care are so different for us—we’re working with patients in their homes, and we don’t have any control over our environment. We’ve requested escorts when we didn’t feel safe, but mostly we haven’t been taken seriously.

The dangers we face became headline news in October 2023, when nurse Joyce Grayson was murdered while doing a medication admin visit.² That tragedy brought a lot of attention to the crisis and promises of better protection, but little actually changed at work in the aftermath.

In December 2023, I was sent to visit a man who was recovering from surgery. I knew he had a history of opioid use disorder and had been on methadone, and I saw a crack pipe underneath his nightstand. That doesn’t automatically mean he’s dangerous—but changing his bandage was taking a long time, and I could tell that he was escalating, so I finished as quickly as I could. At the office, when I opened his medical record to get his prescriptions refilled, I saw that not even a month before his recent surgery, he’d had to be medically restrained in the emergency department (ED) because he had bitten the security guard and threatened to come back and shoot everyone. And there I had been, alone with him in his house, sitting on his bed.

Management was supposed to be doing safety assessments. Why didn’t they check his history? They apologized profusely, and since then they’ve sent two people together to that patient. But a few months later, they sent me to another patient who should have been flagged but wasn’t. When I asked about it, management blamed their faulty internet. I don’t see a lot of patients when the Senate is in session, but that’s two times in five months that management has made it clear that my safety isn’t their priority.

My colleagues all have similar or worse stories. One home health aide, a Dominican woman, had an angry patient tell her that he was going to put her in a barrel and ship her down a river back to the country she came from. When she reported it, management said, “We called him and he says he really likes you, so you should keep seeing him.”

SHERRI: We all have these stories. I’ve been hit, kicked, spit at, threatened, pushed, had bodily fluids thrown at me. I’ve had my life threatened. I’ve been sexually harassed and touched inappropriately.

As a coworker, and as a union president, I’ve also witnessed many horrific things. I’ve seen patients come in with guns, knives, or drug paraphernalia that can cause injuries, like needles or glass pipes. I’ve seen security guards get their hair pulled out and nurses get punched in the face. I’ve had members get concussions that cause horrible migraines for months, and others who got flipped by patients and had to have shoulder surgery. The physical injuries eventually heal. But worse is people who acquire posttraumatic stress disorder (PTSD) after being assaulted and are never able to return to a profession they loved. Prior to COVID-19, almost 21 percent of nurses met the diagnostic criteria for PTSD.³ I’m sure that number is higher now.

Violence drives people out of the profession in multiple ways, and we already have high turnover rates. In all my years, I’ve never seen so many nurses fresh out of nursing school leave not just a job but the profession in the first five years. They put in all the hard work to earn an RN but walk away because it’s not worth it. They get less stressful jobs waiting tables or in retail. I know one nurse who became a truck driver.

EDITORS: How have you tried to address the issue over the years?

SHERRI: The existing workplace violence law in Connecticut requires each hospital to have a committee that meets regularly. In my hospital, it’s a subcommittee of the safety committee. We were doing sweeps where we’d visit different floors and talk to the staff. We also reviewed instances of violence to find trends and do root-cause analysis. That all stopped when COVID-19 hit, and we’ve never gotten back to the same place. It took nine months to resume meetings, and it took another nine months to have the incidents reported out again. Then the hospital tried to revert those meetings to general safety committee meetings, where they deal with patient falls and needle sticks, but we successfully fought that too.

We have made progress in other areas. We have a gunpowder-sniffing dog that rounds occasionally. And the ED has a place to unload guns safely and a locked safe on the premises, as well as shields to protect nurses from being spit on. We’re in negotiations and trying to get contract language on metal detectors, like some other AFT Connecticut locals have, but so far the hospital claims they are too expensive.

As far as federal legislation, US Rep. Joe Courtney has been trying to pass a bill that would require the Occupational Safety and Health Administration (OSHA) to develop a workplace violence standard,⁴ and we’ll keep fighting for that. One of the biggest barriers to our efforts is that we aren’t collecting enough information. Hospitals have only been required to report the OSHA 300 logs (i.e., if someone is hurt enough to miss work or require medical care beyond first aid). But I can’t tell you how many times nurses are hit, punched, bitten, or threatened—and none of that has to be reported. We’re missing a huge piece of the picture.

MARTHA: We get a lot of pressure to not complain. We know we have to protect ourselves and each other because management won’t do it. When we have a home visit in a situation that feels unsafe, we ask a friend to call in 10 minutes and dial 911 if we don’t answer. We know if we tell management, they’ll just give that case to another nurse without telling them the first nurse felt uncomfortable. Or they’ll assign it to a male nurse. But why should he be put in an unsafe situation? When younger nurses get hit on by patients who start stalking them on Facebook, management tells them to set better boundaries or passes the patient on to another nurse. So after we complain, we’re both angry at management and afraid for that other nurse—it feels like we’ve set them up to be assaulted. And management is gaslighting us, making us feel like if we can’t deal with it, we’re not good home care nurses. We’re stuck: we want to provide all our patients with care and also care for each other.

Compounding the problem, one “fix” collapsed. Before my agency was part of Yale New Haven Health, we had a meeting with the police department, which then assigned us retired police officers as escorts. That made us feel a lot safer—but then one of the officers was arrested for dealing drugs. That tanked the escort system, and we haven’t had one since.

EDITORS: You won significant workplace violence legislation this year. How did you organize for this victory, and how will this legislation help keep healthcare workers safe?

MARTHA: After Joyce was murdered, I called the Senate chair of the public health committee and the president of the Democratic caucus and told them we needed to hold a press conference. This tragedy exposed how little protection home care workers get. You don’t want to go into someone’s home fearful or making assumptions—but nurses’ concerns about safety must be respected. That press conference brought much-needed scrutiny to the lack of safety practices.

The Senate Democrats made the health and safety omnibus bill, SB 1,⁵ the top priority, and the bill—now law—starts with the safety of home care workers. That includes nurses like me, as well as in-home companions and homemakers. I don’t know whether that would have happened without a home care nurse in the Senate—and as vice chair of the public health committee—to speak knowledgeably to these issues and champion this cause. Senator Saud Anwar (the public health committee chair) consulted me throughout, and I read the bill often to make sure that the home care and hospital associations weren’t watering it down.

One major provision I worked on requires intake nurses to collect more thorough information about patients and conduct a safety assessment. They have to check judicial and sex offender records and verify whether a patient has any history of violence toward healthcare workers, substance abuse, or domestic violence. They also have to get a list of the patient’s diagnoses and determine whether those diagnoses (e.g., diabetes or a psychiatric diagnosis) have remained stable, what services will be provided, where in the home we can provide private care, and whether there are weapons or other safety concerns in the home. No services will be denied because of the answers to these questions, but any worker assigned to those clients can access the information and decide whether they want to request an escort.

The law also requires that home care agencies perform monthly safety assessments with the workers who are providing direct care and develop and implement home care health and safety training curriculum in order to receive Medicaid reimbursements. The agencies must report verbal threats and abuse to the state public health department as well as physical or sexual abuse, and they must take steps to protect home care workers in response. That reporting is only required annually, which isn’t enough, but any mandated reporting at all is a huge change for us.

Finally, the law establishes a working group to continue studying and developing additional solutions to the safety issues home care workers face. The group must include at least three representatives from home care agencies, including a direct care worker, and representatives from relevant unions and nurse associations.

SHERRI: We paid attention to the promises legislators made at vigils for Joyce in October, and we held them to those promises. We did a lot of organizing, lobbying, letter writing, and calling, and we held meetings at the state house. Because of the horrific situation, there wasn’t much pushback. Even with healthcare organizations, home healthcare companies, and the hospital association, we got much less resistance than usual. They knew we had the public on our side.

The provision relevant to hospitals is short but powerful because it requires healthcare organizations to comply with Joint Commission (JCO) standards for workplace violence⁶ or be subject to state audit. JCO establishes a definition for workplace violence that includes threats, intimidation, and bullying along with physical injuries. That’s a huge shift in how we can push hospitals to think about—and act on—incidents of workplace violence.

The first JCO standard says hospitals must conduct an annual analysis of their workplace violence prevention program and act on the results. In my hospital, that means we now have a legal means to make management resume our pre-COVID-19 practice. The standards also broaden what hospitals must monitor, report, and investigate to include injuries that occur in the hospital, occupational illnesses, property damage, safety and security incidents, and more. Healthcare workers are often discouraged from calling the police or pressing charges because we’re told there’s no point. But the JCO standards support that these incidents need to be reported. At the very least, those data will help us pass additional legislation. In addition, the standards require hospitals to provide regular training, education, and resources to staff. Right now, only ED and psychiatric staff get training, but workplace violence happens in every department.

The bill doesn’t fix the whole problem, but it gives us a path forward. It’s terrible that the catalyst was someone dying. Joyce’s son is a critical care nurse at Backus Hospital, and we’re determined to keep this from happening again.

EDITORS: What advice can you offer other AFT affiliates fighting for similar legislation in their own states?

MARTHA: It’s essential to understand the process of how a bill becomes a law and how to advocate effectively. You have to go to your state legislators and tell them what’s happening in your workplace. It’s also important to know how your state government works so you know where to focus your energies. We went through the public health committee, but in another state the labor committee might make more sense. You also need to find the politicians who will be your champions—and then make sure you support them when they need it because running for office isn’t easy.

Also, know before you start that you might need to take baby steps. You have to run a slow, steady race with anything in government. Take our sick leave fight, for instance. The hardworking people who provide in-home nonmedical care were carved out of Connecticut’s 2011 sick leave law because of their federal job classification as “maids.” I’m so proud that we passed a bill this year expanding paid sick leave so now everyone is covered. That only happened because advocates were persistent. Your legislators talk to lots of people every day, so you need to remind them often that you’re paying attention. Believe me, the persistent advocates are the people who get what they want.

SHERRI: Be prepared for a lot of work. One of the basic things that we’ve done is get pro-union people—like Martha—into the state Senate and General Assembly. I’d like to say there was an easier way, but it’s grassroots. You have to get people who share your values to actually run—and then you have to turn out the vote for them.

It’s also important that people tell their stories. I can go to the state house as a union leader and talk to someone, and they can write it off as the union just making noise. But if Joyce’s son talks to the press about his mother being murdered, it’s a whole different conversation. I know it’s hard to tell those stories and relive those terrible experiences. But it’s so important to tell them if you can, so the next person doesn’t have a story to tell. The more people speak up, the more legislators have to acknowledge how widespread the problem is.

And, as much as we appreciate this victory, we know it’s just one step—not a solution. We need to ensure strong implementation, including workplace violence committees, evidence-based training, and collecting real-time data.

Our union hopes to have a training program in place at Backus in no more than a year. We’re also putting workplace violence language into our bargaining proposals, and we’re willing to stand on the line if we need to in order to get that language into our contract. We have a lot of work ahead of us, from the local level to the state level. We know this is a great victory, and we’re going to celebrate it, but then we’ll be right back at it.

Endnotes

1. C. Jones, Z. Sousane, and S. Mossburg, “Addressing Workplace Violence and Creating a Safer Workplace,” PSNet, Agency for Healthcare Research and Quality, US Department of Health and Human Services, October 31, 2023, psnet.ahrq.gov/perspective/addressing-workplace-violence-and-creating-safer-workplace.

2. D. Collins, “A Convicted Rapist Is Charged with Murder in the Killing of a Connecticut Visiting Nurse,” AP News, April 19, 2024, apnews.com/article/connecticut-visiting-nurse-killed-arrest-b8750187c3d09c86eaaa8a74c5bfe189.

3. M. Schuster and P. Dwyer, “Post-Traumatic Stress Disorder in Nurses: An Integrative Review,” Journal of Clinical Nursing 29, no. 15–16 (August 2020): 2769–87.

4. Office of Congressman Joe Courtney, “Workplace Violence Prevention for Healthcare and Social Service Workers Act,” courtney.house.gov/issues/workplace-violence-prevention-healthcare-and-social-service-workers-act.

5. An Act Concerning the Health and Safety of Connecticut Residents, Substitute Senate Bill No. 1, Public Act No. 24-19, cga.ct.gov/2024/ACT/PA/PDF/2024PA-00019-R00SB-00001-PA.PDF.

6. Joint Commission, “R³ Report: Requirement, Rationale, Reference,” Issue 30, June 18, 2021, https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3-30_revised_06302021.pdf.

[Photos, from top: courtesy of Connecticut Senate Democrats and Backus Federation of Nurses; courtesy of Backus Federation of Teachers; Screengrab / CT-N via CT News Junkie; and courtesy of Backus Federation of Teachers]