What Do We Owe Health Workers Earning Low Wages Who Are at Risk of Harm?

Abstract

Psychiatric aides and psychiatric technicians are part of direct care workforces in psychiatric inpatient units. They experience high rates of violence, but, compared to other members of treatment teamsincluding physicians, nurses, and social workers-they receive low wages. This commentary on a case considers the nature and scope of the ethical obligations of clinicians of higher social status (eg, physicians and nurses) and organizations to workers whose safety is at risk for little compensation. CaseAfter high school graduation, HH hopes someday to go to college and become a health professional. For now, HH takes care of their mother, as they have for the last 3 years, and takes a 40-hour course to become a psychiatric aide. HH now works full time in an inpatient psychiatry unit, earning just above minimum wage during an overnight 8-hour shift in which they monitor a patient, who is involuntarily committed.HH's patient is ZZ, who is 58 years old and has a history of bipolar I disorder. ZZ's symptoms were well controlled with risperidone and lamotrigine until a right rotator cuff repair surgery 5 days ago. Since then, ZZ has been demonstrating acute psychosis and hyperverbalism (inability to stop talking). Dr P's and nurses' efforts to redirect, interrupt, or calm ZZ have not succeeded, and ZZ's agitation has now increased to aggression toward anyone who tries to administer medication.None of the psychiatric aides wants to monitor ZZ, whose hyperverbalism is exhausting and whose aggression, when not well controlled, is unpredictable and generally feared. HH is assigned to monitor ZZ for the third night in a row. Last night was particularly stressful, as ZZ asked HH to help her use the bathroom and then pressed HH to a wall before others intervened.In the morning, during rounds, ZZ points to a bruise on her right shoulder and shouts, "That dyke man-handled me!" Dr P, the lead psychiatrist, asks HH about the incident. Dr P looks to HH and says, "Don't worry, we know nothing happened."