A security officer at a Memphis hospital told me he’d been punched, spit on, and threatened with a knife, all in the same calendar year. He’s been on the job for six years. He weighs 240 pounds and stands six-two. None of that mattered when a patient’s family member swung at him in the ER waiting room on a Saturday night in April.
“People show up scared, angry, high, or all three at once,” he said. “The ER is the front door of the hospital, and everyone walks through it.”
He asked me not to name his employer. I’m honoring that request because the specific hospital doesn’t matter. Every major medical facility in Memphis deals with this. Methodist Le Bonheur Healthcare, Baptist Memorial Health Care, Regional One Health, the VA Medical Center on Jefferson Avenue. They all have security teams managing volatile situations with a mix of training, technology, and quiet endurance that doesn’t make the news often enough.
Healthcare security is a world apart from commercial property patrol or retail loss prevention. The rules are different. The stakes are different. And in Memphis, where violent crime has been climbing for three consecutive years, the pressure on hospital security teams is intense.
The Scale of the Problem
OSHA estimated in 2018 that healthcare workers experience workplace violence at rates four times higher than workers in other industries. That number captures everything from verbal threats to physical assaults. In hospitals specifically, security personnel and nursing staff bear the highest risk.
The International Association for Healthcare Security and Safety surveyed its members in early 2019. Among the findings: 73 percent of hospital security directors reported an increase in violent incidents over the previous two years. The most common settings for violence were emergency departments, psychiatric units, and parking structures.
Memphis mirrors the national pattern with some local intensity layered on top. Shelby County’s violent crime rate pushes certain problems directly into hospital lobbies. Gunshot victims arrive at Regional One’s trauma center on an almost nightly basis during summer months. The people who come with them, friends, family, sometimes rival gang members, create a secondary security challenge that has nothing to do with the patient on the gurney.
A supervisor at one Memphis hospital security department gave me rough numbers. His team of 28 officers responded to over 1,100 incidents in the first eight months of 2019. That includes everything from verbal altercations and trespassing to physical assaults and weapons discoveries. About 15 percent of those incidents involved physical contact with a patient, visitor, or trespasser.
The ER Problem
Emergency rooms are open 24 hours. Anyone can walk in. By design, they don’t turn people away. That openness, which is essential to healthcare’s mission, creates a security environment unlike anything else in the commercial world.
I spent an evening observing ER security operations at a Memphis hospital in August. I won’t describe the specific layout for security reasons, but I can share what I noticed.
The security desk sits about fifteen feet from the entrance. Two officers were posted there during my visit. One handled the metal detector. The other monitored a bank of eight camera feeds. Every person entering the ER walked through the metal detector. Bags went through an X-ray machine similar to what you’d see at a courthouse.
This level of screening is relatively new for Memphis hospitals. Five years ago, most ERs in the city had no metal detection at the entrance. Today, all the major systems have it. The investment was driven by specific incidents. In 2017, a man brought a handgun into a Memphis hospital waiting room. Nobody was shot, but the gun was discovered only when it fell out of his waistband in the restroom. After that, screening protocols accelerated across the city’s health systems.
The metal detector catches weapons. It doesn’t catch intent. The officers at the desk told me their biggest challenge isn’t the person with a pocketknife. It’s the person who’s sober enough to pass screening and angry enough to assault a nurse two hours later when the wait gets long.
Wait times are the accelerant. Memphis ERs routinely see wait times of three to six hours for non-critical patients. A person who arrives at 11 PM with a family member in pain and doesn’t see a doctor until 3 AM has been stewing for four hours. Frustration escalates. Alcohol or drugs in the system make it worse. By the time the security radio crackles, someone has already been shoved or screamed at.
Visitor Management
Hospitals have to balance access and control in ways that commercial properties don’t. A locked-down office building can badge every person through a turnstile. A hospital can’t do that without impeding patient care.
The approach most Memphis hospitals have adopted involves tiered access. Ground-floor public areas like lobbies, cafeterias, and outpatient clinics have minimal restrictions during business hours. Patient floors require check-in at a nursing station or a visitor badge from a front desk. Restricted areas like operating rooms, pharmacies, and neonatal units use electronic access control with proximity cards.
Methodist Le Bonheur’s main campus on Union Avenue has implemented a visitor management system that photographs each visitor, prints a badge with the patient’s room number, and logs entry and exit times. The system checks the visitor’s name against a restricted persons list maintained by the hospital. If there’s a match (a former patient with a trespass order, for example), the system alerts security before the badge prints.
Baptist Memorial on Walnut Grove Road uses a similar approach across its campus. The technology costs between $15,000 and $40,000 per facility depending on the number of entry points and the level of integration with existing security systems.
St. Jude Children’s Research Hospital operates with the strictest access controls of any Memphis medical facility. Given the population they serve, critically ill children, their security posture is understandably elevated. Every visitor is screened, badged, and escorted if they’re outside designated public areas. St. Jude’s security operation is often cited as a model, though other hospitals note that St. Jude has funding levels and a visitor profile that make strict controls more feasible.
Guard Burnout and Retention
Healthcare security officers in Memphis earn between $12 and $18 per hour depending on the facility, experience level, and whether the position is armed. That’s roughly comparable to what commercial security companies pay for patrol work. The job, however, is harder.
Hospital security involves constant contact with people in distress. Guards de-escalate psychiatric patients. They restrain combative individuals with clinical holds that require specific training. They respond to code whites (combative patient), code pinks (infant abduction drills), and code silvers (active threat), any of which can happen without warning during a routine shift.
Turnover in healthcare security runs between 30 and 50 percent annually at Memphis hospitals, according to two security directors I interviewed. That number is slightly above the national average for the healthcare security sector. The reasons aren’t mysterious. Low pay for high-stress work. Irregular hours. Physical risk. And the emotional weight of working in a place where people are suffering and dying.
“I’ve lost two officers this year who went to Amazon warehouses,” one director told me. “They make more money, the work is predictable, and nobody spits on them. I can’t compete with that.”
Recruitment efforts have shifted. Several Memphis hospitals now offer tuition reimbursement, healthcare benefits (which guards at contract security companies often don’t get), and paid training certifications. Some have created career pathways from security officer to security supervisor to emergency management roles. These incentives help, but they don’t eliminate the fundamental challenge: the job is physically and emotionally demanding, and the pay hasn’t kept pace with what the market offers for easier work.
OSHA and Regulatory Pressure
OSHA’s Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, updated in 2016, recommend that healthcare facilities implement written workplace violence prevention programs. The guidelines aren’t mandatory. They’re recommendations. Tennessee has not enacted state legislation requiring hospitals to maintain specific security staffing levels or violence prevention programs.
That regulatory gap frustrates hospital security professionals. Several I spoke with want clearer standards. “We’re making this up as we go,” one supervisor said. “Every hospital does it differently. There’s no minimum standard for ER security staffing in Tennessee. None.”
California passed a healthcare workplace violence prevention law in 2014 requiring hospitals to develop and implement violence prevention plans. Similar legislation has been proposed in other states. Tennessee hasn’t moved in that direction yet, though the Tennessee Hospital Association has discussed voluntary guidelines.
For now, each Memphis hospital sets its own security standards based on internal risk assessments, accreditation requirements from the Joint Commission, and budget constraints. The result is significant variation. Some hospitals run 24-hour armed security with dedicated teams for the ER, psychiatric units, and parking structures. Others rely on a skeleton crew of unarmed officers supplemented by contract guards from companies like Securitas or GardaWorld during high-volume shifts.
What Needs to Change
I’ll take an editorial position here because the reporting demands it.
Memphis hospitals need standardized minimum security staffing ratios. One officer per 50 ER beds during peak hours should be the floor, not the ceiling. The Tennessee General Assembly should study California’s model and consider what a Tennessee version would look like.
Hospital security officers need higher pay. Twelve dollars an hour for a job that involves physical confrontation, emotional trauma, and genuine danger is inadequate. The facilities that pay better retain better. The math isn’t complicated.
Training standards need teeth. De-escalation training, clinical restraint techniques, and active threat response should be mandatory and standardized, not optional and inconsistent. TDCI licenses security guards. The state could add healthcare-specific endorsements to that licensing framework.
None of this will happen quickly. Healthcare budgets are tight. Legislative priorities compete. And the guards who keep Memphis ERs safe will show up for their shifts tonight regardless of whether anyone in Nashville is paying attention.
They deserve better. So do the patients and staff who depend on them.
Amanda Torres is a field reporter for TN Security Review covering community security and industry news across Tennessee.