Preventing Workplace Violence

Unfortunately, this necessary part of the job exposes nurses to a higher risk of violence than other workers. The U.S. Bureau of Labor Statistics reports that health care workers are 5 times more likely to experience workplace violence.

According to The Joint Commission, workplace violence (WPV) includes:

• Aggressive behaviors like yelling or throwing things
• Bullying, harassment, or intimidation
• Physical assault
• Sexual assault or harassment
• Written or verbal threats

WPV seriously impacts the health and well-being of nurses. It also affects their ability to care for patients and can lead to burnout and turnover. By forming a committee dedicated to the safety of healthcare workers, organizations can help empower their employees to report violence. This creates a stronger, safer workplace.

Many Violent Incidents Go Unreported
Sadly, WPV is on the rise. In a recent study by health care improvement company Premier, more than 50% of health care workers reported an increase in WPV during their tenure.

The work to reduce and prevent WPV incidents starts with reporting them, yet many nurses don’t. In fact, a study by the Occupational Safety and Health Administration (OSHA) [PDF] found that up to half of all occurrences aren’t reported.

Unreported acts hamper the ability of health care organizations to fully understand the risk of WPV and take action to prevent future incidents.

There are multiple reasons why nurses don’t report WPV, says #healthynurse Dawn Fletcher, DNP, RN, NEA-BC. Dawn is a nurse administrator at the Mayo Clinic in Jacksonville, Florida. She is also a nursing instructor at the Mayo Clinic College of Medicine and Science. Dawn serves on the WPV committee for ANA and is chair of the American Academy of Ambulatory Care Nursing (AAACN) Workplace Safety and Workforce Well-being Special Interest Group.

Dawn cites 2 reasons why nurses may not report a violent incident:

Unintentional acts of violence
According to Dawn, nurses don’t always report incidents that result from “unintentional” acts. An unintentional act could include aggressive or violent behavior from patients with dementia or those who wake up from anesthesia feeling disoriented.

“Often, those things are dismissed as part of the job,” says Dawn. “But they are not part of the job. They are examples of workplace violence.”

Bullying and intimidation
Another example of unreported WPV is in cases of bullying — especially when it’s done by a colleague or superior. A nurse experiencing bullying may feel uncomfortable facing their aggressor or worry about losing their job if they report it.

“We tend to be conflict-avoidant as people,” says Dawn. “We’re not all taught how to deal with these situations.”

A Silver Lining
The good news, according to Dawn, is that there is a growing conversation in the health care industry around preventing WPV. This could be why the number of reported cases continues to rise.

“People are tired and burned out and don’t want to accept it anymore,” she says. “They are being more intentional about reporting the violence they’re seeing.”

Safety Committees Create Safer Environments for Nurses and Health Care Workers
So, how can health care organizations encourage more reporting, implement effective policies, and protect their workers?

This falls under the umbrella of a safety committee, says Dawn.

“Many organizations have a committee, subcommittee, work group, task force, or similar team set up to address employee safety and workplace violence,” she says.

The American Hospital Association (AHA) offers a framework [PDF] for safety committees to address WPV. It includes:

• Creating a culture of safety by prioritizing the physical and psychological safety of employees and patients
• Mitigating risk by educating and training staff to recognize, report, and respond to threats
• Preventing violence by conducting risk assessments, setting up reporting and data collection protocols, and creating action plans to address threats
• Providing trauma support for workers who experience or witness violence in the workplace

According to Dawn, having executive leadership buy-in at the system level is key. Their support helps ensure the success of the safety committee and the WPV prevention program.

Dawn says it’s also important for the committee to include stakeholders from across the organization. These could include:

• Administrative representatives
• Clinical representatives from high-risk departments
• Human resources personnel
• Nursing representatives
• Security personnel
• Customizing the Approach to Employee Safety
  There is no one-size-fits-all approach to WPV prevention, according to Dawn. Each organization has its own risks and threats, security needs, and types of interventions to put in place.To understand an organization’s WPV prevention needs, the safety committee must analyze data collected from frontline workers — especially nurses.

  Dawn says using daily multidisciplinary huddles to report WPV incidents is a great way to collect accurate data for the safety committee. In her experience from a previous organization, implementing daily reporting helped nurses overcome the “it’s part of the job” mentality.

  “Daily reporting normalized the process and took away any deterrent,” she says. “And then [the organization] was able to intervene in situations a lot earlier. We could do threat assessments and other things behind the scenes.”

  WPV Prevention: Tips for Smaller Facilities
  While a safety committee may be common in hospitals and large health care systems, smaller care facilities don’t always have one, says Dawn.

  Small ambulatory care settings and nursing homes face the same risks but may not know how to implement WPV programming like a large organization, she says.

  Dawn recommends these tips to get started:

  • Partner with local law enforcement. They can come into an organization and help conduct WPV risk assessments.
  • Download the OSHA checklist for workplace violence prevention policies and procedures. The checklist [PDF] can help organizations identify potential problems, risks, and threats.
  • Read The Joint Commission compendium of resources with ideas [PDF] for developing, implementing, and evaluating an organization’s WPV prevention program.
  • How Nurses Can Effect Positive Change
    Nurses play a vital role in WPV prevention and ending the abuse of health care workers. The ANA recommends nurses:
    • Participate in your organization’s prevention programming. Offer input and spread the word to increase awareness.
    • Report any acts of aggression or violence you experience or witness. Share feedback on your organization’s reporting process if improvement is needed.
    • Support legislative action at the state and federal levels.