It has been a little over a year since cardiologist Dr. Michael J. Davidson, 44, was shot and killed at Brigham and Women's Hospital in Boston. He was murdered during the day by the son of a patient he treated who had died a few months prior to the shooting. I remember that day well. I was working in my clinic and all of us wondered, “How could this happen? And could it happen in our clinic?” I like to think that all of our patients and families are thankful and appreciative for all we do for them, but unfortunately that isn't always the case.

Patients and families all process situations differently. On occasion, the caregivers, nurses, and doctors can become the object of their anger. This certainly seems to be the exception, but for those that are unable to effectively move through the grieving process, or for those that have an unmanaged mental illness, it can be very difficult to process emotions effectively. If you have been a nurse long enough, you have encountered these individuals. It may be an enraged family member present during an office visit with a patient. It may be an angry patient in the treatment room acting inappropriately. It may be a threatening family member coming into the clinic after the patient has died.

In the outpatient setting, our clinic is a stand-alone building in a rural setting. We do not have on-site security. It is the company’s responsibility to make sure our patients and staff are in a safe environment.  We control the flow of people through the building by having doors that open in certain directions preventing people from having access to certain areas. We have locked areas that can only be entered using a security badge. The back of our building has a security camera and is accessed only through a security badge system or by being “buzzed” in. We have emergency pull cords in exam rooms and in all bathrooms. When one of the cords is pulled, an alarm sounds at one of the nurses stations. In the offices that are more isolated and in the infusion room, we have what we call “panic buttons” that when pushed our security company is alerted, which then notifies the police. Is all of that enough? I am unsure. Thankfully, when threatening events have arisen, our staff has been able to effectively defuse the situation. However, if someone were to walk in with a gun, I am not sure we are prepared enough.

It turns my stomach that this is even a topic of discussion, but unfortunately it needs to be to ensure safety of patients and staff. I want to see the good in people, and I want to believe they all understand that we're doing the best we can for them and their loved ones. But to not be prepared for a possible violent event would be negligent on our part. What are some of the security measures that your institution has in place to ensure safety in the outpatient oncology clinic?