Combatting Workplace Violence

Attacks against nurses are not just part of the job

A nurse looks overwhelmed in scrubs, gloves, and a mask. She has her hands up as if preventing someone from hitting her

Even before the outbreak of COVID-19, some nurses felt that walking into work every day posed a threat to their health and safety.

More Dangerous Than Policing

Statistics from the federal Department of Labor reveal that nurses are at greater risk of being assaulted during their shift than are police officers! Nurses trying to provide kind, compassionate care may be hit, punched, kicked or spat on.

COVID-19 has only made matters worse. Vocera Chief Nursing Officer Rhonda Collins, RN, DNP, FAAN, recently described the current healthcare environment as “a pressure cooker of human response.”

Patients are critically ill, and families are unable to be with their loved ones. Nurses are fighting to keep themselves safe from a highly contagious disease, sometimes without the necessary equipment and support to do so. It’s a situation that almost invites overreaction and conflict.

Now more than ever, we need to talk seriously about workplace violence and what we can do to stop it.

Grim Statistics

Nurses know that the impact of workplace violence involving healthcare workers is very real.

According to a 2015 OSHA report:

  • 21 percent of registered nurses and nursing students report being physically assaulted.
  • 80 percent of assaults are committed by patients.
  • Registered nurses are four times more likely to be assaulted than are workers in other industries. Nurses experience an average of 14 violent injuries resulting in days away from work per 10,000 fulltime employees (compared with an average rate of 4.2 injuries per 10,000 fulltime employees for all U.S. private industry).
  • Across several healthcare occupations, the most common causes of violent injuries are hitting, kicking, beating and/or shoving.

Those numbers have been rising over the past 15 years. A 2015 study in the CDC journal Morbidity and Mortality Weekly Report found that between 2012 and 2014 alone, the rate of violent injury for nurses and nursing assistants almost doubled.

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When it comes to the violence facing nurses at work, statistics tell only part of the story. The profession of nursing is centered around caring, which can be extremely difficult to practice when we are afraid for our safety. Violence against nurses strikes at the very heart of what we do.

“Elise’s Law”

Many states have passed laws making assaulting a healthcare worker a felony or have increased penalties for such assaults, especially for repeat offenders. (The California Legislature passed such a measure in 2015, but it was vetoed by then-Governor Jerry Brown.)

In 2017, Massachusetts passed “Elise’s Law” after nurse Elise Wilson, RN, was stabbed 11 times by a patient. That law requires that employers develop workplace violence prevention plans and provide employees with paid time off to deal with legal issues.

The law also requires that warning signs be posted in hospitals, sending the message that violence will not be tolerated.

Yet, all too often, it is.

“In my experience as a frontline nurse, workplace violence became commonplace; somehow both shocking and expected each time,” says Brittany Turner, RN, MSN, nurse planner for the Ohio Nurses Association.

“Oftentimes, the shock factor came from the response from my coworkers pressuring me to tolerate violence as a part of the job,” she adds. “We can’t change organizational response, policy or law until we change our own nursing culture.”

When Conflict Sparks

Nurses in many practice settings may face a variety of emergent, rapidly escalating, sometimes dangerous scenarios.

Drug and alcohol withdrawal/detoxification, mental health emergencies and altered mental states can all potentially lead to violent situations — even if the patient has no history of violence. Patients or family members under high levels of stress may also present an elevated risk of violent confrontation.

Nursing Education

Across the country, people have come to blows over COVID-19 infection control measures in supermarkets and convenience stores, so the potential for violence in a healthcare environment, where the stakes are even higher, is great.

While we cannot control the actions of everyone who enters our care, we can empower our nurses with appropriate de-escalation techniques. Needed, too, is greater access to resources for managing potentially violent situations, whether that means increased staff with specialized training, increased security or other effective safety protocols.

After an Attack

Nurses need to be prepared in the event a violent act does occur. As with any emergency, response time is crucial. Rhonda Collins emphasizes the importance of organizations’ implementing protocols and technologies that cut response time in critical moments when nurses need assistance. The sooner reinforcements and resources are available, the sooner a violent situation can be safely resolved.

Once the incident is over, the nurse involved should be the priority. Experiencing a violent assault, whether physical or verbal, is traumatic. It is a serious incident and should be treated as such, each and every time.

The healthcare profession has begun to acknowledge the importance of trauma-informed care, but we are often slow to apply this evidence-based, compassionate approach to our own colleagues.

Nurses who seek help or resources are not weak. They should not be derided as “emotional” or “dramatic” for needing help. They were assaulted, and should be treated accordingly. Nurses must move away from shame, bitterness and recrimination and strive to create an atmosphere of openness and support for the victims of violence.

Reporting should be encouraged, regardless of the situation; reporting allows for proper investigation of the situation and helps institutions develop better procedures for dealing with future incidents. It is critical that nurses understand how to report an incident and are never deterred from doing so.

Time to Do Better

We have to support each other in these times of crisis. Workplace violence should never be considered “just part of the job.” We need to treat these incidents with the seriousness they deserve and stop sweeping workplace violence under the rug. Changing this picture starts with us.

JESSICA DZUBAK, RN, MSN, is the director of nursing practice for the Ohio Nurses Association and a freelance writer specializing in the healthcare industry.

JASMIN MORA is a Los Angeles-based illustrator. Reach her at www.jasminmora.com.

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