Interview with Brad Rathke at Virginia Mason

In July, Rathke, a nurse on the med-surg unit, was stabbed in the face with a butter knife. The patient was upset that he needed to stay at the hospital another night. Rathke thought it might be a good idea to get him a “sitter,” or a staffer who could sit in the patient’s doorway and make sure he didn’t harm himself or others, he said.

No one was available. A half hour later, the patient called Rathke back into his room, asking him to examine his lower back. When Rathke bent down to take a look, the patient took the knife from under his hospital gown and stuck him in the jaw.

After the incident, Rathke became a reluctant voice for workplace violence. Then, he leaned into his new role.

We asked Rathke a few questions about himself and his experience with workplace violence.

Where did you grow up?

Sandy, Oregon, an hour east of Portland. I have been in Seattle since I was 18.

Tell us about your education.

I received a bachelor’s degree in psychology from Seattle Pacific University in 2012, an associate degree in nursing from Seattle Central in 2018, and a bachelor of science in nursing from Western Governors University in 2020 (while working at Virginia Mason).

When you were young, what did you want to be?

When I was young, nursing was the last thing on my radar. My grandma and mom were both nurses, and I had three aunts who were in nursing. Nursing was too familiar for me in high school.

I originally went to college to study music recording. But as soon as I got into a recording studio, I knew I didn’t want to spend time behind a computer.

After college, I became a bartender and did high school tutoring and social work. I liked working on my feet and with people, and I wanted to do something that would help my community more. That’s when the idea of nursing slapped me in the face. I decided to become a nurse.

How did bartending help you with being a nurse?

Bartending was very relevant. For one, when I was still in my early 20s going to school, bartending was a good way to break out of my shell, talk to people from all different backgrounds and ages, and build social skills.

I learned de-escalation because I had to keep people from starting arguments with each other and escalating into violent behavior. I did this by treating people with respect and keeping things from getting worse.

Did you ever have a violent incident of bartending?

I never did, although people would yell and scream.

As a nurse, did you ever expect workplace violence to be part of the job?

Absolutely not. My mom was a GI nurse and worked in procedures. The patients were sedated and in recovery. My grandma worked in a rural clinic. Neither talked about WPV (workplace violence.)

What kind of experience have you had at the hospital with agitated patients?

Before the pandemic, folks would come in and have dementia and flail arms but not commit an intentional act of violence. We had folks that would make threats, and a few angry folks would raise their voices.

Back then, we were admitting people with IV drug-use infections. Heroin was more popular than fentanyl, and people would be in hospital for weeks and didn’t want to be there. People were getting agitated on a more frequent basis. But I didn’t have anyone trying to hurt me.

Now that fentanyl has taken over, patients get Narcan and go home. I would expect the workplace to be safer. But recently, I have heard of more WPV issues than before.

How did the July incident affect you?

In the moment when it happened, my heart was pumping four to five hours later. I didn’t know if he was trying to murder me or what. I felt like I could have lost an eye. I went to the ER and asked my supervisor if someone could replace me. I had a cut on my face, but there was no one to replace me. I didn’t want to leave my colleagues, so I went back to work.

Did you get any closure?

Before I left, and before I filed a police report, I talked to the guy. I went back into his room, and he was in restraints. I said, “Hey, do you remember what happened last night?” He said, “Someone got stabbed with a butter knife.” I said, “Yeah, you stabbed me with a butter knife.” He said, “I’m sorry that happened.”

There was one thing that bothered me. He was trying to avoid culpability. He said, “Maybe we can talk more on a level playing field.”

I said, “I’m talking to you now, because this is the last time I will ever see you again.”

Why do you think it happened?

I had taken care of him a few days prior. The night that it happened, his wife called me in because he was becoming confused and trying to follow her home. We were both trying to convince him to stay another night.

How did it feel to tell your story?

It’s a little strange to be a spokesperson for WPV. I was not expecting that. But something happens to you in the moment. When you are a victim of violence, you have a responsibility to share what happened so it doesn’t happen again. It’s not something I asked for.

What effect did it have on other nurses?

Many people since then have come up and said they heard about it on the news or on social media.

Do you feel your power as a nurse?

No. When short-staffed, I feel more powerless. I have a skill that I can give. But I’m oftentimes not able to work at a standard that is appropriate for more patients. Sometimes, I feel powerless when I go into work, because I’m not given the opportunity to do my job the best I can with short staff.

What would you tell people considering nursing?

If someone is motivated and wants to take on responsibility, then yes do it. However, there are a lot of misconceptions. Some people are going to be grateful that you are caring for them. But you deal with some pretty wild scenarios and people resisting your care. It takes more courage than you’d expect.

I feel like a lot of nurses have been waiting for things to change since the pandemic. In the first year or second year after pandemic, nurses were holding out. Now, there are extreme staffing shortages. Each year, we are wondering when are things going to change? At this point, the union contract is one of the last hopes.

Note: This interview was done while nurses at Virginia Mason were in tough negotiations with management, not knowing where things would end up.