DiversityNursing Blog

Healthcare Workplace Violence Prevention Resources

Posted by Erica Bettencourt

Thu, Nov 04, 2021 @ 10:47 AM

stopviolenceViolence against healthcare workers is more common than most people realize. The environment of a healthcare institution can create high levels of stress for patients, their loved ones, and staff. Fear and illness are major contributors of agitation and aggression from patients.

National Institute for Occupational Safety and Health classifies work place violence (WPV) into four basic types:

  • Type I: Involves “criminal intent.” In this type of workplace violence, “individuals with criminal intent have no relationship to the business or its employees.”
  • Type II: Involves a customer, client, or patient. In this type, an “individual has a relationship with the business and becomes violent while receiving services.”
  • Type III: Violence involves a “worker-on-worker” relationship and includes “employees who attack or threaten another employee.”
  • Type IV: Violence involves personal relationships. It includes “individuals who have interpersonal relationships with the intended target but no relationship to the business”

According to the American Nurses Association, 1 out of 4 Nurses is assaulted on the job and only 20% to 60% of Nurses report the incidents. The lack of reporting is a serious barrier to effective research and regulatory or legal action.

Three of the most common reasons for not reporting violent incidents are:

  • Fear of retaliation
  • Lack of a clear reporting method
  • Belief that nothing will be done about it

Studies show that WPV can affect the quality of care and care outcomes, contribute to the development of psychological conditions, and reduce the RN's level of job satisfaction and organizational commitment.

If an attack happens, Nurse.org recommends these suggestions:

  • Try to escape - If you can’t escape, yell loud enough to get help.
  • Create a barrier - Put something between that person assaulting you and yourself so you might be able to escape. 
  • Defend yourself - You can defend yourself. You are allowed to meet the attacker with equal force to get them to stop. Some people don’t know that. 
  • Report the incident - Notify your facility of the assault.
  • Take a leave of absence - Many people will be nervous to go back to work after an incident. If you are struggling emotionally with the trauma, people need to begin to realize that trauma and anxiety are legitimate reasons to get a leave of absence. Don’t rush back to work if you aren’t ready. 
  • Get support and seek help - Surround yourself with people that you trust. Consider getting trauma counseling. 

The World Health Organization (WHO) holds employers accountable for both ensuring the safety of their employees and acting to treat them after an act of violence has occurred.

Hospitals should establish a culture of safety by implementing WPV prevention programs and by showing support of incident reporting. 

The Joint Commission released new and revised requirements addressing workplace violence prevention programs which will be effective on January 1, 2022.

These requirements include hospitals providing de-escalation training, education, and resources at time of hire, annually, and whenever changes occur regarding the WPV prevention program. Also the program should be led by a designated individual and developed by a multidisciplinary team. 

The American Association of Critical-Care Nurses (AACN) urges hospitals to:

  • Establish a clear and consistent reporting structure for workplace violence, with easy to understand policies and procedures on how to report violent incidents to law enforcement.
  • Encourage employees to press charges against persons who assault healthcare workers, and support staff members who do.
  • Provide resources and support programs for employees to help them cope with violent incidents.
  • Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.
  • Ensure the presence of sufficient security systems, including alarms, emergency response and available security personnel.

Many hospitals have set up personal security and safety protocols in case of an altercation or attack. 

Cox Medical Center in Branson, MO installed a panic button system. The hospital said about 300 to 400 staff will have their own personal panic buttons on their badges. If the button is pushed, it activates a personal tracing system, security is notified and an alert on hospital computers shows the employee's location.

Resources

Training:

Workplace Violence Prevention for Nurses

Podcasts:

Combating Workplace Violence in Health Care by Creating Safer Workplaces

Trauma And Trauma Informed Care

M.O.V.E. to Prevent Workplace Violence

Websites:

victimlaw.org 

Futures Without Violence: Workplace

Workplaces Respond National Resource Center

DOL Workplace Violence Program

Hotlines:

The National Domestic Violence Hotline is 1-800-799-7233, or you can text LOVEIS to 22522 if you cannot speak safely.

Workplace Harassment & Discrimination – Employee Concern Hotline Services: 800-307-5513

Fact Sheet:

Building a Safe Workplace and Community A Framework for Hospital and Health System Leadership

Guide:

End Nurse Abuse Resource Guide

Topics: workplace violence, employee safety, nurse safety, incident reporting, WPV, workplace violence prevention, workplace violence prevention program, nurse violence, healthcare workplace violence, safety culture

Violence Prevention in Home Care Nursing

Posted by Erica Bettencourt

Fri, Jan 15, 2021 @ 03:15 PM

knockingThe need for in-home care has grown since COVID-19 because many fear contracting the virus in hospitals and clinics, especially among the elderly population.

With no security like hospitals usually have, home visiting Nurses put themselves at risk whenever they enter a patient's home alone. 

Ha Do Byon, Assistant Professor of Nursing at the University of Virginia School of Nursing mentions in a  STAT news article, "Even before the pandemic struck, I heard Nurses’ stories of home visits — some during my time as a visiting Nurse, and others as part of a study I am conducting to understand violence faced by home visiting Nurses. They told me about patients who blared pornography, or being groped while administering care. About patients who waved handguns and hurled racial insults. About being bitten, punched, kicked, or slapped. About dealing with screaming fits, intoxicated family members, and dogs that bit them or threatened to."

According to a 2015 study by BMC Public Health, the threat of workplace violence was one of home health workers’ top concerns, ranking above transportation issues or environmental hazards.

Developing a safety program for your home care workforce is crucial in reducing health care worker stress and turnover.

The rate of patient-on-Nurse violence among home visiting Nurses is unknown.

An article in Home Care Magazine states, only one-fifth of violent incidents “are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients." Nurses have cited fear of retribution from supervisors, the complexity of the legal system and disapproval from administrators as barriers to reporting workplace violence.

Nurses and providers can take measures to prevent violent situations.

The National Institute for Occupational Safety and Health Centers for Disease Control and Prevention released a list of recommendations for employers and workers to ensure safety.

Some recommendations for Employers:

• Ask employees to report each incident, even if they think it won’t happen again or it might not be serious.

• Train employees to recognize the signs and body language associated with violent assault and how to manage or prevent violent behavior, such as verbal de-escalation techniques, management of angry patients, recognizing and protecting themselves from gangs and gang behavior.

• In the case of an unacceptable home environment, advise the patient on working with social service agencies, the local police department, or family members and neighbors to make the home less hazardous so care can continue.

• Provide cell phones to all staff on duty. Home healthcare workers consider cell phones to be lifelines.

• Consider other equipment, such as employer-supplied vehicles, emergency alarms, two-way radios, and personal bright flashlights to enhance safety.

• Establish a no-weapons policy in patient homes. If such a policy is not required, request at a minimum that, before service is provided, all weapons be disabled, removed from the area where care is provided, and stored in a secure location.

• If possible, visits in high-crime areas should be scheduled during daylight hours.

Some recommendations for visiting Nurses:

•Acknowledge the person’s feelings.

• Avoid behaviors that may be interpreted as aggressive (for example, moving rapidly or getting too close, touching unnecessarily, or speaking loudly).

• If possible, keep an open pathway for exiting.

• Trust your own judgment; avoid situations that don’t feel right.

• If you cannot gain control of the situation, take these steps: Shorten the visit. Remove yourself from the situation. If you feel threatened, leave immediately.

• Use your cell phone to call your employer or 911 for help (depending on the severity of the situation).

• Report any incident of violence to your employer.

• If you are being verbally abused, ask the abuser to stop the conversation.— If the abuser does not stop the conversation, leave the premises and notify your employer.

• Consider working in pairs in high-crime areas.

• Always let your employer know where you are and when to expect you to report back.

• During the visit, use basic safety precautions:— Be alert.— Evaluate each situation for possible violence.— Watch for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drugs or alcohol abuse, or the presence of weapons.

• Maintain behavior that helps to diffuse anger:— Present a calm, caring attitude.— Do not match threats.— Do not give orders.

We view Nurses and healthcare workers as heroes and we should appreciate the essential work that home visiting Nurses provide by making sure they can safely do their job and feel comfortable enough to notify management when they aren't safe.

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Topics: home care, visiting nurse, nurse safety, Violence Prevention in Home Care Nursing, at home care, home care nursing, violence in the workplace

Quality Patient and Nurse Safety

Posted by Erica Bettencourt

Mon, Oct 30, 2017 @ 03:43 PM

nurse-safety.jpgNurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team but, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient. This means Nurses have the critical role in ensuring a patient's safety.

Nurses ensure their patient's safety by monitoring them for clinical deterioration, detecting errors, understanding care processes, and performing countless other tasks. There are many ways to help you achieve quality safety for yourself and your patients. Here are a few...

Nurse-to-patient ratios

According to Agency for Healthcare Research and Quality, assigning increasing numbers of patients eventually compromises a Nurses' ability to provide safe care. Several seminal studies have demonstrated the link between Nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and even mortality as the number of patients per Nurse increases. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum Nurse-to-patient ratios; in California, acute medical–surgical inpatient units may assign no more than five patients to each registered Nurse.

Safe and healthy workplace

OSHA, which enforces the Occupational and Safety Health Act of 1970, ensures employers are providing a safe and healthy workplace for workers and comply with OSHA’s regulations. Some of the obligations include:

• Complying with your employer’s policies and procedures based on its obligations under OSHA;

• Using personal protective equipment, including masks, when indicated;

• Informing your Nurse manager and others designated in the facility policy of workplace violence (e.g., bullying, intimidation, verbal abuse);

• Using proper body mechanics when lifting, pushing wheelchairs or otherwise working with patients;

• Reducing risks for slips, trips or falls by removing obstacles, wiping up wet walking surfaces and wearing shoes that support your feet and your walking;

• Speaking with your Nurse manager and CNO when policies and procedures governing safety are not being followed.

Overtime and long shifts

It is common for hospitals and clinics to request that their Nursing staff work overtime. While working overtime can be an effective solution to a Nursing shortage, it also can present a number of problems. Nurses risk becoming burned out, tired and/or stressed if they take on too much overtime.

 A study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The most common medication errors identified in the study due to Nurse fatigue were wrong doses, dose omission and extra doses.

Communication

Health care teams that communicate effectively and work togehter reduce the potential for error, resulting in an improved clinical performance. According to the American Hospital Association,  A key aspect in improving teamwork and communication in health care is engaging patients and families. Increasingly, research shows a correlation between increased patient and family engagement and fewer adverse events. Determining how patients and families want to be involved in their care and then engaging them in designing their plan of care increases their understanding of tests, procedures, and anticipated care outcomes, including a successful discharge.

If you have any questions about patient or staff safety, please click below to ask your question and a Nurse Leader will respond.
Click Here To Ask Question

Topics: patient safety, nurse safety

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