Workplace Violence Takes Toll on Nursing Staff

“Staggering” is the word Renee Smith, MSN, RN, DNP, EdD(c), CEN, PHN, ACNP, TCRN, trauma program manager at St. Francis Medical Center in Los Angeles, used to describe the violence plaguing patients in the inner-city trauma unit.

St. Francis Medical Center serves an area of Los Angeles where violence — including homicides, shootings, stabbings, blunt force injuries and vehicular injuries, as well as assaults, child abuse, domestic violence, elder abuse, burns and self-inflicted injuries — impacts people of all ages, according to Smith.

“The Trauma Center at St. Francis Medical Center treats greater than 2,400 cases annually,” Smith said. “A large percentage of injuries — one of the highest in the nation — comes from that of gunshot wounds and overall assaults. The impact of violence to the community is further complicated by socioeconomic complexities, gang activity, illegal drugs and alcohol use.”

Violence takes a big toll, according to the longtime nurse. Cumulative exposure to trauma can directly and indirectly impact providers, including nurses, surgeons, physicians and others.

“The extent and how the cumulative exposure is managed can impact the overall trajectory of a provider’s career,” Smith said. “The emotional and physical toll [from] years of witnessing trauma, acutely injured patients and patients dying from horrific injuries, despite optimal care, can be devastating. When one reflects, we as human beings were never meant to see such horror.”

You must increase violence awareness

In 2016, the American Hospital Association developed the Hospitals against Violence (HAV), or #HAVhope Friday, a national day of awareness. This year, #HAVhope Friday took place on June 8. The aim is to encourage hospitals and health systems to partner with community groups to address violence and share best practices for preventing it.

Community violence is a serious public health issue directly affecting men and women at the frontlines who are caring for victims and families of assault at hospitals and health systems, said Melinda Hatton, the American Hospital Association’s general counsel.

“Estimates are that nationally at least 2.3 million people are treated every year in U.S. emergency departments for violent injuries,” Hatton said. “The toll violence takes on human life and well-being is incalculable. But to highlight the enormity of this issue as a public health problem, a study released by the AHA found that in 2016 hospitals and health systems spent approximately $2.7 billion, for which they were uncompensated, treating victims of violence along with preventing and otherwise coping with violence.”

Victims of violence often end up in hospital emergency departments, where nurses are among the frontline providers who deal with not only the medical emergency, but also the emotional, psychological and spiritual effects of assault on patients and their families.

Nurses also help connect those families and patients with the resources they need to move on, said Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, president of the American Organization of Nurse Executives and chief operating and chief nursing officer at Midland Health in Midland, Texas.

Just as communities vary, so do the causes and effects of the attacks. As a result, there is no single solution to stopping violence.

But if we work together we can make our communities and workplaces healthier and safer, Hatton said.

“Becoming involved with the community is the answer,” Smith said. “Education, employment training and successful prevention programs with a willingness to change are answers.”

The American Hospital Association’s webpage exploring street and gang violence offers several webinars and podcasts showcasing how hospitals and systems are partnering with communities to stop violent acts.

The page includes podcasts featuring University of Maryland Medical Center experts describing the way the medical center “uses an individual’s admission to the hospital from violent injury as an entry point to start intensive case management with the victim and surround him or her with the social and medical support needed to reduce risk and recidivism.”

Another example of American Hospital Association members making a difference is John H. Stroger Jr. Hospital of Cook County.  The hospital collaborated with The University of Chicago Medicine Comer Children’s Hospital and the Center for Nonviolence and Social Justice at Drexel University in Philadelphia to start a hospital-based violence intervention program called Healing Hurt People-Chicago.

The program’s goal is to help youth who have been physically and emotionally harmed by violence get needed access to intensive case management, group therapy and mentoring, according to American Hospital Association.

Be alert and prepared to act when attacks occur

Nurses and hospitals need to be alert to the possibility of violence, Dent said.

“We need to be aware that a patient may be a victim of violence and ask the right questions. In their assessment, nurses should look at the cues that the patient may be a victim,” Dent said. “Oftentimes, victims of sexual abuse or human trafficking may be reluctant to speak up.”

Situational awareness helps nurses prevent further violence after victims come into emergency rooms or are admitted to hospitals, Dent said. Tensions are high among patients and their families who have experienced violence, and more violence, including retaliation, are real possibilities when patients enter hospitals and hospital systems.

Being situationally aware helps to identify potential threats. Hospital-based prevention and training programs help to protect the workplace practice environment, staff and other patients, Dent said.

“It’s not just in the emergency room, but we’re seeing violence against nursing staff in pretty much all areas of the hospital,” Dent said. “So, it’s being aware and having everything that nurses and staff will need to have a safe working environment.”

The big problem of violence is calling for big measures, Dent said.

“Increasingly, what we’re finding is that hospitals are putting police departments into their workplaces. It has gotten to where, in a lot of cases, having a security department may not be enough,” Dent said. “So there are full-fledged police departments with a police chief, video surveillance and folks watching that on a regular basis.”

There’s also the need to emphasize civility, Dent said.

Dent and colleagues at the Tri-Council for Nursing developed the Nursing Civility Proclamation that calls on nurses to “recognize Nursing Civility and take steps to systematically reduce all acts of incivility in their professional practice, workplace environments and in our communities.”

“It’s about treating people with civility,” Dent said. “Just be nice, regardless of who the other person might be. Then, there’s a call-to-action that, as nurses, it’s not just about practicing nursing within the four walls of a hospital. We’re nurses 24-7. Whether we’re on a flight across the country or at a community event, whatever it may be, we’re nurses. As professional nurses, we can collaborate with our community to stand against all forms of violence and treat people nicely. By being involved, nurses can model what is right.”

Resources that can help you address violence

  1. American Organization of Nurse Executive’s webpage on workplace violence includes “Guiding Principles on Mitigating Violence in the Workplace,” released by the American Organization of Nurse Executives and the Emergency Nurses Association in 2015 to offer a framework to reduce lateral and patient and family violence in hospital settings.
  2. The CDC also offers a violence prevention section on its website with resources and prevention strategies for different types of violence, from child abuse and neglect to elder abuse.
  3. Read tips you can apply in your hospitals and share with your staff in our Prevent Workplace Violence digital edition.