Workplace safety has become a top concern for nurses and direct care professionals. To attract and retain the best talent, healthcare leaders should promote an inclusive work culture that meaningfully engages clinicians and caregivers in violence prevention programs.
Barriers to staffing and career satisfaction
Incidents of workplace violence—physical acts, intimidation, and threats—have reached epidemic proportions in the healthcare industry. According to a 2020 Bureau of Labor Statistics report, healthcare workers incur 78 percent of all nonfatal workplace injuries that lead to missed workdays in the US.
In a National Nurses United 2023 survey, nearly half of nurses reported that they experienced an increase in workplace violence over the previous year. More than 1 in 10 nurses were unaware of their employer’s violence prevention efforts, and only 1 in 10 were included in their organization’s violence risk assessment process.
Workers on the receiving end of rude, aggressive, or violent behavior are more likely to decline in performance or leave their jobs. To truly value and protect our clinicians and caregivers, healthcare organizations need to meaningfully involve them in workplace safety conversations.
Engaging clinical staff in the decisions that affect them is not only the right thing to do; it is what works.
Culture’s role in safety strategies
I have convened interactive groups of safety leaders in our home health care organization to study and work on the prevention and de-escalation of workplace violence, with an emphasis on effective teaming. We are learning that physical safety hinges on psychological safety, and psychological safety hinges on culture and communication.
To illustrate, our organization maintains a 24/7 on-call telephone system in case questions or incidents arise. But if caregivers were to question the utility or possible ramifications of proactively speaking up, those systems would break down.
Relationships, effective teaming, and two-way communication are key, and a caring culture is what makes all the difference. Not just a corporate values statement posted on the wall, but a set of mutual commitments to each other that are lived and internalized. A shared experience of trust and respect can hold teammates together and set an organization apart.
Understanding the safety team process
Harvard Business School’s leading authority on psychological safety and teaming in organizations, Amy Edmonson, describes psychological safety in the workplace as an environment of candor, where workers can be direct, take risks, and not be afraid to ask questions or to admit mistakes. Research cited in Clapper, Merlino, and Stockmeier’s safety guide, Zero Harm: How to Achieve Patient and Workforce Safety in Healthcare, makes a direct connection between such a supportive culture and fewer adverse patient care incidents.
I will share how culture promotes psychological safety and effective teaming in our organization, but first: Why is culture such a critical component?
A violent incident usually comes with some kind of warning—what safety and security expert Gavin de Becker calls a “pre-incident indicator.” These indicators are important data points, and their human detection is largely intuitive. Someone made you uncomfortable, or the way they interact with your patient, or how your patient’s demeanor changes in their presence, gave you bad vibes. Clinicians are empathetic and perceptive, and it would be a missed opportunity not to listen to their gut feelings.
Older models of how health care organizations gather and investigate incident reports were not built for that. But as we evolve our teamwork around workplace safety, our driving tenet is that everyone should feel like their voice is important and their experiences are worth sharing.
Early detection enables better intervention and prevention, and every recorded data point helps to find trends and insights.
Inclusive safety solutions
Following Edmonson’s lead, we are thinking about safety teaming “as both a mindset and a set of behaviors that share and synthesize knowledge.” Edmonson categorizes those behaviors as a continuous cycle of 1) Speaking up, 2) Collaboration, 3) Experimentation, and 4) Reflection.
For us, this includes monthly Clinical Advisory Board meetings with clinicians from nationwide service offices and specialty practices; monthly Safety Squad meetings with clinical leaders and heads of employee engagement and organization development, where evidence-based safety practices are considered; and monthly Roundtables with local clinical managers across the US.
These touchpoints, plus anonymous all-staff surveys, take the pulse of service and support employees and make sure they are getting what they need. For example, we are working on pre-assessing care settings; refusing derivations from very specific care plans; extra precautions, protective equipment and devices; high-priority tools for threat response; and removing barriers that lead to underreporting.
Per Edmonson, teaming is a dynamic activity created by attitudes—that is the important culture piece. We mitigate the fear of shame, blame, or being a nuisance to keep actionable communication flowing, and that kind of psychological safety comes largely from assuming positive intent. Strong culture programming embraces an attitude of continuous improvement where every colleague, at every level, feels safe to speak and confident that they can make a difference. Our high employee engagement scores are a key performance indicator.
We are finding that investments in diversity, equity, inclusion, and belonging (DEIB) programming promote psychological safety and lead to fuller participation and contribution as measured by program feedback, Newsweek scores for workplace diversity, and psychological safety questions on our employee experience survey.
We are preparing clinicians for success with vastly popular Renewal Retreats that review self-care basics, stress management, and intervention and de-escalation strategies. We received a great response to new safety trainings, leading to more role playing and scripting tools, by job role, to respond to inappropriate care requests. And we make sure workers know we have their back with team supports, Employee Assistance Program services, and a charitable Employee Relief Fund.
A new text distribution of short safety microlearnings has been well received, and we are advancing mobile access to clinical and disease information, instructional videos, and robust intervention strategies.
The common, authentic message is this: Employee well-being is our top priority. When your clinicians and caregivers truly believe that, then your organization can chip away at the friction in its safety team cycle.
Amanda Tilton
Mandy Tilton is the Chief Nursing Officer at BAYADA Home Health Care. She is a certified professional in patient safety (CPPS™) as well as a certified nephrology nurse (CNN®). She earned a doctor of nursing practice (DNP) degree at Bradley University in Peoria, IL and her BS, RN, MSN, and MBA at Lewis University in Romeoville, IL.
