What's the Word on Workplace Violence? Part Two

CNOs must protect and support nurses from workplace violence using methods that are tried and true, say these nurse leaders.

Nurses everywhere continue to experience high levels of violence and abuse at work on a regular basis.

In 2023, eight in 10 nurses experienced at least one type of workplace violence, according to a National Nurses United report. While prevention isn't always possible, CNOs need to make sure that nurses are getting support and assistance after workplace violence incidents occur.

Nurse leaders must advocate for using evidence-based approaches to find out what really works and what doesn't.

Prevention

According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, there need to be more studies done to see what prevention methods are actually effective. For example, weapons detection systems might prevent people from bringing weapons in, but they will not mitigate the typical violence that nurses face in the workplace, Kingston explained.

"Look to see what makes sense within your organization," Kingston said, "but also go back and look for the evidence about what does work, and what truly does help keep people safe."

Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member, emphasized the need for proper patient assessment and de-escalation training as prevention methods.

"Make sure staff know about all of the different things that we have to offer for them to support them," Schuetz said, "then make sure that we're assessing the environments [and] making sure we have environmental controls in place that make sense for the location."

To Kingston, prevention involves three key factors:

"I'll focus on the training and practice and preparation, partnering with safety and security, and really assessing the physical environment as well as all aspects of the environment," Kingston said.

Leaders can control environmental factors by making sure that nurses have exits that they can get to at all times, and assessing items in the room that could potentially become weapons in the midst of an incident.

Kingston emphasized that partnerships with safety and security teams, other departments in the health system, and organizations within the community are also critical. Behavioral health response teams can be particularly beneficial.

"When you feel as though a situation is beginning to escalate, you can call for support and have that show of support, as opposed to a show of strength," Kingston said, "a show of support for both the patient and for the nurse at the bedside."

CNOs can also leverage technology for workplace violence prevention.

"With some of the technology that's out there now, you can have a button or some type of alert on your badge, or on some other type of device," Kingston said, "and you can alert folks when you need help, [and] that can prevent an incident from going to injury."

Schuetz added that a zero-tolerance policy for patients behaving aggressively is essential, as well as proper procedures for removing patients when necessary.

"Our facility developed a pretty rigorous process around patient dismissal when they cannot really participate with the team in a way that's conducive for them to get better and it's abusive to our team," Schuetz said.

If patients come through the emergency department, they will still be treated as required, but patients will be discharged and dismissed from the health system if they cannot comply with the patient code of conduct, Schuetz explained.

"A number of these patients will stop coming back to the facility once they have been dismissed because they don't want the hassle," Schuetz said. "It's our hope that they find a facility where they can have a relationship with the team where they can get the care that they need."

Support after incidents

When incidents inevitably do occur, the next steps that CNOs and other nurse leaders take can make a huge difference for the nurse.

Schuetz explained the peer-to-peer support program at her health system, and their new program that involves a team of people that can provide resources to everyone involved in an incident.

"Oftentimes there's collateral damage, people that witness an event are equally as traumatized as the person," Schuetz said.

The program brings leadership, counseling, and chaplain support to the person or people involved to help them recover. Survivors of workplace violence incidents can suffer from PTSD, which can severely impact their careers if they do not receive the proper support and resources.

"We're trying to wrap our arms around those people," Schuetz said, "[by] making sure that they get some time off work if they need it, making sure they know about pressing charges and the support they can have for pressing charges."

Kingston noted that CNOs need to understand that the impact of workplace violence often lasts beyond the incident.

"I think in healthcare we've done a reasonable job of initial follow-up," Kingston said, "but we have to recognize that this can have an impact days after and weeks after." 

CNOs should implement a series of responses, according to Kingston, starting with a strong employee assistance program. Organizations should have a formal support process that is not dependent on the individual manager or leader.

It's also important that other types of violence don't go unnoticed.

"If someone's being called a horrific name all day long while they're working, they may not have a strained shoulder or a bruise, but they are also experiencing workplace violence," Kingston said, "and I think we have to recognize the cumulative impact of some of the behaviors we see."

Lateral violence, such as bullying or incivility at work, are also issues that need to be addressed.

"We have to support our frontline leaders to be able to address those types of behaviors," Kingston said. "They're not something that's reported because people don't even recognize that always as another form of workplace violence."

Part one of this piece was published on Monday, June 24, 2024.

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