A year since home health nurse Doug Brant was killed

On the afternoon of Dec. 1, 2022, Doug Brant, my friend and colleague at Providence Visiting Nurses Association (VNA) Home Health in Spokane, was shot and killed by a patient’s grandson during his initial assessment of the patient. The shooting occurred without warning, was unprovoked, and was committed by a man with a known history of mental illness and physical aggression.

As with anyone experiencing grief, I cycled through shock, denial, anger, depression, and guilt — sometimes all in the same day. I made very few home visits that day and the next. I just sat in the office to be with people who understood what I was going through.

Providence VNA brought in a counselor, but I don’t think anyone spent time with him that first day. We just wanted to be with others who understood how we felt. We needed to understand what had happened and why. If we could just understand it, then maybe we could prevent it from happening again.

Unfortunately, no one had answers. I heard a nurse talk about the need to carry a weapon for self-defense. Our policy about firearms in the home was discussed, and just as in society in general, our staff had strong opinions. Some said it wasn’t the gun that killed Doug but a mentally deranged person. Some said that the two cannot be separated. At the time, many said this tragedy was unpreventable, a totally unpredictable act of violence from which Doug could not protect himself.

Reading and listening to the news about Doug’s death, as well as reading comments on social media by people who quickly assigned blame, was very difficult. Mixed in with the sadness was also anger.

A press release from Providence stated that Doug was a “caregiver,” the internal term used for all employees. Unfortunately, news sources in Spokane continued to use this term. The term “caregiver” undermines the profession’s efforts to be respected for more than “the most trusted profession.” For the nurses, this was like throwing salt in our wounds.

In the days and weeks to follow, we nurses were supported at work by our co-workers, our leaders, mental health professionals, and the wider community of fellow healthcare professionals.

The outpouring of expressions of sympathy in the form of cards, flowers, meals, and snacks from the community did provide some solace. We were offered a variety of tangible support from Providence, which was helpful since we all needed something different. We were so grateful for the solidarity and love from other nurses, WSNA, and AFT. WSNA provided us with the opportunity to communally and publicly share our grief, our memories of Doug, and indirectly, what it is like to be a home care nurse.

Providence immediately offered to have someone accompany us on a home visit. I took advantage of this for one specific visit about three days later. Something I read in the medical record of a potential new patient was a trigger, and I was worried. I don’t know how many nurses took advantage of this, but it was a huge relief to me. Before Doug’s passing, I would not have thought twice about it, but my perspective had changed.

Afterward, I seemed to be doing okay, but at the two-week mark, I became very depressed and didn’t leave the house for a week. When I went back to work, I thought I was coping well until I caused a car accident in January while working. Two weeks later, I hit a phone pole while parking because I stepped on the gas instead of the brake. That’s when I knew I was not OK. I took a six-week leave and underwent intensive trauma counseling.

In the year since the horrible act of violence perpetrated in our workplace, Providence has responded thoughtfully and tangibly. We have been offered physical self-defense training, the continued ability to request accompaniment on visits, permission to leave a house at any time, panic alarms, and fanny packs to hold our phone and keys on our person. Most importantly, we have a change in policy regarding screening of patients.

Although our patient consent form has a line about providing a “safe environment” for the staff, and the multiple pages of literature we provide have a line telling the patient that weapons must be secured, this was rarely discussed with the patient before December 2022. The workplace violence prevention training we received did not include in-person physical self-defense. We were not issued “panic buttons.” Training and policies have been in place in the hospital setting for quite some time. How did we go so long without them? We have a strong policy about pets, smoking, and drug use; we have discharged patients who do not adhere to them. Why wasn’t our firearms policy just as strong?

Violence against healthcare workers, especially nurses, has been steadily increasing, according to the Bureau of Labor Statistics and recent data from Press Ganey. Although we do get our fair share of angry patients and family members, actual physical violence is rare at our home health agency. Unfortunately, there is very little data available regarding violence against home health nurses. Due to the isolating nature of the work, home health nurses are very vulnerable. The environment is unpredictable. The only thing we have absolute control over is whether to stay or leave. We travel to neighborhoods with more crime. We travel after dark, especially in the winter, but also when we are on call at night.

Many nurse friends said they would never put up with these working conditions. So why do so many of us choose to stay in this field of nursing? One of the reasons is the personal relationships we build and the sense of accomplishment that comes with knowing that we are enhancing an individual’s quality of life. The reason I work in home health is the same reason I chose the nursing profession, which is the potential to improve a person’s health.

I have experienced no greater joy in nursing than hearing the gratitude of patients and family members who have experienced “aha” moments and achieve better health as a direct result of what they learned. I know I make a difference.

Home health nurses are a tough breed, willing to work in homes with unpleasant odors, filthy floors, unhealthy air quality, ambient temperatures that are uncomfortably hot or cold, insufficient lighting, no surface area to set up a clean work area, and no chair for the nurse to sit on. We often work on the floor or bent over a bed that is too low. We perform procedures that require three hands without any help.

We do all this so that we can provide the same level of compassionate care to everyone, despite their circumstances. For most of us, each encounter is an act of love.

To succeed as a home health nurse, one must have strong assessment skills, including listening, keen clinical decision-making skills, creative problem solving, a willingness to engage in forthright communication, attention to detail, self-confidence, proficient time management, understanding of adult learning principles, motivational interviewing skills, the ability to steer or end a topic of conversation, flexibility, a good sense of humor, lots of patience, empathy, interpersonal skills to develop therapeutic relationships with varying personality types, tact, and diplomacy.

Above all, one needs the belief that every person is worthy of love and respect. We can teach a nurse the technical skills needed for procedures performed in the home, but we cannot teach that.

Doug embodied all those attributes, some of which I didn’t know until after his death. I honor Doug by trying to be more like him. I find myself thinking, “What would Doug do?”

Since that day, a new policy of asking screening questions about violent behavior and firearms has been implemented at our agency before staff members visit the home. Someone from the office calls the patient and asks, “Do you own firearms, and if so, do you agree to secure them during home health visits?” They also ask, “Is there a possibility that anyone with a history or verbal or physical aggression could be present during home health visits?” If we had asked these questions last December, Doug might still be alive.

These questions provide some measure of safety, but we know they are not a guarantee. We go into homes with a healthy sense of faith, whether it be in God or in our common sense of humanity. We also know there is more work to be done.

Before Doug’s death, I could find only one other instance of a home care nurse killed in a patient’s home. The American Journal of Nursing reported that Carrie Lynn Johnson, 39, was just doing her job at her 68-year-old patient’s Detroit home when someone entered, shot and killed them both, and set the house on fire on Jan. 21, 2010. The suspect stole Johnson’s car and fled the scene.

On Oct. 28, 2023, a visiting nurse in Connecticut was killed during a home visit. Joyce Grayson, 63, the mother of six, went into a halfway house for sex offenders in late October to give medication to a man with a violent past. She didn’t make it out alive. Police found her body in the basement and named her patient as the main suspect in her killing.

This latest incident and the one-year anniversary of Doug’s death has brought it all back to the forefront of my mind. I do not let fear rule me, but I will keep advocating for more safety for home health nurses.

If we feel uncomfortable or unsafe, it may be too early to dial 911, since it is not yet an emergency; if the situation escalates, it may be too late to complete a 911 call. I want someone to know where I am and be ready to act if needed (i.e., location services). I want someone to be on standby if trouble arises during a visit (i.e., proactive chaperone). If I find myself in an unsafe situation, I want someone to act without my having to call 911. If I identify a potential risk to my safety and want support and reassurance, I want someone to provide it. I can’t call 911 and say I am nervous.

Organizations and legislators must do more to protect home health nurses. First responders, including law enforcement, firefighters, and paramedics, all have more security than home health nurses. It is time to rethink the security provided to us.