'Now is not the time to remove protections from COVID-19,' NNU president says in a letter to the CDC.
National Nurses United (NNU) is asking the Centers for Disease Control and Prevention (CDC) to walk back the latest update to its infection control guidance for health workers because it will cause “decreased protections” for healthcare workers and patients.
The move is a major shift from its previous recommendation for universal masking, and one that has prompted the nurses’ union to send a letter to the CDC urging the agency to “recommend optimal workplace protections for nurses and other healthcare workers.”
“While some changes move in a more protective direction, overall, these updates will result in decreased protections for healthcare workers and our patients, which will result in increased transmission, illness, and death,” says the seven-page letter, addressed to CDC Director Rochelle P. Walensky and signed by NNU President Jean Ross, RN.
“Now is not the time to remove protections from COVID-19,” Ross says in the letter. “The United States continues to see a significant level of transmission, with over 88% of U.S. counties experiencing high or substantial transmission.”
More than five million new cases of COVID-19 have been reported in the U.S. in the last two months, which the CDC estimates is likely only one-fourth of the true infections that occurred, and more than 350 people die each day from the virus, the letter says.
The risk of reinfection has substantially increased due to a combination of the emergence of the Omicron variant, waning vaccine immunity, and lack of public health measures, according to Ross.
The CDC’s infection control guidance updates will result in decreased protection for nurses, other healthcare workers, and patients, including:
Only recommending the use of source control—such as a facemask—in healthcare facilities in areas with high COVID-19 transmission levels.
Specifying that healthcare workers may choose not to wear source control when they are in “well-defined areas that are restricted from patient access” if community levels are not high.
Changing language on universal PPE use for healthcare providers from a clear recommendation to a suggestion.
“Nurses and other health care workers have been—and continue to be—on the front lines of responding to the Covid-19 pandemic,” the letter concludes. “As general public health measures are rolled back, it is of even more importance that our healthcare facilities remain safe places for healing, including for our most vulnerable patients.”
U.S. Medical Staffing must also pay a civil money penalty of $700,000, “for the willful nature of its violations,” according to a labor department news release.
U.S. Medical Staffing provides staff to various agencies, including schools and group homes for individuals with disabilities. Employees include direct support and intellectual disabilities professionals, residential aides, personal care assistants, home health aides and licensed practical nurses.
An investigation by the department’s Wage and Hour Division found that from at least September 24, 2017, through at least May 22, 2022 the employer denied overtime pay to the affected employees.
U.S. Medical Staffing paid the employees straight time for all hours worked but did not pay the time-and-one-half required rate for hours more than 40 in a workweek, the division determined. That is in violation of the Fair Labor Standards Act.
Investigators also determined:
In some cases, the employer claimed falsely to be a registry through which the company’s clients solely employed the workers.
In other cases, U.S. Medical Staffing misclassified employees as independent contractors.
After the investigation, U.S. Medical Staffing agreed to the consent judgment.
“This consent judgment makes clear to all healthcare industry employers that just like U.S. Medical Staffing, they will be held accountable when they fail to pay employees their legally earned wages,” said Seema Nanda, solicitor of Labor. “The U.S. Department of Labor is prepared to use every tool available, including litigation, to prevent employers from violating workers’ rights.”
In fiscal year 2021, the division recovered $13.8 million in back wages for more than 17,000 workers in the healthcare industry, where low wages and high rates of violations are common.
With an aging U.S. population and a growing demand for home health and personal care services increasing, employment in support healthcare occupations is projected to grow 17.8% from 2021 to 2031, according to the U.S. Bureau of Labor Statistics.
“As employers struggle to find the people they need to operate their businesses, those who ignore workers’ rights to full wages and benefits are likely to struggle to retain and recruit workers,” said Jessica Looman, Wage and Hour principal deputy administrator. “Employers who abide by the law will certainly have a greater appeal than those who do not.”
MMC, in Portland, Maine, was first designated as a Magnet Recognition organization in 2006 and is one of less than 10% of U.S. hospitals or healthcare organizations that are recognized as Magnet Recognition hospitals.
During the ANCC site visit, appraisers noted the teamwork that MMC nurses displayed in tackling complex problems; praised the hospital’s improvement processes and clinical nurse advancement program; and commended the nurses’ significant number of authored or co-authored peer-reviewed publications and national and international podium presentations, according to MMC.
It also noted MMC’s excellence in three areas of patient care: reduced surgical errors, workplace violence prevention, and innovation:
1. Reduced surgical errors in ambulatory and procedural areas
“For Magnet, we have to outperform the national benchmark for at least five out of eight quarters,” says Devin Carr, DNP, RN, RRT, ACNS-BC, NEA-BC, the hospital’s chief nursing officer. “We outperformed for all eight out of eight quarters.”
In fact, for that benchmark, MMC couldn’t have done any better. “We were zero errors for that time period,” he says.
That reflects a meticulous and attentive nursing team, Carr says. “That speaks to a lot of efforts around making sure that we're doing just the appropriate thing … that we don't rush through the safety checklists, and we ensure that we're doing those in a consistent way so that we don't have errors that occur,” he says.
Maine Med’s surgical teams, for example, take a “timeout”—a universal protocol that The Joint Commission recommends—before any surgical procedure begins, Carr says.
In the timeout, the entire surgical team verifies the patient’s identity, the procedure, and the surgical site.
“We follow a consistent procedure,” Carr says. “We make sure that we have the consent for the patient and that consent specifies specifically what we're doing and where we're doing. We do all the required things like marking the site, so if we're going to operate on your right knee, we would mark your right knee in advance.”
“It’s the basic things that have been recommended for a while,” Carr says. “It’s just a matter of working to hardwire those practices to make sure that we're doing them in a highly reliable way.”
Hardwiring comes from high expectations and reviewing their practices, Carr says.
“It’s something that we ingrained into the team as an expectation and we worked across all provider levels so that anesthesia, surgeons, and all of the staff in the room know that this is an expectation and that they engage in that practice,” he says.
“We have learned from mistakes over time,” Carr says, “so that has helped to hardwire that as well.”
2. Workplace violence prevention
“We, like everybody else, have experienced a significant increase in workplace violence,” Carr says, “and that's despite legislation calling for charges to be brought against people who assault healthcare workers.”
MMC has experience violence predominantly, though not exclusively, in the emergency department, so it has increased a security presence with more security guards on hand, Carr says. MMC has a secure acute psychiatric unit with the emergency department, so additional security guards are stationed there, as well.
The hospital’s security assessment, which looked at risk relative to access points, resulted in locking down some doors and installing metal detectors at main entrances and at the ambulance entrance. “It's surprising how many weapons we've been able to detect,” Carr says.
The hospital’s workplace violence coordinator conducts education and training, and, when a violent incident occurs, follows up with the affected staff members to debrief and support them, Carr says.
“We also have a pretty robust peer support program, where we connect people who have experienced workplace violence with someone who can counsel them and follow up with peer support,” he says.
Additionally, MMC has advanced practice psychiatric nurses who help in handling difficult patients, he says. “They help in rounding, and they help us develop management plans for how we're going to address and deal with behavior.”
3. Innovation in creating projects to improve patient care
“We have an innovation center here and we have the ability to give people some initial startup funding to support innovative ideas,” Carr says.
Two in particular were included in MMC’s Magnet documentation, including a safety bra developed by an emergency department nurse.
When a patient is determined to be at elevated risk for suicide, they are required to change out of their clothing—underclothes included—and into paper scrubs so there is nothing that could be used as a ligature or to do self-harm, Carr says.
“It’s a bra that is Velcro® and is breakaway in such a way that you couldn't really use it to harm yourself, but it does provide some foundational support that would be missing,” he says.
The other innovation is a patient gown invented specifically for patients with neurologic injury, or patients that clinicians want to be able to get up and move.
Standard hospital gowns are open in the back, “so you’re exposed and there’s not a lot of privacy,” Carr says.
A nurse at MMC invented a romper-style patient gown that provides privacy, yet, with easy snaps along the side and inseam, allows quick access to medical tubes by the care team. The design also decreases fall risk and discourages patients from tampering with their medical lines.
The gold standard
The Magnet Recognition Program is considered the gold standard for nursing quality, and for MMC nurses to have earned the achievement through the extraordinary difficulties caused by the COVID-19 pandemic “shows our nursing team is clearly one of the very best in the country,” Carr says.
“To have been able to sustain this during COVID has been an even bigger challenge,” Carr says, “so we are super proud of our team here for good reason.”
Agencies must have applications completed by October 1 to be in compliance with Ohio law.
Ohio nonmedical home health/personal care agencies, which must now be licensed, must have their completed applications for licensure submitted to the Ohio Department of Health (ODH) by October 1.
Agencies must have applications to ODH by that deadline, along with a non-refundable application fee of $250to be in compliance with Ohio law.
Besides agencies providing nonmedical home health/personal care, those providing skilled home health care and non-agency providers of nonmedical home health/personal care services will be required to be licensed by October 1.
Anyone who operates a home care agency or who provides nonagency home care without completing the application by the deadline could face criminal prosecution.
Nonmedical home health agencies that provide these services in a person’s home must be licensed, according to ODH:
Hands-on assistance with activities such as bathing, dressing, toileting, and ambulation.
Assistance managing the individual’s home and handling personal affairs.
Assistance with self-administration of medications.
Homemaker services including meal preparation, assistance with feeding, mail, and laundry.
Catheter care, but not insertion.
Respite services for the individual’s caregiver.
Errands completed outside of the presence of the individual such as picking up prescriptions and groceries.
Second settlement brings the total amount the health system will pay in restitution to $114K.
Overseas nurses charged an “illegal” repayment fee if they resigned or were fired within the first three years of employment at Albany Med Health System in New York got their money back.
New York Attorney General Letitia James recently saw the return of more than $24,000 to eight nurses who paid illegal repayment fees to Albany Med between 2007 and 2010, according to her office.
It was the second such settlement involving Albany Med and repayment fees. In 2021, after the matter was referred to James’ office by the New York State Nurses Association (NYSNA), James recovered more than $90,000 for seven former nurses of the health system who each were forced to pay up to $20,000 if they resigned or were fired within three years of employment, the AG office said.
The repayment provision threatened the nurses, most of whom were from the Philippines, with legal action and the involvement of immigration authorities if they did not make the payments, according to James’ office.
The provision discouraged nurses from leaving Albany Med, even if employment conditions were unsustainable, or if they were able to find higher payment or better opportunity elsewhere.
Albany Med was found to have violated the Trafficking Victims Protection Act through its provision, which constitutes a threat of sufficiently serious legal and financial harm “to compel a reasonable person of the same background and in the same circumstances to perform or to continue performing labor or services in order to avoid incurring that harm.”
The 2021 settlement required Albany Med to remove the repayment provision from all employment contracts and notify current and former nurses of the clause’s removal. The health system also must submit written reports on their compliance to the attorney general’s office. Albany Med has since complied with all stipulations of the agreement.
Following the news of that settlement, additional former nurses of Albany Med came forward and reported similar treatment, which resulted in this latest settlement, bringing the total amount Albany Med will pay in restitution to $114,000.
“I will not allow hardworking nurses—frontline workers—to be taken advantage of in New York state,” James said. “Our healthcare system is dependent on nurses, and they deserve to be treated with the highest respect and dignity.”
“I am proud that we can continue to protect the nurses who were impacted by these illegal contracts, return the funds stolen from them, and hold employers accountable,” she said.
NYSNA also reacted favorably to the settlement it set in motion.
“This second settlement for Albany Medical Center nurses is a victory for immigrant nurses and workers everywhere who have been subjected to coercive employment contracts,” said Nancy Hagans, RN, BSN, CCRN, president of NYSNA. “We applaud Attorney General Letitia James’ office for taking action to protect New York’s workers—wherever they hail from—and winning a settlement that returns some of the nurses’ hard-earned money.”
Albany Med did not respond to HealthLeaders’ request for comment.
A unique partnership with the Highmark Caring Place grief center helps equip nurses with the tools they need.
Leaders of a workshop originally designed to teach nurses to interact with and nurture children visiting critically ill loved ones at Penn State Health Milton S. Hershey Medical Center quickly shifted direction after realizing that nurses needed to focus on their own trauma and grief before being able to care for visiting children.
Penn State Health in Hershey, Pennsylvania, has collaborated with Highmark Caring Place, a center for grieving children, adolescents, and their families, on a project to help nurses working in ICU/CCU units process their experiences of grief and loss caused by the COVID-19 pandemic, along with the difficult work they must do.
Nurses continue to struggle with their own psychological stress and trauma from the harsh effects of the COVID-19 pandemic and the conditions it has caused.
Unaddressed trauma can significantly increase the risk of mental and substance use disorders, along with chronic physical diseases, but with proper support and intervention, people can overcome traumatic experiences, according to the Substance Abuse and Mental Health Services Administration.
HealthLeaders spoke with Mary Jane Bijelic, nurse practitioner for Penn State Health’s Neuroscience Critical Care Unit (NCCU) and lead advanced practice provider for the Department of Neurosurgery, and Terri Bowling, manager of Highmark Caring Place, about the workshop they created to help nurses with their trauma.
HealthLeaders: The partnership between Highmark and Penn State Health began pre-COVID. How did that come about?
Mary Jane Bijelic: The project initially started as a way to support children at the bedside when they're visiting a dying loved one, or someone who is critically ill in the ICU, and it developed into how to care for our nurses to be able to care for the family and to be able to care for those children at the bedside.
When COVID hit, with all the trauma from that, we started to delve into how we are coping with COVID during our workshops and that became big discussion points at our workshops during the pandemic and after the pandemic. We’ve been doing it a little over five years now.
HL: How, exactly, do the workshops work?
Bijelic: We spend eight hours of a day with the nurses and Highmark the Caring Place does their session in the morning. After lunchtime is where they really work with our nurses exploring their feelings about death and dying, exploring grief, and how their personal grief affects them on their job.
It helps to recognize grief, because before these workshops, you would think you were suffering alone, and then once you start hearing what other nurses are feeling, you realize we are all going through similar things.
Eventually, we have our chaplain services and music therapists come and talk with the nurses and those two conversations are different from other workshops where there is mainly a family and patient focus. Their message here is, “We are here to support you as nurses, as providers of these patients. We know we need to care for you in order to care for our patients and our family better.” And so, it's a bit of a different message.
HL: Are the workshops regular or as needed?
Terri Bowling: We’ve had to keep this project alive through COVID, so that’s created all kinds of challenges. When we started out, we had a goal of getting every nurse trained in the Neuro ICU unit, which is where [Bijelic] is housed, to, in theory, make sure that everyone had a core foundation for what we were trying to do and to see if it would prove out that the interrelationships on the unit would actually be impacted and change and start to shift culture in a different way.
We had successes early with that and then we had to flip everything into a virtual or hybrid platform [because] hospitals weren't accepting us as clinicians, and we weren't able to come in, so we had to be on screen. Right now, our biggest challenge, as a result of COVID, is staffing and trying to work this in schedule. We can't take many nurses out of a single unit at any one point in time because of the staffing shortages.
HL: How did you recognize even before COVID that something like this was needed for nurses?
Bowling: We initially were getting nurses together to talk about the child's point of view, but very early on, the conversation kept coming back to themes such as, “I'm struggling with having to keep patients alive and I don't have time; how am I possibly going to take care of someone at a bedside?” and, “I've got so much I'm dealing with and then I'm crashing and burning,” or “I'm totally emotional after that and I've got to suck it up and go into that next room.”
Those were emerging themes that we saw very early on that kind of put the brakes on [the original child-focus] and we realized we needed to take a step back. [We approached it as], “The work you're doing is so very impactful and intense and in straddling that every day you're on the job on the floor, you are experiencing a world between life and death, and that is impactful and that's really hard. How are you managing that? And until you can do that with yourself, how are you possibly going to do that with others?” So that was the impetus; it naturally bubbled to the surface early on that we need to help take care of these nurses.
HL: How do you begin to counsel nurses on the moral distress and trauma they’ve been through?
Bowling: Some of it is helping them label some of what they're experiencing and helping them through an experiential perspective. We do a lot of hands-on activities through some art activities, and through sharing of those moral dilemma situations so we can process some of that out in a dialog way.
We include some psychoeducation in there to help them label and understand that what they're experiencing is normal and that this is really hard stuff. We help through compassion and caring that we generate throughout the group, creating that safe environment for processing and debriefing. There are complicated scenarios that the nurses don't have time to talk about and process, and to do that with each other and get different perspectives from people that might be on the other side of that is really valuable and brings people together.
HL: How are nurses responding to the sessions and what outcomes are you seeing from these workshops?
Bijelic: Right from the beginning, we knew that it had an impact on our staff from the feedback from the surveys. I also would see them in the unit, and they would come up and start talking to me about the workshop, saying things like, “We've never been through anything like that. Thank you for doing this workshop. Keep doing it.”
Many of them would love to do this workshop every six months. We’ve already talked about as we move forward, what this would look like and it’s just a matter of keeping the program going and expanding it.
The goal? To combat a 'growing distrust with all aspects of healthcare that has affected our interactions with one another,' association CMO says.
Lack of trust between leaders and staff in long-term care facilities is detrimental to vaccination uptake, patient safety, quality of care, and staff well-being, says the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which has launched a new education program to help rectify that.
The course is designed for formal and informal leaders within long-term care in both clinical and nonclinical roles, such as administrators, directors of nursing, medical directors, senior leaders, and department heads, as well as infection preventionists, quality improvement coordinators, and influential staff, according to AHCA/NCAL.
The course, funded by a grant from the U.S. Centers for Disease Prevention and Control, includes four lessons:
Introduction to the Three Drivers of Trust for COVID-19 Vaccine Uptake
The First Driver of Trust: Empathy
The Second Driver of Trust: Logic
The Third Driver of Trust: Authenticity
After completing the course, nursing home leaders will be able to, among other things, assess the presence of trust in their facility, listen for understanding in conversations with staff, address misinformation, and connect to people’s shared values to motivate commitment to vaccinations, says AHCA/NCAL.
“The pace of change and uncertainty that facilities have faced since the beginning of the pandemic, including an unprecedented workforce crisis, has been overwhelming, resulting in a growing distrust with all aspects of healthcare that has affected our interactions with one another,” said David Gifford, MD, chief medical officer at AHCA/NCAL, and board-certified gerontologist.
“What is exciting about our new course is that it really addresses this issue of trust,” he said. “Trust building creates this essential foundation for facilities and their teams to adapt and thrive in times of continuous change, which ultimately leads to a stronger operation that allows for further improvements in care and outcomes.”
The bill doesn't provide full practice authority, but it does recognize the role APRNs have in the U.S. healthcare system.
Newly introduced bipartisan legislation to improve healthcare access for Medicare and Medicaid beneficiaries would expand authority for advanced practice RNs (APRNs) to treat those patients.
The legislation does not provide full practice authority (FPA) in all 50 states—individual states govern those guidelines—but it does reduce a number of federal barriers that impede access to care for millions who receive healthcare through Medicare and Medicaid.
The Improving Care and Access to Nurses(ICAN)Act—orH.R. 8812—would allowAPRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists, to order and supervise cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more
The legislation, introduced byRep. Lucille Roybal-Allard (D-Calif.) and Rep. Dave Joyce (R-Ohio), could benefit hundreds of thousands of patients. Today, more than 200,000 APRNs are treating Medicare patients, and about 40% of Medicare beneficiaries receive care from APRNs, according to a joint press release sent out by the nursing organizations.
This report recommends that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.”
Strong support from nurse leaders
The legislation is receiving strong support from national nursing organizations:
“The health of Medicare and Medicaid beneficiaries depends on timely access to high-quality healthcare,” said April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “It’s critically important that healthcare policies reflect who is providing care in our communities and that our healthcare system is effective and efficient. The ICAN Act would move healthcare delivery forward for patients, providers, and our nation.”
“It is time for Congress to eliminate burdensome laws and regulations,” said Angela Mund, DNP, CRNA, president of the American Association of Nurse Anesthesiology (AANA). “Allowing certified registered nurse anesthetists and other APRNs to practice to the full scope of their training and licensure will ensure that patients are put first, that competition drives down costs through the removal of artificial and unnecessary barriers, and that providers of all types are able to better serve their patients.”
“It is critical that laws and regulations facilitate the most efficient relationships between healthcare professionals and create systems in which midwives and other APRNs can communicate openly, practice collaboratively, and provide quality care that falls within everyone’s professional scope of practice,” said Katrina Holland, CEO of the American College of Nurse-Midwives. “Decades of research demonstrates that midwifery care can improve maternal health outcomes, and the ICAN Act ensures that certified nurse-midwives can bring their evidenced-based skillset and knowledge to fully meet the needs of their patients.”
UW Health management also welcomed the agreement announced Tuesday in which both sides agreed to seek a ruling from the Wisconsin Employment Relations Commission on whether the health system must recognize their union.
“This is all positive news, and we are excited to be moving forward together to gain legal clarity,” said a statement from UW Health.
Hundreds of nurses threatened a strike this week unless UW Health recognized and bargained with the nurses’ union, which is part of the Service Employees International Union (SEIU). Administrators, however, maintained that the hospital couldn’t legally collectively bargain under the state’s Act 10 legislation, which passed 11 years ago, removing UW Health from being required to recognize unions.
Gov. Tony Evers brought both parties together over the weekend at his residence to mediate and reach an agreement stating that UW Health and the nurses’ union, SEIU Healthcare Wisconsin, “intend to work together to address critical challenges and issues facing the nursing profession at UWHCA.”
Sarah Quinn, RN, an inpatient psychiatry nurse at UW Health for 13 years who has been active on hospital councils and resource groups, was among the celebrants and spoke with HealthLeaders about this development.
1. You’ve worked at UW Health both with and without union representation. What has the experience been like in each circumstance?
Sarah Quinn: I started here under a union, and it felt like nurses and management were really working together on everything … like what was a concern to us was going to be heard. I had a strong voice in my workplace and that gave me a sense of being invested, and it made me feel like more than just someone working for an organization; it made me feel like I was really, really part of it.
When we lost the union, I’m optimistic by nature, and I wanted to feel like we were going to move forward with management in the same way, but over the years, it's become clear that that's just not the case. We’ve tried to work within the systems we have, like through our councils, but when you don't have a voice and can't talk directly to people, it's been very different and disheartening
2. UW Health had maintained that the health system couldn’t legally collectively bargain under Wisconsin law, so is the fight against the health system or the state of Wisconsin?
Quinn: It was with our health system of UW Health. Because we had a clear opinion from [Wisconsin attorney general] Josh Kaul, as well as many attorneys across the country, and so have always believed that the hospital could voluntarily recognize us. Part of this process was that the hospital has believed that wasn't the case. So, it has been more with the hospital, not the state.
3. If union representation returns for UW Health nurses, what changes and goals do you and other nurses anticipate?
Quinn: The fact that we're able to join a union immediately, that we're going to be sitting down to talk with management, mediate, and discuss, which we did not have before this. The problems of how we're retaining nurses, how we're lowering burnout, making sure that we have the resources we need to care for our patients, caring for us to make sure that this is a profession we can stay in long term—I know that nurses at that table are going to be able to help make those changes in the hospital that's going to allow all that to happen.
Violence should not be considered 'part of the job,' Press Ganey's chief nursing officer says.
More than 5,000 nurses were assaulted on the job in the second quarter of 2022 alone, according to staggering new data from Press Ganey.
That equates to more than two nursing personnel assaulted every hour; 57 per day; and 1,739 per month, the data reveals.
“Nurses take an oath to do no harm, and many put their own safety and health at risk to help a patient. However, violence should not be considered just ‘part of the job,’” said Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN, Press Ganey’s chief nursing officer.
“What’s especially concerning about these numbers is that they are likely even higher, as assaults generally go underreported by healthcare professionals—and nurses in particular,” Doucette said.
Press Ganey’s analysis was based on findings from 483 facilities in its National Database of Nursing Quality Indicators® (NDNQI®). The analysis also defined assault as any encounter involving deliberate forcible, unwanted physical or sexual contact, regardless of whether there is intent to harm.
Nurses fed up with the violence directed at them and other frontline healthcare workers marched in Washington, D.C., this spring with the message that, as Doucette stated, violence is not “part of the job.”
Press Ganey’s analysis also revealed:
The highest number of assaults occurred in psychiatric units, emergency departments and, surprisingly, pediatric units such as pediatric burn, pediatric rehabilitation, and pediatric surgery.
The lowest number of reported nurse assaults were in obstetrics and neonatal intensive care units.
Most assailants are patients, but family members, co-workers, visitors, and intruders also perpetrate violence.
Most assailants are male, except in pediatric and rehab units, where females are more likely to get violent.
Psych and rehab units have the largest percentage of assaults resulting in moderate or severe injuries.
Mitigating the violence
Nurses are demanding, and getting, workplace protection from assailants.
RNs at Hazel Hawkins Memorial Hospital in Hollister, California, not only got a wage increase with the ratification of a new four-year contract, but they also bargained for and got a Workplace Violence Prevention Committee created.
The committee, which will have two of its seats filled by RNs, will address workplace violence concerns and update current policies in accordance with California’s Workplace Violence Prevention Act.
And when an altercation—verbal or physical—begins at Inova hospitals, it is quickly met with a rapid-response team specially trained to de-escalate and safely contain the fracas.
The Safety Always for Everyone (SAFE) team, Inova's major response effort to de-escalate issues and provide support for team members while also assuring safe care to patients, has resulted in fewer incidents and a staff much more confident in their workplace safety, says Kathy Helak, MSN, BSN, RN, FACHE, CPPS, Inova's assistant vice president for patient safety.
Press Ganey also offers steps that healthcare organizations can take to mitigate violence against their nurses:
Implement reporting systems for record-keeping and safety and well-being program evaluation.
Ensure caregiver safety is a core value and set the expectation that violence on the job is neither expected nor accepted.
Enact formal policies and procedures for risk identification, hazard prevention and control, standard response plans, and post-incident support.
Implement training and education programs that teach warning signs, de-escalation techniques, progressive behavior control, emergency management, and communication and teamwork.
“Violence toward nurses has reached an alarming rate, nearing, if not already, an epidemic. We are calling on all healthcare leaders to declare zero tolerance for hostility toward healthcare workers, improve caregiver well-being, and advance our shared commitment to zero harm,” Doucette said.
“Nurses deserve to be protected and feel safe,” he said, “while caring for people in their most vulnerable state.”
