Reducing Workplace Violence for Nurses
By Matt Phillion
The statistics establish a challenging truth. According to the Emergency Nurses Association, seven out of 10 emergency room nurses report being kicked or hit on the job, and one in four nurses in general report having experienced workplace violence involving a patient—and that such violence is underreported.
What steps can hospitals and other healthcare organizations take to reduce the risk their nurses face every day and create a happier, healthier, safer environment for their staff?
In her new eBook On Workplace Violence Against Nurses, Rhonda Collins, DNP, RN, FAAN, and chief nursing officer with Kontakt.io, examines how leaders and hospital executives can take action right now and moving forward to prevent workplace violence.
“I think we have small pockets where people have made great strides, but great change happens when events facilitate it. People don’t respond to this topic unless they’ve had a problem,” says Collins.
That hard conversation is becoming more and more common, Collins notes.
“I was at a recent conference, speaking with an influential leader in nursing, who brought up that it’s the only thing people are talking about,” she says. “If you listen to where nurses talk online, social media and chatrooms, you see the conversation happening.”
These frank discussions also highlight some of the issues nurses face when trying to address workplace violence.
“Just this weekend I saw someone saying nursing is the only job that allows your employees to be assaulted and then normalizes it. And other nurses responded: just wait until management asks you what you could have done to prevent it,” says Collins.
Conversations like these are why the industry needs a cultural shift, Collins adds.
“We have a culture of shame around it. It’s uncomfortable and people get nervous talking about it,” she says. “Traditionally in nursing, the belief is this is your patient and you’re here to take care of your patient. You can’t react to how they’re responding, even if you’re being kicked or bit…This has to stop—and I think we’re making some enormous strides in this.”
The Joint Commission, for example, has updated its reporting requirements to increase transparency on workplace violence toward nurses. The risk to nurses is truly unique, Collins explains.
“[In] what other scenario can you be kicked or punched and then need to talk about how you could have responded? Usually, people are arrested for assaulting someone,” she says. “I believe we’re at a time in society where there has to be a social contract with the patient back to the people who care for them. We need to stop the escalation.”
How to lessen the risk
Healthcare is not a discipline that leads from the front when it comes to culture and tech adoption, Collins notes. Organizations tend to proceed cautiously and avoid risk for good reason. But this is not the time to shy away from change, she explains.
“Usually, the industry likes to see what other people are doing, but I do think what we’re getting right is putting this topic at the forefront of the conversation—organizations are not backing away from it—and developing toolkits to help set up processes and policies to help drive behavior,” says Collins.
Looking at those earlier stats—that a quarter of nurses report being the victim of assault, and that two nurses are assaulted every day—we also know those reported numbers are low.
“OSHA says they estimate that at least 80% of violent incidents are unreported,” says Collins. “This goes back to that culture of shame: That I should have done something to prevent it, or it’s just part of the job and I’ll deal with it.”
In a time when we’re seeing a historic nursing shortage, this type of cultural issue can increase the amount of burnout and fatigue the industry can’t afford to leave unaddressed.
“I spoke with a young ER nurse who said she kisses her family goodbye like it might be the last time she sees them every time she goes to work,” says Collins. “I think, for people who have no resources, or who are struggling already, needing emergency care can push them over the edge and they can sometimes react with anger. But people are also intolerant of waiting, and they’re in an environment that makes them uncomfortable. Nobody is at the hospital for grins and giggles. You’re there because something is wrong, and you’re agitated, angry, and fearful.”
While all those things can increase erratic or angry responses, we can’t allow this to become normalized, Collins explains.
Technology and support
One of the things Collins is happy to see is combining technical solutions alongside policies and protocols, security management, and community law enforcement to build a robust support system for staff.
“We’re never going to have zero incidents, but we can have a zero-tolerance policy,” says Collins. “This is what professional organizations are advocating for: that we respond accordingly and support our staff accordingly.”
The best solutions she has seen combine all these components to enable nurses to call for help when they need it. Everyone has a policy in place, she notes, but how do you support that policy?
“First, we need to recognize the problem and report the problem,” she says. “From there, we lay out the landscape of zero tolerance toward violence in the workplace and then look for solutions that specifically support nurses, providing them with a way to summon help the moment they need it.”
It truly requires administration buy-in to make this work, Collins explains.
“Culture is built by peoples’ behavior—that becomes the culture. As leaders, they need to lead and determine exactly how to respond to incidents,” says Collins.
Leadership can also then call in those experts, whether they’re security, nursing department, or other, to explore and identify the right solutions for their organization.
In extreme cases, Collins has seen organizations “fire” problem patients who harm the safety of their staff, though this is a last resort option.
“There’s an assumption that you have a moral obligation to take care of the patient,” says Collins. “But there is also a moral obligation on the part of the patient to treat the staff in a safe manner as well.”
Because we know violent incidents are underreported, it’s difficult to parse out the exact impact on violence and the growing number of professionals leaving nursing, but anecdotally it’s possible to take the temperature of the room, Collins notes.
“While I don’t have an exact metric about how much it plays into turnover, I can say it is always mentioned in the list of reasons for burnout, fatigue, and frustration,” Collins says. “OSHA says there is no other profession where this type of violence happens and it’s not dealt with aggressively. Healthcare is a negative exception on this topic.”
If we’re going to solve the problem of workplace violence nurses face, the conversation needs to keep going. She compares the challenge to medication errors and how often they went unreported when the process was punitive.
“When reporting medication errors became an opportunity to learn rather than a punitive, disciplinary process, reporting increased,” enabling the industry to find ways to prevent it, Collins says. A change in culture around violence could help lead to similar improved reporting.
By combining technology with policy there’s an opportunity for even wider scale understanding of workplace violence, Collins notes.
“If you equip nurses or anyone who might be at risk with duress buttons, you can then look at the data being generated by that,” she says. “We can get a better understanding of the causes: are there hot spots? Do we know how long patients wait? Is there a particular area of the hospital that triggers patients? This provides an opportunity to talk about those issues.”
Real-time data analytics allow organizations to be proactive rather than reactive when it comes to violent patients.
“I think there are so many opportunities to understand the operational aspect,” says Collins. “We can identify ways we need to change the environment and the patient interaction to create a safer work environment.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.