A CDC report that examined traumatic injuries suffered by healthcare workers between 2012 and 2014 turned up a serious problem that many of us are already aware of: nursing staff are more often the target of workplace violence than any other sector of healthcare workers. During the two-year study period, the rates of workplace injuries resulting from violence rose steadily.
Nurses can quickly become patients themselves when patients become violent. Last year, a RWJF report titled Nurses Face Epidemic Levels of Violence at Work chronicled the story of an emergency room nurse who “was assaulted dozens of times during nearly two decades on the job.” Because he was often the only male nurse in the department, he was asked to get involved any time a patient became aggressive, suffering abuse from both patients and family members.
Nurses are the most common targets of workplace violence for several reasons: they are the largest sector of the healthcare workforce, they spend the most time face to face with patients, and they are very likely to be female. Not surprisingly, the emergency department is one of the settings where violence is most likely to erupt. A 2014 study in the Journal of Emergency Nursing found that three out of ten nurses surveyed reported some sort of physical abuse, while three in four had experienced either verbal or physical abuse. Stress factors that may lead to violence in the ER include long wait times and delayed pain medication, as well as a patient population that may be more prone to cognitive problems, substance abuse, or mental illness.
So what’s to be done?
Several states have legislation in place that provides stiffer penalties for assaults on nurses, yet this clearly not enough. The ANA has created a model bill that states can adapt for their own use, with language that requires healthcare facilities to actively create violence prevention programs. The programs must include a written prevention plan that identifies risks that are specific to the facility, as well as methods for mitigating these risks. At the very least, state laws like this ensure that hospitals recognize workplace violence against nurses. Yet, according to the ANA, violence prevention programs should also provide:
- Training for nurses on how to avoid situations that might escalate into violence
- Security guards in key areas, like the emergency department or behavioral health center
- A clear system in place for dealing with aggressive behavior before it turns into violence and for summoning security personnel
- Adequate lighting both inside and outside the facility
- Alerts in the patient record, indicating a previous history of violence or abuse
- Workplace design and staffing procedures that don’t isolate individual nurses with patients
- A systematic procedure for reporting and investigating instances of abuse, and measuring progress in deterring violent encounters
When it comes right down to it, however, nurses are largely dependent on their own de-escalation skills and situational awareness. Consider taking a continuing education course in de-escalating conflict. Always observe patients and visitors for verbal, situational, or body-language clues that indicate violence may be imminent. If you can’t de-escalate, remove yourself from the situation.
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