Nursing CE Central
Violence against nurses has risen to a level never seen before in Terry Foster’s 45 years of nursing. As the president of the Emergency Nurses Association, Foster has seen so much violence it has become a morbid norm “that happens in the emergency department on a regular basis.
The U.S. Bureau of Labor Statistics found that in 2018, healthcare workers experienced 73% of all nonfatal injuries from workplace violence. Unfortunately, these cases are only becoming more common over time, with 58% of nurses in one study reporting an increase in violence since COVID-19.
This week, the Columbus Regional Hospital reported that there had been 100 incidents of violence against staff on the job this year, compared to 86 incidents during the same period last year, and 84 incidents in all of 2021. The hospital’s staff are also finding that the severity of violence is increasing.
Studies have found that nurses are the primary victims of workplace violence, especially those in emergency departments. Why is this, and what can be done to protect the nurses who keep patients safe?
Violence in healthcare settings disproportionately affects nurses. One study published in January found that 40% of healthcare workers have experienced workplace violence in the last two years. Of those workers who experienced violence, 60% were nurses.
When dealing with a combatant patient, one study found that 62% of nurses were scratched, bitten, or hit; 21% had patients throw objects; 14% experienced sexual assault/harassment; and 1% were shot using a firearm.
Many issues can be attributed to workplace violence such as poor communication, inadequate security, financial burdens, etc. These problems are not the fault of nurses, but patients may displace their anger onto them in times of duress.
The effects of workplace violence on nurses can be difficult to overcome. Whether the injuries are physical or nonphysical, the stress can negatively affect nurses’ mental health, erode their confidence, and interfere with patient care.
According to NDNQI, the National Database of Nursing Quality Indicators, the departments with the highest number of assaults are psychiatric units, pediatric units, and emergency departments. Emergency department staff are 5 to 12 times more likely to experience physical violence than other fields.
Stress plus the high acuity of the ED means patients sometimes misconstrue what we can do, and how quickly we can do it, for them. When their expectations are not met, it leads to frustration, which they sometimes take out on providers.
– Dr. Nyema Woart, DO, emergency medicine
Another study found that 63% of emergency department violence occurred in the waiting room. These cases are attributed to high levels of anxiety and stress by patients during long waits.
Terry Foster discussed his own role in redirecting violence in the emergency room, stating “I don’t want you hitting one of our young nurses. And that’s a protective father stance or whatever it is. But that poor girl or young guy is trying to help you. And you’re going after them? No way. No way. It’s very, very frustrating.”
The American Nursing Association published a handout on workplace violence, stating that general OSHA guidelines are insufficient at protecting healthcare employees as they are not enforceable. This leaves healthcare employees and employers without necessary clarity on the expectations for reducing workplace violence.
In April of this year, the Safety from Violence for Healthcare Employees or the SAVE Act was reintroduced. SAVE was originally proposed in June 2022 as a bipartisan bill that aims to grant hospital employees the same federal protections as aircraft and airport workers.
SAVE will attempt to deter hospital violence with severe penalties such as fines and up to 10 years of imprisonment for general assault or up to 20 years for assault with a dangerous weapon. It also proposes new grant programs that hospitals can spend on programs that reduce violence and intimidation.
This bill has been supported by the president/CEO of the American Hospital Association (AHA) and the CEO of the American Organization for Nursing Leadership (AONL). AONL’s letter states that nurses are leaving direct patient care due to workplace violence and intimidation.
There are other similar bills like the Workplace Violence Prevention for Health Care and Social Service Workers Act that would mandate health care and social service employers implement a comprehensive workplace violence prevention plan.
Awareness is another method that could aid in reducing workplace violence. Healthcare professionals may be in denial about the risk of workplace violence, leading to 72% of victims not being able to foresee the violent incident before it occurred. Preparing healthcare professionals for their increased risk of violence could help them safely prepare for or manage potentially violent situations.
De-escalation is a common technique nurses are encouraged to use when dealing with frustrated, potentially violent patients. Terry Foster stresses the importance of de-escalation, asking “do you want to be right? Or do you want to be at peace?”
However, de-escalation training itself may present a problem, as one nurse states that nurses may not report an assault due to fear of retaliation when employers overly focus on whether proper de-escalation training protocols were followed.
Workplace violence in healthcare facilities is a tragic trend that must not continue to be normalized or swept under the rug. Nurses are now being encouraged to speak up and report any violence they experience.
Giving more attention to this rising problem will hopefully prioritize change that better protects nurses and gives them the peace of mind to work without fear of intimidation or violence.
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