She's also witnessed violence against coworkers. "Once a patient strangled one of our nurses. He grabbed the nurse's shirt and kept twisting."
Another time, she saw a drug-seeking patient hold a knife to a nurse's throat as he demanded narcotics. Papa walked closer, told the man the nurse didn't have the keys to the drug cabinet, but she did. Only if he dropped the knife would she consider helping him. He did and the crisis was averted.
Papa has become a leading voice for this issue, speaking at events internationally and helping format a guideline for hospitals to safeguard their emergency workers.
In 2010, it started to pay off. The Joint Commission published Sentinel Alert #45, Preventing Violence in the Workplace Setting, which called attention to the issue on multiple levels.
Papa's spoken frequently to leaders with the Occupational Safety and Health Administration to help them appreciate the increasing problem of violence in healthcare settings and has helped develop a toolkit for hospital administrators to evaluate the safety of their EDs and trauma centers.
The ENA says hospital leaders can reduce violent incidents if they: