What's the Word on Workplace Violence? Part One

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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