Greenville Community Hospital (GCH) was located in an affluent suburb of a metropolitan area. A large psychiatric hospital was geographically adjacent. In fact, the two hospitals shared facilities, such as a conference center and some office buildings. Thanks to good teamwork between the two, a consistent pattern of admitting patients via the Emergency Department (ED), then to the psychiatric hospital had emerged. Lately, however, an uptick of substance abuse-related ED admissions had created a large backlog in GCH. The patients could not be admitted to the psychiatric hospital because they were short on beds for long-term rehab. Drug rehabilitation facilities in the area were either too expensive (\($24,000\) – \($40,000\) for 28 days), if private pay, or overbooked, if Medicaid supported. In the meantime, the patients had multiple health issues secondary to drug use. The patients were now being placed on a non-secure unit, along with routine medical–surgical patients. On a night lit by a full moon, Rosemary, a floor nurse, went in to take vital signs on a young female patient who had been admitted for a heroin overdose. She found the girl in bed with her boyfriend, having sex. When she told the boy visiting hours were over and he had to leave, he leaped up, screamed obscenities, and chased her out of the room.Rosemary ran for the nursing station and help. Fortunately for her, he was ataxic and uncoordinated due to his own illegal drug ingestion. She made it to the desk and called security just as he collapsed to the floor. Then she called for a rapid response team to revive the boyfriend. She wondered how much longer she could do this job. There was no way to call for help, no safe place or room for staff to hide from aggressive patients. It was only a matter of time before she was injured—or killed.

DISCUSSION QUESTIONS 

1. What are the facts of this case?
2. What are the management implications of this case? What should management be doing to protect their employees?
3. If Rosemary had been injured, who would have been responsible?
What if the visitor attacked another patient? What are the legal and ethical obligations GCH has to its employees and to its patients and how do they apply to this case?
4. What would be the optimum physical space for these patients?
How much do you think it would cost to install a panic alarm in the patients’ rooms? At the nurse’s station? A safe room? What are the costs of doing nothing?
5. Create an emergency plan for the staff in this unit while they await administration’s decision on renovations.