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In China, Nurses Risk Physical Abuse to Treat to the Sick

Recent years have seen an alarming uptick of "revenge" attacks on Chinese hospital workers, with women experiencing the majority of the violence. We spoke to experts and nurses in China about the scope of the problem and what is being done to address...
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On Boxing Day last year, a Chinese man dragged a nurse out of a hospital at knifepoint. "You gave my son a lethal injection," onlookers heard him say before he pulled the woman into a car. She died hours later of fractures to her skull and spine.

The hospital denied the attack was motivated by revenge, but Chinese newspapers assumed the opposite. In China, reports of angry patients, or their families, attacking medical staff are common. In the past two years, social media-tracking website What's On Weibo estimate Chinese media has reported at least 30 violent medical disputes, while thousands of smaller incidents have gone unacknowledged. Figures from The Chinese Hospital Association show the number of violent attacks on medical staff doubled from 57 to 130 between 2010 and 2013, and not every case makes the official records.

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Nurses make up the majority of the clinical workforce out numbering doctors 10 to 1. And 95.6 percent of nurses are female. "Nurses are the most at-risk group of staff in a hospital," says Dr. Qunhong Wu of the Department of Health Policy and Hospital Management at Harbin Medical University School of Public Health. "Patients deal with nurses most of the time, so once patients are any dissatisfied, they turn to nurses."

Last year, research by Dr. Wu into workplace violence revealed that 80 percent of nurses interviewed experienced abuse, ranging from verbal threats to physical attacks. Nurses told Dr. Wu and her team that many patients regard them as inferior to doctors. "Also, it's easy to attack females," she says.

Nurses are the most at-risk group of staff in a hospital.

Market reforms in the hospital sector have prompted relations between staff and patients to sour in past decades. Hospitals are perceived to charge high prices and deliver poor outcomes, and media reports of doctors cheating patients for personal profit have caused many to lose faith in the system. In this tense atmosphere, nurses can expect to be shouted at, to receive abuse from family members of patients, or even to face a gang of thugs sent by the extended family – a practice known as yinao, or "medical disturbance."

Liu Qing, 23, is an undergraduate student training to be a nurse and works regular shifts at her local hospital. "There are so many cases of verbal abuse that I can't even remember the details," she says. "If anything goes wrong, the patient blames the nurse."

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In the past 12 months, there have been reports of nurses being paralyzed, disfigured, and forced to miscarry due to physical violence. Events have become so bad that last November the government strengthened laws to punish perpetrators.

But even with more legal protection, Dr. Wu fears nothing will change. "Nurses think it is shameful to experience this," she says. "They won't want to make it public. If they are beaten or abused, they think people will assume they are incompetent and it will ruin their career. There isn't a zero tolerance attitude to violence like in other countries."

"In foreign countries, every hospital will refuse to treat you if you attack staff," she notes. "In China, no hospital dares do that."

There are so many cases of verbal abuse that I can't even remember the details.

According to Wu, just 15 percent of the nurses her team spoke to reported incidences of workplace violence. "It is useless to [report abuse]. Violence and abuse are very common in hospitals and people have got used to it," she says. "Nurses see themselves as unlucky and try to be more careful." And, even if they go to the police, staff have little confidence the authorities will support them, she explains.

A 25-year-old nurse from Nanjing describes a typical story of police intervention: "One of our nurses was attacked while on night shift in the emergency department. A drunk hit her. Her husband saw the attack and intervened. After a few minutes, five men came and brutally attacked him.

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"We thought the police would punish them, but they were seen accepting cigarettes from the gang. They agreed to let them go if they paid the medical fee. The nurse's husband stayed in hospital for three months. He still can't do things properly."

Such flaws in the justice system lead the public to take the law into their own hands. Dr. Shiyan Ren is a cardiovascular surgeon at The China-Japan Friendship Hospital in Beijing. Eighteen months ago, he says, the hospital's executive team hired guards to protect staff.

"In the ER, abuse is very common. We had two or three serious cases," he tells Broadly. "One time, the patients' relatives hired people to make turmoil. They made a tape of abusive words and played at top volume every day in the waiting room."

It is useless to [report abuse]. Violence and abuse are very common in hospitals and people have got used to it.

The aim of these yinao gangs is to force hospital management to offer financial compensation to patients who perceive that they were somehow wronged. "You can't negotiate with these mobs. They are cruel enough to kill you. If yinao happens to me, then I'll run. I won't give up my life for my job," says Liu Qing.

In 2014, Dr. Ren co-authored a paper called "Stop violence against medical workers in China." In the future, people will avoid the medical profession because it's "too dangerous," he says.

"At least some of my classmates were afraid of yinao and decided to change their occupation," says the nurse from Nanjing.

There are now concerted efforts to improve conditions for medical workers in China, with doctors strongly recommending better conditions for patients to prevent outbreaks of violence. However, there remains a central belief that the actions of staff are also to blame: Nurses need to pay more attention to their own provocative behavior and become more adept at identifying potential threats, says Dr. Wu. "There are problems with nurses' attitudes. They are impatient. They don't listen. If you talk to people patiently, then they will understand you," she says.

Liu Qing agrees that her attitude is all-important to avoiding abuse at work: "I am always nice to patients. Once, when a patient shouted at me and complained, my colleagues know my temper and so didn't think I did anything wrong. The problem was solved."

But while being nice patients is a laudable aim, it's hardly the solution to a systemic problem of workplace violence against women.

Additional reporting by Lirong Li.