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What started out as a routine assessment became a life or death situation for Elise Wilson, an emergency room nurse with over 36 years of experience. Her seemingly unaggressive patient quickly became violent as he punched her and yielded a knife, stabbing her 11 times. This left her fighting for her life, needing to be resuscitated and airlifted to a higher level trauma center. More than a year later, Elise is still recovering and has not yet been able to return to work due to the extent of her injuries. “If this could catch me off guard with 36 years of emergency room experience, it could happen anywhere anytime to anyone.” -Elise Wilson, 2018.
Recently, violence against nurses has been shown in the media at alarming rates; however, this issue is not uncommon. According to OSHA, the incidence of serious workplace violence is, on average, four times more common in healthcare settings than private industry. In fact, according to US National Library of Medicine: National Institutes of Health, workplace violence against healthcare staff is underreported. This is especially concerning due to the rising prevalence of incidents that are reported. Nurses and healthcare staff need to be prepared at all times. We are fully trained and prepared for disasters and emergencies when it comes to our patients health, but are we prepared to save and protect our own lives from harm? Implementing standardized violence prevention training for all staff in the workplace and retaining competence with annual refresher courses would improve satisfaction and safety for patients as well as staff.
How it works
Goal two of the National Patient Safety Goals (2018) is most relevant to our topic: improve the effectiveness of communication among caregivers. Implementing standardized workplace violence training leads to a safer work environment and higher employee satisfaction, improved patient outcomes and decreased loss of revenue. In an ANA Health Risk Appraisal survey, of 3,764 RN’s and SN’s, 21% have been physically assaulted and over 50% verbally assaulted in a 12-month period. Another survey done by the Emergency Nurses Association claims that in 7,169 nurses surveyed, 12% were physically assaulted and 59% verbally abused in a 7-day period. An example from OSHA’s website concludes, “healthcare and social assistance sector has 7.8 cases of workplace violence per 10,000 employees compared to 2 per 10,000 in the construction, manufacturing and retail sectors.” It is evident that something must change to decrease injuries toward healthcare staff.
There are a multitude of factors to consider when determining how to change these statistics. There must be consideration of de-escalation tactics, safety policies in place, psychiatry, access to guns/weapons, our culture, etc. Therefore, when we are looking at a resolution for this problem, we must take into consideration, “it is a very complex and multi-faceted issue, (which) affirms that there is no easy answer or single strategy for its prevention,” according to the National Institute for Occupational Safety and Health, 2016. QSEN goals include safety, teamwork, collaboration and communications; these are all areas in which interventions to reduce workplace violence can be implemented.
According to Managing Workplace Violence With Evidence-Based Interventions: A Literature Review, several precautions to prevent workplace violence include: understanding that all patients have the ability to cause harm to health care workers, being observant of the environment to minimize the risk of injury, keeping a safe distance away from patients that are agitated, and learning de-escalation techniques to reduce the risk of harm to others. Additional interventions include: boards identifying high risk behavior, standardized team meeting to make others aware of violent behavior, and performing appropriate reviews of incidents that have already occured.
Expected outcomes of proper training are: incorporate workplace violence training into completion of orientation upon hiring for new staff members and increase reporting of incidents. If more episodes of violence were reported, risk management could develop new methods of prevention to improve the safety of all. In collaboration with the Center for Disease Control and The National Institute for Occupational Safety and Health, a free course has been developed in which healthcare workers can become self-aware of what defines workplace violence, what places people at greater risk, and teaches prevention strategies. Participants in a study by the NIOSH suggest implementing workplace violence training in nursing school programs so new nurses are more prepared to face these challenges as they transition from student to nurse.
The most common reasons for failing to report workplace violence include: the perception that violence is part of the job when it comes to the healthcare industry, a lack of proper training or policies/supportive measures by management, and a long process to finalize a report. In addition, the perception that it happens so frequently, it would be too time consuming to report every incident and management will not handle the complaint seriously. There is a fear of blame being placed on the victim and a belief that patients will not be held accountable.
The most common type of workplace violence in the healthcare setting is called client-on-worker violence. This includes patients, family members or visitors. Next is criminal intent. This is when the person is not involved in the business or employees and is usually committing a crime along with the violence, such as robbery, trespassing, and assault. Worker-on-worker violence is also known as horizontal or lateral violence. This occurs when the nurse bullying or “nurses eat their young” mentality we have all heard about. Lastly, there is personal relationship or domestic violence. This is violence from home that “spills over” into one’s workplace. Our goal in introducing this topic to nurses is to inform them of the need to partake in violence prevention training, and to become familiar with ways in which this training is implemented in the workplace. There is no standardized violence training for healthcare workers that is recognized nationally; however, OSHA and the ANA have recommendations for organizations to follow to reduce injuries related to workplace incidents.
We will introduce a course distributed by the CDC specifically for nurses titled “Workplace Violence Prevention for Nurses.” This is an online, self taught if preferred, course including case studies to bring situations to life. Along with the introduction of this course, we will address audience questions about the information. We are also going to perform an active demonstration sharing several techniques based on the Crisis Intervention Training program, currently implemented in local hospitals around Dane County. All of these topics will be shared via powerpoint presentation and a quiz to solidify the knowledge of the information gathered. At the end of our presentation, our audience should be able to: define workplace violence, understand why underreporting happens, acknowledge risk factors for violence, understand prevention strategies, and have the opportunity to demonstrate two simulation techniques to use when faced with violence or aggression.
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