VIOLENCE IN THE WORKPLACE: NURSING

Heather Hulien NURS 450

VS

OBJECTIVES

Define workplace violence

Discuss theories from nursing and other disciplines that relate to violence in nursing

Explore the healthcare environment and develop a root cause analysis

Review consequences and implications of violence in nursing

Discuss recommendations for improvement

Discuss QSEN competencies and ANA standards related to violence in nursing

WHAT DO YOU CONSIDER WORKPLACE VIOLENCE?

Bullying

Verbal Threats

Written ThreatsHarassment

Gestures

Verbal Abuse

Throwing Objects

Swearing

Insults Condescending Language

Physical Attacks Shoving

Hitting

Kicking

Spitting

Pushing

Intimidation

Humiliation

Embarrassment

Destroying property

Rumors Pranks

Vandalism

Theft

Sexual harassment Rape Arson

Murder

Gossiping

Stalking

DEFINITIONS OF WORKPLACE VIOLENCE The National Institute for Occupational Safety and Health (NIOSH) - "...any physical assault, threatening behavior, or verbal abuse occurring in the work setting" (NIOSH, 1996).

The World Health Organization (WHO) and the International Council of Nurses (ICN) -"...incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health"

Type 1: Violence by stranger with criminal intent

Type 2: Violence by a customer or client

Type 3: Coworker (worker-to-worker) violence Lateral/Horizontal Violence

Type 4: Personal relationship

http://www.youtube.com/watch?v=SEcaD4gypFs http://woodtv.com/2014/03/26/nurse-stabbed-in-parking-ramp-suspect-on-the-run/

NURSING THEORY Dorothy Johnson: Behavioral System Model

ASSESSMENT OF THE HEALTH CARE ENVIRONMENTNo federal standard that requires workplace violence preventionAccepting attitude toward violence in nursing- “It’s part of the job.” Reports of violence are often not taken seriously or thoroughly investigated by managers and supervisorsLack of laws protecting nurses against violence

MATCHING

1.) A “simple” assault or assault and battery of a police officerB- 2 years; $2,000

2.) A “simple” assault or assault and battery of a healthcare workerA- 93 days; $500

3.) An assault of a police officer that causes a bodily injury requiring medical attentionC- 4 years; $5,000

4.) An unarmed assault of a healthcare worker that inflicts serious or aggravated injury D- 1 year; $1,000

A.) A misdemeanor punishable by imprisonment for up to 93 days and/or a $500 maximum fine

B.) A felony punishable by imprisonment for up to 2 years and/or a $2,000 maximum fine

C.) A felony punishable by imprisonment for up to 4 years and/or a $5,000 maximum fine.

D.) A misdemeanor punishable by imprisonment for up to 1 year and/or a $1,000 maximum fine

“Health care workers are more

likely to be attacked at work than prison guards or police

officers. Nurses are the health

care workers most at risk”

ROOT CAUSE ANALYSIS Roland is a nurse working in the emergency department of a local hospital in a midsize town. Among the physician staff there, Dr. Johnson is

known to be difficult to deal with. He is an angry man ever since his daughter was killed in a car accident caused by a drunk driver ten years ago.

He is rude and obnoxious both to staff and patients.

This evening, Roland is working in trauma room 1 and needs to obtain a piece of equipment from trauma room 3. The door to room 3 is closed, as

Dr. Johnson is suturing a patient there. Roland knocks on the door and opens it slowly, excuses himself, and announces his need to obtain

equipment from the room. Abruptly, Dr. Johnson gets up, walks to the door, and slams it shut, hitting Roland in the face and crushing his wire-rim

glasses. As a result, Roland must delay treatment for the patient he was caring for in room 1.

No action has ever been taken in regard to Dr. Johnson’s violent behavior despite Roland and the other nurses in the emergency department having

reported such behavior many times before. The department manager has told the nurses that Dr. Johnson is dealing with grief and that they should

understand what he is going through. After all, the ED is already understaffed with nurses and doctors, and it is hard to find doctors to staff the ED.

Dealing with such situations is just “part of the job.” As a result, the nurses have become resigned to this physician’s behavior and try to avoid any

interaction that might cause him to abuse them. After this latest incident, Roland complains to his coworkers but does not report it.

Seeing too many such scenarios go unreported and get swept under the rug, another nurse decides to contact the new medical director, Dr.

Bachhuber. The next day, Dr. Bachhuber calls Roland into her office and asks about the recent incident with Dr. Johnson. Roland is asked to

complete an incident report describing what happened. The medical director tells him there will be an investigation carried out to determine the

extent of the problem, offers to have Roland evaluated medically, and assures him that his glasses will be replaced at the hospital’s cost if necessary

ROOT CAUSE ANALYSIS

“It’s part of the job”

Incidences do not get reported

Manager does not take action to address issues

Difficult to staff the ED

Death of daughter

Nurses have become resigned to the physician’s behaviorED understaffed Lack of

emotional support for the physician?

Worker-on-worker violence

INTERDISCIPLINARY THEORY Theory of Learned Helplessness

Martin E.P. Seligman

“Animals and people actively learn that outcomes are uncontrollable, leading to the development of an expectation for non-contingency that results in subsequent motivational, cognitive, and emotional deficiencies.”

IMPLICATIONS AND CONSEQUENCESNurses leaving the field

Post Traumatic Stress Disorder

Decreased performance after a violent event

Severe injuriesEvelyn Lynch Andy Hull

Death Gail Sandidge

RECOMMENDATIONS Bills need to be passed

All hospitals need to have violence prevention programs

Hospitals need to increase security

Nurses need to do their parts!

What can I do? I’m just a nursing student!“The Henry Ford Hospital in Detroit

implemented metal detectors in an effort to prevent weapons from entering the facility. In

their first 6 months of screening, officials confiscated 33 handguns, 1324 knives, and 97

chemical sprays”

ANA STANDARDS

Standard 8: Education The registered nurse attains knowledge and competence that reflects current nursing practice.

Standard 11: Communication The registered nurse communicates effectively in a variety of formats in all areas of practice.

Standard 15: Resource utilizationThe registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective and financially responsible. 

QSEN COMPETENCIES

Teamwork and Collaboration Knowledge: Discuss effective strategies for communicating and resolving conflict

Skills: Initiate actions to resolve conflictAttitudes: Contribute to resolution of conflict and disagreement

Quality Improvement Knowledge: Describe approaches for changing processes of careSkills: Use measures to evaluate the effect of changeAttitudes: Value local change (in individual practice or team practice on a unit) and its role in creating joy in work

WHAT DID YOU LEARN?? 1. What are the 4 types of workplace violence?

Stranger, patient, worker-on-worker, personal relationship

2. What type of violence is most common in the healthcare setting?

Type 2- patient

3. How many states require employers to provide violence prevention training?

Seven states

4. What is one reason why many nurses do not report violent events?

Won’t change anything, fear of being fired, fear of being blamed, worried about incident being seen as incompetence

5. Is assaulting a nurse in Michigan a misdemeanor or a felony?

Misdemeanor

6. What are two consequences of violence in nursing?

Nurses quitting, PTSD, decreased performance, injuries, death

Bonus question: How many days until graduation day???

37!

ON THE BRIGHTER SIDE…

http://www.youtube.com/watch?v=2M3ZniK8u-Y

References

American Nurses Association. (2014). Workplace violence. Retrieved from http://nursingworld.org/workplaceviolence

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Gates, D. M., Gillespie, G. L., & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29(2), 59-66. Retrieved from

http://www.nursingeconomics.net/ce/2013/article29059066.pdf

Health behavioral theory. (2013). Retrieved from http://www.nursing-theory.org/theories-and-models/johnson-behavior-system-model.php

Kvas, A., & Seljak, J. (2014). Unreported workplace violence in nursing. International Journal Review , 61(3), 344-351. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/inr.12106/pdf

Lancotot, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and Violent Behavior, 19(5), 492-

501. doi: 10.1016/j.avb.2014.07.010

Michigan Nurses Association. (2013, June 6).Legislation & politics news: Workplace violence legislation passes senate. Retrieved from

http://www.minurses.org/legislation-&-politics/news/p/openItem/5431

Nelson, R. (2014). Tackling violence against health-care workers. The Lancet, 383(9926), 1373-1374. doi: 10.1016/S0140-6736(14)60658-9

Strickler, J. (2013). When it hurts to care:workplace violence in healthcare. Nursing, 43(4), 58-62. doi: 10.1097/01.NURSE.0000428329.78235.6f

Swan, J., & Mitus , M. C. (2014). Workplace violence. Retrieved from http://www.nursingceu.com/courses/455/index_nceu.html

The Joint Commission. (2010, June 3). Preventing violence in the health care setting. Retrieved from http://www.jointcommission.org/assets/1/18/sea_45.pdf

Tiggemann, M., & Winefield, A. H. (1987). Predictability and timing of self-report in learned helplessness experiment. Personality and Psychology Bulletin, 13(2), 253-264. doi:

10.1177/0146167287132010