By Carmen Kleinsmith
He’d been coming to the clinic for wound care for weeks. Gradually, the nurse manager noticed the patient’s demeanor was becoming more aggressive with each visit. Then one day she noticed he was wearing his gun.
Thankfully our health system had procedures in place, and we engaged our hospital security team to talk with the man before he returned to the clinic for his next appointment, explaining that guns aren’t allowed in our facilities. The situation ended without incident but served as another reminder of the potential for violence, harassment and abuse faced by health care workers every day when caring for patients.
Rates of serious workplace violence – requiring workers to take time off from work to recover – are four times greater in health care settings than in private industry. According to the Occupational Health and Safety Administration (OSHA), a number of factors contribute to the difference, including a greater likelihood of encountering people who are delirious, under the influence of drugs (like opioids and alcohol) or have a history of violence.
In addition, health systems like ours are treating larger numbers of gunshot and stabbing victims in our emergency departments, bringing further challenges. Local news headlines reflect the trend. Just this week our local affiliate reported, “Victim from Iowa City Shooting Walks into Cedar Rapids Hospital.” These cases often mean greater volatility and larger crowds accompanying patients – family members, law enforcement and others – adding tension to an already stressful environment.
To address these challenges, my organization is spearheading an important effort to prevent violence and abuse in the health care workplace. Beginning this year, a cross-functional team from across our health system is prioritizing plans to ensure every team member who steps through our doors feels safe at work. We are upgrading our reporting systems, making it easier to capture what happens in our hospitals, clinics and home care settings so that we can more readily identify areas of opportunity. Next steps include establishing a safety assessment baseline – to help us understand whether our people feel safe at work today. Going forward, we will revisit this data on a regular basis, monitoring for changes – positive or negative – reported by our team members.
We’re also working to standardize de-escalation training, so everyone on our team has the skills to handle conflict and resolve tense situations safely. We’ll use our electronic medical record to better evaluate patients for the risk of potentially violent behavior and communicate findings across all sites where patients receive care.
These are essential building blocks for a strong culture of safety across our health system. At the same time, our facilities teams are addressing our physical environment through enhanced outdoor lighting, additional push-button emergency alert stations, longer building lockdowns in certain locations and increased presence of security officers and dogs.
Perhaps most importantly, we’re also stepping up the direct support we provide to our staff. Soon we will implement an emotional support process, already being utilized by one of our teams, across the entire organization. When a team member reports physical violence, verbal abuse or harassment, his or her manager is trained to respond immediately to provide psychological first aid at the point of care to support the team member’s emotional wellbeing. The process includes a 30-, 60- and 90-day check-in with that team member. Work like this helps pave the way for change across our health system and the entire industry.
This is important work. Sometimes it’s scary, but we can’t let fear win. Nothing bothers me more than to see the passion of a nurse or other team member slowly fade due to fears for their safety when they’re just trying to perform their jobs. Our work won’t stop until we’ve done everything in our power to keep our teams safe from workplace violence and abuse across all the places we provide care.
Carmen Kleinsmith is the senior vice president and chief nurse executive of UnityPoint Health – St. Luke’s and also serves as the workplace violence prevention committee chair. UnityPoint Health is the nation’s 13th largest nonprofit health system and the fourth largest nondenominational health system in America.
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