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Legacy directs nurses, ED staff to act as security, pat down patients

The new directive, following the recent fatal shooting of a security guard, sparked outrage among staff who say it will endanger them
Following the shooting at Good Samaritan hospital in Portland, pictured here, Legacy Health is directing some nurses and emergency department staff to search incoming patients for weapons when security officers aren’t available. | JAKE THOMAS/THE LUND REPORT
August 17, 2023

For weeks since the fatal shooting of Bobby Smallwood at Legacy Good Samaritan in Portland, and for years before that, nurses and other Legacy Health staff have been urging management to beef up security.

Recently, some of them received a response they hadn’t expected — directing them to take on responsibilities normally conducted by security personnel.

According to internal documents obtained by The Lund Report, Legacy Health is directing some nurses and emergency department staff to search incoming patients for weapons when security officers aren’t available, including patting them down, using metal detector wands, as well as searching bags and belongings. 

It’s unclear how many Legacy workplaces are seeing this change, and Legacy did not respond to questions about its extent. Some Legacy staffers contacted by The Lund Report were not aware of it. 

For those who are, however, the new practice is sparking concern.

“I think it’s outrageous,” Jenni Suarez, emergency room charge nurse at Legacy Mount Hood Medical Center, told The Lund Report. She said she’s “1,000% worried” that having nurses check patients for weapons and other prohibited items will make security worse. 

Gordon Lee Gillespie, professor of nursing at the University of Cincinnati College of Nursing, told The Lund Report that having nurses wand patients is “definitely an abnormal thing to ask a nurse to do.” He said he’s not aware of any hospital or health system requiring nurses to do security screenings as a standard practice. 

“Your role as a nurse is to develop the therapeutic relationship. ... And if you’re the one wanding, you’re not demonstrating concern and compassion, you’re demonstrating what the (patient) might perceive as, ‘you don’t trust me.’”

“Your role as a nurse is to develop the therapeutic relationship,” he said. “And if you’re the one wanding, you’re not demonstrating concern and compassion, you’re demonstrating what the (patient) might perceive as, ‘you don’t trust me.’”

Gillespie said the only exception might be a situation where a patient expresses an intent to harm themself or others. But he said it would still be preferable to have security personnel perform the screening. 

Legacy Health may not be alone in asking nurses to do this. According to the Oregon Nurses Association, Oregon Health & Science University proposed that nurses “pat down and wand patients and visitors.”

The nurses union stated in a blog post dated July 28 that OHSU management made the proposal during contract negotiations. The nurses union rejected the proposal, calling it “inappropriate.” 

An OHSU spokesperson said they were not aware of such a move, saying, “We have not had, nor do we contemplate having, OHSU nurses wand or search patients’ persons.” 

Providence Health & Services, however, issued a statement in response to questions from The Lund Report indicating that the “safety screening is a security department responsibility.”

“While all caregivers are encouraged to say something if they see something, we don’t ask clinicians to screen for weapons in the emergency department,” reads the statement. “Caregivers can request security assistance if needed, and screening wands are available if a nurse determines there is an immediate need.”

Nurses not trained for security functions

Legacy administrators pledged to increase security in the wake of Smallwood’s death. But Suarez said this won’t help.

She said that medical staff don’t have the training or means to protect themselves from patients who become upset after they are found with a weapon. Suarez, who is also the bargaining unit head of the hospital’s recently unionized nurses, said she has pushed back on the requirement. 

One of the documents obtained by The Lund Report includes a flowchart outlining the circumstances of when emergency room staff should search incoming patients for weapons. 

The flowchart, dated Aug. 4, directs emergency department staff to search patients arriving via ambulance if a security officer isn’t present within five minutes. If nurses discover weapons or unsafe items on a patient they are directed to call security. The expected wait time for security is 10 minutes, according to the flowchart. 

Another internal document includes a checklist of steps emergency room staff should take to search patients for weapons. The document instructs emergency department staff to ask patients if they have weapons or sharp objects in their belongings and to inform them that they will search their bags and coats. 

The checklist also includes instructions on how to use a metal detector wand on patients. Staff should keep the wand 1 to 2 inches from a patient, according to the document. Staff should use the wand to follow the body curvature of each patient, paying special attention to their belt line, ankles, pockets and underarms while never placing it in front of their face. 

The document includes instructions on what to do if the metal detector alerts during the search. 

“If a patient can participate, ask them what is in that area that may have triggered the alarm,” reads the document. “If patient alerts to weapon or unsafe item - STOP and notify security.” 

Suarez said the protocol in the checklist puts emergency department staff in potentially dangerous situations if they discover a weapon on a patient and have to wait 10 minutes for a security officer to show up. 

Nationally, nurses have faced an increase in physical violence and verbal abuse from patients and visitors compared to before the pandemic. Research shows that on average 57 nurses are assaulted each day in the U.S. 

Bill Schueler, government affairs chairperson for the Oregon Emergency Nurses Association, told The Lund Report hospitals are trying to find ways to mitigate rising violence. 

He called wanding patients a “sticky issue” and said that research shows that nurses are afraid to even ask patients if they are carrying drugs or weapons. Schueler said he’s not aware of any hospital in Oregon directing medical staff to conduct security searches on patients. 

“It for sure creates angst when you’re asking nurses who are trained to care for patients to act as security,” he said. 

Matt Calzia, nursing practice and professional development director for the Oregon Nurses Association, told The Lund Report that nursing education programs do not cover how to screen patients for weapons or other security measures. 

He said requiring nurses to treat patients as potential threats makes it harder for them to establish therapeutic relationships. The Oregon Nurses Association, the state’s largest nurses union, has criticized hospitals for not doing enough to retain and increase staff. Calzia said that asking nurses to perform security functions is “demoralizing” and another burden for frontline health care workers.  

“It shows the disconnect between the reality of what healthcare workers are going through and executives who are just totally disconnected from that reality,” he said. 

You can reach Jake Thomas at [email protected] or via Twitter @jakethomas2009.