Workplace Violence

Dealing with Patient Violence in Today’s Workplace

As a new nurse, I can clearly remember two events that dealt with patient violence.

Personal anecdote #1:

I was still in nursing orientation.  I was a brand new LPN and hadn’t even taken the NCLEX-PN yet.  My preceptor and I came onto the unit. The unit was abuzz with chatter.

“Did you hear about Betty?”  (Name has been changed.)  

As it turned out, a patient had become confused from a medication he received and as a result, became violent.  He cornered Betty and twisted her arm, breaking it. Betty ultimately required surgery and was out of work recovering for several months.

Personal anecdote #2:

After I had graduated with my RN, I was also newly on nursing orientation.  I was taking care of a patient with “sundowner’s” and this particular patient was still alert and oriented when I rounded at the beginning of my shift and performed my initial assessment.

An hour later, sitting down to chart, the patient came out to the nurses’ station.  He was clearly not the same patient I had met with an hour before. He ranted and raved, then came behind the nurses’ station before I could get out.  

The patient cornered me between the desk and the tube system.  He tried to punch me but only caught me with his fingertips before another nurse was able to pull him away.

Patient Violence, by the Numbers

In both of these instances, the patients were confused.  In the anecdote that directly involved me, perhaps it could have been prevented – I knew the patient suffered from “sundowner’s” – as a rookie RN, there were tactics I could have used to prevent the patient from getting out of bed, such as using a posey alarm or a bed alarm.

But does this make it right?

According to the Occupational Health and Safety Administration, serious workplace violence is more common in healthcare than in any other private sector industry.  Managed Care Mag states, “The health care and social assistance sector recorded almost eight cases of serious workplace violence per 10,000 full-time employees in 2013, compared with two cases per 10,000 workers in fields such as construction, retail, and manufacturing.”

American Nurse Today also reports the following statistics:

  • The emergency department (ED) and psychiatric nurses are the most at risk for patient violence.
  • 67% of nonfatal violence occurs in healthcare – but healthcare jobs only contribute to 11.5% of the total workforce.
  • Upwards of 25% of psychiatric nurses experience disabling injuries related to workplace violence during their careers.

OSHA states, “…the spectrum [of violence]…ranges from offensive language to homicide, and a reasonable working definition of workplace violence is as follows: violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.”

How can we prevent workplace violence from occurring?

Proper Communication

In nursing school, we are taught how to communicate with patients and with each other.  Sometimes these skills are tossed to the wayside, especially if we work in high-stress environments because the focus is on stabilizing the patient rather than having a therapeutic conversation.

However, it is important to remember how to speak with patients – being calm, supportive, and building rapport can help to de-escalate a potentially violent situation.

Here are some great strategies from Managed Care Mag:

  • Validate feelings and respond to requests in a timely manner
  • Show respect by introducing yourself.  Address your patients formally (Mr., Mrs., Ms.) unless requested otherwise.
  • Explain care prior to providing and allow time for questions.
  • Pay attention to body language and tone of voice.
  • Offer choices whenever possible.
  • Listen to what patients say.
  • Discuss concerns and address them if possible

It is not always possible to de-escalate a patient with communication.

Request Training

There are some facilities that receive formal training on de-escalation to prevent violent situations.  For example, Massachusetts General and the Veterans Health Administration (VHA) both have such programs in place.

The VHA’s program “…includes training employees to de-escalate violent situations to keep employees, patients, and visitors safe; establishing a system to report patients whose behavior causes concern; assessing if a patient actually poses a threat to staff; and establishing a clinical management plan for treating that patient.”

Massachusetts General uses a computerized system to identify patients that are at risk for violence.  In addition, they have music and colors in certain areas of the hospital to reduce stress to at-risk patients.

Legislation

Depending on the location of patient-to-nurse violence, the patient could be penalized.  There are upwards of three dozen states that have legislation in place that allows for penalties to a patient who assaults nurses or other healthcare personnel.

For example:

  • In Florida, assaults to healthcare personnel may be upgraded based on the type of assault.
  • In California, a log of violent incidents must be kept and violence prevention plans must be in place.  All violent incidents must be reported to Cal/OSHA.

The Bottom Line…

As the old adage says, “Nothing changes if nothing changes.”  We must advocate for change, especially in areas of the U.S. where legislation is not happening, where our healthcare staff is literally being beaten without consequences. 

Resources

Bromley, G., Federspiel, K.A., & Locke, L.  (2018, May). Patient violence: it’s not all in a day’s work.  American nurse today.  Retrieved from https://www.americannursetoday.com/patient-violence/

Ladika, S. (2018, May 8). Violence against nurses: casualties of caring. Retrieved from https://www.managedcaremag.com/archives/2018/5/violence-against-nurses-casualties-caring

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