CNOs must come up with innovative ways to prevent workplace violence.

Nurses across the country are experiencing record levels of workplace violence, for many different reasons. 

CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they implement prevention measures and prepare nurses for what they might face. 

Here's what you need to know about workplace violence, according to Mary Beth Kingston, executive vice president and CNO at Advocate Health, and Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member. 

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Workplace violence incidents in healthcare are seemingly on the rise. Let's take a look at why, according to these nurse leaders.

Nurses across the country are experiencing record levels of workplace violence.

According to a National Nurses United report, in 2023, eight in 10 nurses experienced at least one type of workplace violence within the past year. Additionally, 45.5% of nurses reported an increase in workplace violence on their unit in the previous year.

The nurses involved in the report cited many types of violence, with 67.8% reporting verbal threats and 38.7% reporting physical threats. Nurses experienced being pinched, scratched, punched, kicked, spat on, and groped at alarming rates. Only 18.4% of participants reported no experiences of workplace violence.

CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they come up with innovative ways to prevent workplace violence.

Understanding the numbers

According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, it's hard to say one way or another that the incidents are rising, but it has become a more publicized issue.

"I'm not sure we have a have a good baseline to even say that [incidents are] increasing," Kingston said. "With that being said, it certainly feels as though things are increasing and we’re hearing about it more and more."

However, Kingston explained that in health systems implementing basic measures to prevent workplace violence, there have been improvements. Those measures include training and better reporting processes that can help identify where issues are, so health systems can target their approach. Health systems should also have risk and assessment processes, mobile duress technology, and behavioral health response teams.

"There's a number of basic foundational things that we can put in place to help keep all those providing care safe," Kingston said, "and not just those providing care, but everybody in the whole environment safe."

According to Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member, the uptick is due to more reporting and less tolerance amongst nurses.

"Historically, nurses sort of accepted that there was a certain amount of abuse that they would have to take as part of their job," Schuetz said, "so it was and is drastically under reported."

Schuetz also said that the lack of resources for people with mental health conditions might also be contributing to the issue.

"If someone has a challenging life situation that requires some type of care in a facility, those facilities are not always available," Schuetz said, "and so the hospital becomes kind of the de facto place to put the patients so that they're kept safe."

Identifying the root cause

CNOs and other leaders need to first identify the reasons workplace violence is occurring in their health systems. For Kingston, it's important to consider the patient's perspective.

"It could be fear of the unknown or a fear of diagnosis that causes them to react, or pain," Kingston said. "Sometimes it can result from frustrations in some of our processes, [such as] long wait times."

For other patients, it could be cognitive difficulties or behavioral health issues. However, Kingston emphasized that it's important not to stereotype those patients.

"This is not to say that it is patients who have behavioral health problems are the ones that cause violent incidents all the time," Kingston said, "and I think sometimes we do jump to that decision, but there are certainly circumstances."

Kingston also mentioned that recently, there has been a general lack of boundaries between patients and nurses. CNOs must work to reemphasize the role of the patient and the nurse in a healthcare environment, and reinforce those boundaries between the patient and their care team.

"So again, [there are] many, many reasons [that workplace violence occurs]," Kingston said, "which makes it difficult to have the formula to say here's what we can do in every situation to prevent or to mitigate."

Training the workforce

One of the best things CNOs and other nurse leaders can do for their nurses is prepare and train them properly. According to Schuetz, nurses need to know how to identify and assess patients that may be at risk for violence. It's critical that nurses use the proper assessment tools so that they can get the support they need.

"Coming into the hospital, you might have a patient that has not and does not appear to be violent or have violent tendencies," Schuetz said. "The added stress of being in the hospital often just brings out the worst in people that already have a propensity to act out in certain situations."

Nurses also need to be aware of their environments and know the proper procedures for when incidents do occur. De-escalation training is crucial, according to Kingston and Schuetz.

"We have yearly training around how to de-escalate patients that are escalating," Schuetz said. "Sometimes, we're inadvertently causing patients to be escalated."

"It's really about listening and trying to understand what's going on before something erupts," Kingston said. "Practicing with de-escalation, even having folks act in the patient role and being able to practice that, I think is important."

Kingston believes more advanced training is necessary for nurses who work in high-risk areas, including self-defense.

"I don't know that everyone needs that, but certainly de-escalation and more of a focus on trauma informed care," Kingston said, "understanding where that patient is at as they're coming in…so that we can try to understand [and] mitigate before it becomes very difficult."

Peer support training is also key, so that nurses know how to help each other in the workplace setting.

"That to me is so important because [in] these situations, if our response is elevated and the patent is not as elevated yet, they will rise up to meet us," Kingston said.

According to Kingston, training should start as soon as possible while the nurses are in their undergraduate degree programs. To Schuetz, it comes down to looking at the tools that are available to you, and utilizing both mandatory and optional training.

"For nursing, there's so many things that we have to teach and train," Schuetz said. "Healthcare workers are just inundated with information and so they don't always know what's available to them."

Ultimately, it comes down to communication and using a combination of methods to try and prepare the nurses for what they might face.

"I'm a firm believer that it's a million little things that make a difference," Schuetz said. "If there was one thing that could solve this, that would have happened many, many moons ago."

Part two of this piece will be published on Monday, July 8, 2024.

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To inquire about attending a HealthLeaders CNO Exchange event, email us at exchange@healthleadersmedia.com. 

Properly measuring ROI is critical to the success of virtual nursing, say these nurse leaders. 

Executives from a dozen health systems met in Atlanta in early June for the HealthLeaders Virtual Nursing Mastermind program, in a forum to establish common goals, challenges, and successes.

The program, which included three virtual roundtables, established a number of key metrics that executives are focusing on as they evaluate their virtual nursing strategies.

Here are four key metrics CNOs need to be measuring to prove the ROI of their virtual nursing program. Click here to read the full article by HealthLeaders editor, Eric Wicklund. 

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

CNOs need to be clear and transparent in communication surrounding AI, says this nurse leader.

AI has been all over the news recently, especially when it comes to nurses.

Many have questions about implementation and ethics, and it is up to CNOs and other nurse leaders to communicate with their workforce about what AI means for nurses. 

Concerns

According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, there are three main concerns that nurses have with AI. The first is about the ethics of generative AI.

"We've not explored this too much in nursing workflows," Rocchio said, "so taking a look at some of those ethical considerations and getting out ahead of it may help us a little bit."

The second concern is job displacement.

"While we have no plans on it taking out jobs, I do think it is informing, a little bit, how we practice," Rocchio said, "which can make some just a little bit nervous."

The third is loss of human touch and connection with the patients.

"Nursing depends on us being up close and personal with the patient," Rocchio said. "Sometimes nurses think that some of these automated, generated things may get between that relationship with the patient."

Nurses also have concerns about how AI will integrate with their workflows. Since AI implementation is so new, many health systems do not know where they will use it yet.

"That unknown entity of how we might use it in the future might be driving some of the trepidation behind AI," Rocchio said.

Settling doubts

The purpose of generative AI implementation in nursing, according to Rocchio, generally consists of these three key points:

"I think the purpose is going to be around leveraging technology to optimize nursing practice to assist some nurses with [getting] information out of our EHR directly to the front lines, [and] to help us improve outcomes for patients," Rocchio said.

Rocchio mentioned three ways that Mercy is communicating to their workforce, to help nurses understand AI's relationship with their workflows.

The first is through education and training. Nurses are used to receiving a lot of education and training, Rocchio explained, but not usually around process issues.

"We're going to have to start thinking about [incorporating gen AI] into our training programs," Rocchio said. "There are going to be applications where we use it in healthcare and many nurses may not even be aware that we are using it in certain circumstances today."

The leaders at Mercy are also trying to emphasize that when AI is placed into workflows to help quicken information delivery and documentation processes, it frees up nurses to spend more time with patients.

"That [loss of] human touch they're so worried about can be mitigated [by] giving them back more time at the bedside," Rocchio said.

Additionally, Rocchio said they try to engage nurses directly with the AI implementation process on the front lines.

"When you're thinking about what may help them at the front lines, [in] that implementation phase," Rocchio said, "they should be directly responsible and [involved] in some of that."

Beyond AI

It's important for nurse leaders to communicate about all new forms of technology and integration, beyond just AI, so that nurses can understand what's coming next. According to Rocchio, one of the best things to do is talk about what regular communication patterns will look like between leaders and nurses.

"Nurses need to know what to expect and where the communication source is coming from," Rocchio said, "not just from nursing leadership, but [also from] our office of transformation."

Nurse informaticists and the rest of the digital team should be a part of the communication process as new technologies are deployed. Rocchio said that the communication patterns that come from nurse leadership and digital leadership should be consolidated into one single framework so that nurses can consume it.

Mercy has also launched a learning module around some of the new technologies.

"Nurses are starting to learn that there are going to be different ways to do things within our learning management system," Rocchio said, "so we're using what they're used to getting education and communication patterns with…to talk about AI."

Transparency

CNOs must be clear with nurses about the implementation process, goals, and outcomes, Rocchio explained.

"Being transparent about our plans for the new technologies as well as our timelines and goals and our expected outcomes," Rocchio said, "and then making sure we provide regular updates on [if we are] hitting the goals."

Leaders also need to be clear about when problems arise.

Rocchio explained how when they launched their emergency department to inpatient handoff process with AI, they did not get it right the first time. When the pilot was launched on one unit, the AI had a couple "hallucinations," where the incorrect data was pulled into the format.

"We were very transparent with the nurses," Rocchio said. "We showed them how it happened, and we went back and corrected it, so they could see ethically that we were doing the right thing."

Leadership visibility and accessibility are also key.

"When we launched our workforce platform with AI in the background, the other thing we did was make sure that leaders and individual caregivers were there to make decisions around how that AI was put into the system," Rocchio said.

"I think both of those things are really important to make sure that those key messages are consistent across all platforms," Rocchio said.