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Nurses and Workplace Violence

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Title: Nurses and Workplace Violence


1
Nurses and Workplace Violence
  • By
  • Michele M. Valentino, MSN,CNS, BC, NP

2
Objectives
  • Identify scope of WPV in the health care settings
  • Identify the role of professional nursing
    organizations
  • Describe violence in psychiatric, ED Homecare
    settings
  • Interventions for reducing WPV
  • Recommendations for reducing WPV

3
SCOPE of the Problem
  • Violence is pervasive in our world!!!!!
  • Smoyak Blair wrote in 1992 that violence was
    epidemic with US Dept. of Justice statistics on
    violence increasing each year.
  • 2002 US Dept. of Labor reported nearly 2 million
    acts of nonfatal work-related violent acts
    annually.
  • 2006 ICN reported that occupational violence is a
    major worldwide public health problem

4
Scope
  • Work-related violence is the 3rd leading cause of
    occupational injury fatality in the US
  • 2nd leading cause of death for women at work
  • 10 yr study of rape in the workplace in
    Washington State found 11 of victims were health
    care workers in hospitals or other care
    facilities.
  • 2007 Hatch-Maillette found 63 of sample reported
    sexual threat 84 reported a past incident of
    physical or sexual assault

5
Scope
  • According to the Department of Justice (Myers,
    1996), nurses are identified as the occupation
  • experiencing the greatest number of assaults
    by a client, patient, or student served by the
    facility.
  • These results were further validated by the
    Occupational Safety and Health Administration
  • (Trape, 1998) stating more assaults occur to
    health care and social services industries than
    any other, with nurses experiencing the most
    assaults.

6
Scope
  • In addition, mental health professionals
    experience assault robbery at the alarming rate
    of 79.5 (Lanza Campbell, 1991).
  • Workplace violence has been linked to decreased
    job performance and job satisfaction, as well as
    increased absenteeism and mental health issues
  • among doctors, nurses, and other health care
    professionals (Bartholomew, 2006).

7
Scope
  • Nurses are exposed to, or are victims of, various
    types of abuse from sources that include
    patients, visitors, other nurses, physicians, or
    others in the work environments.
  • As the incidence and severity of workplace
    violence rises in all areas, the issue becomes of
    significant concern in healthcare settings
    (Jackson, Clare, Mannix, 2000).
  • Over 2 million workers are victims of harassment,
    threats, or assault each year

8
Scope
  • the actual scope of workplace violence is
    difficult to capture since more than 50-80 of
    acts may go unreported (Gates, 2004, Lanza
    Campbell, 1991, Gates, Ross McQueen, 2006).

9
Background
  • Violence in the workplace is one of the most
    dangerous hazards facing nurses (McPhaul and
    Lipscomb, 2004).
  • Violence against all health care workers presents
    a special challenge. Nurses experience the most
    assaults.
  • (U.S. Department of Justice Federal Bureau of
    Investigation 2004, 54) of health care workers.
  • In 1999, 2,637 nonfatal assaults on hospital
    workers occurred in the following settings
  • Hospitals rate of 8.3 assaults/10,000
    workers
  • Private sector industries 2
    assaults/10,000
  • workers (Centers for Disease Control
    and
  • Prevention/NIOSH, 2002, 1)

10
Hospitals
  • Canadian Study (Hesketh et al., 2003)
  • Emergency Nurses
  • 39.9 percent were threatened with assault
  • 21.9 percent were physically assaulted
  • Medical Surgical Nurses
  • 22.6 percent were threatened with assault
  • 24.2 percent were physically assaulted
  • Psychiatry Nurses
  • 20.3 percent were threatened with assault
  • 43.3 percent were physically assaulted

11
Hospitals
  • Florida Study (May and Grubbs, 2002)
  • Emergency Nurses
  • 100 percent were verbally assaulted
  • 82 percent were physically assaulted
  • ICU Nurses
  • 85.2 percent were verbally assaulted
  • 77.8 percent were physically assaulted
  • Floor Nurses
  • 80.6 percent were verbally assaulted
  • 63.3 percent were physically assaulted

12
References
  • Centers for Disease Control and Prevention/NIOSH.
    2002. Violence Occupational Hazards in
    Hospitals. CDC National Institute for
    Occupational Safety and Health, No. 2002-101.
    Retrieved February 16, 2006, from
    www.cdc.gov/niosh/2002-101.html.
  • Hesketh, K., S. M. Duncan, C. A. Estabroks, et
    al. 2003. Workplace violence in Alberta and
    British Columbia hospitals. Health Policy 63
    311.321.
  • May, D., and L. Grubbs. 2002. The extent, nature,
    and precipitating factors of nurse assault among
    three groups of registered nurses in a regional
    medical center. Journal of Emergency Nursing
    28(1) 11.17.
  • McPhaul, K., J. Lipscomb. 2004. Workplace
    Violence in Health Care Recognized but Not
    Regulated. Online
  • Journal of Issues in Nursing 9 (3) Manuscript 6.
    Retrieved February 16, 2006, from
    www.nursingworld.org/
  • ojin/topic25/tpc25_6.htm.
  • U.S. Department of Justice Federal Bureau of
    Investigation. 2004. Workplace Violence Issues
    in
  • Response. Retrieved February 16, 2006, from
    www.fbi.gov/page2/march04/violence030104.htm.

13
Incidence
  • Bureau of Justice workplace assaults injure 1.7
    million workers (2001)
  • Health care social service industries are 2nd
    only to law enforcement for WPV (2003)
  • Nearly 500,000 nurses become victims of violence
    in workplace annually.
  • Nurses are 3 X more likely to be victims of
    violence than any other professional group

14
Incidence
  • Nursing Management 2008 1400 respondents 74
    experienced some form of violence in the
    workplace (Hader, 2008). Included US 17 other
    countries.
  • 51-75 were bullying, intimidation harassment.
  • 26 physical violence
  • Weapons 5.6 to 7.5
  • Perpetrators 53/2 patients, 52 colleagues,
    49 physicians, visitors 47, other health care
    workers (37.7)

15
Incidence
  • Joint Commission found that more than 50 of
    nurses reported verbal abuse ( AACCN, 2005)
  • Survey of 303 nurses, 53 reported being bullied
    at work(Vessey, Demarco, Gaffney Budin, in
    press)

16
Attention to WPV
  • ICN, AAN, ANA have advocated for increased
    protective regulations research to study
    effective risk management programs.
  • The Center for American Nurses has issued a
    statement on WPV a position statement on
    Bullying Horizontal Violence.

17
Attention to WPV
  • AORN 2003 2007
  • Am. Assoc. of Critical-Care Nurses (2004)
  • National Student Nurses Assoc 2006
  • Code of Ethics for nurses ( ANA 2001)
  • Joint Commission 2007
  • APNA Position Statement (Oct. 2008)

18
OHIO NURSES ASSOCIATION (ONA)
  • SCDONA (Stark-Carroll District of ONA) wrote a
    reference item for convention in 2007 concerning
    WPV
  • ONA requested that SCDONA write submit a
    position statement on WPV
  • adopted by ONA in 2008

19
Position Statement on WPV Nursing Practice
Statement NP 83
  • Developed 2007 Revised
  • The American Nurses Associations Code of Ethics
    for Nurses states, in part
  • The nurse, in all professional relationships,
    practices with compassion
  • and respect for the inherent dignity, worth, and
    uniqueness of every
  • individual, unrestricted by considerations of
    social or economic status,
  • personal attributes, or the nature of health
    problems.
  • The nurses primary commitment is to the patient,
    whether an individual,
  • family, group, or community.
  • The nurse promotes, advocates for, and strives to
    protect the health,
  • safety, and rights of the patient.
  • The nurse owes the same duties to self as to
    other, including the responsibility
  • to preserve integrity and safety, to maintain
    competence, and to continue
  • personal and professional growth.
  • The nurse participates in establishing,
    maintaining, and improving health
  • care environments and conditions of employment
    conducive to the
  • provision of quality health care and consistent
    with the values of the
  • profession through individual and collective
    action.
  • The profession of nursing, as represented by
    associations and their members,
  • is responsible for articulating nursing values,
    for maintaining the integrity of

20
American Nurses Associations Bill of Rights for
Registered Nurses
  • Nurses have the right to practice in a manner
    that fulfills their obligations to society and to
    those who receive nursing care.
  • Nurses have the right to freely and openly
    advocate for themselves and their patients,
    without fear of retribution.
  • Nurses have the right to a work environment that
    is safe for themselves and their patients

21
Workplace Violence
  • One of ONA's goals is to prevent violence in the
    workplace, and ONA supports the following
    objectives
  • Pursuit and support of legislation making
    the assault of any nurse a felony offence,
    punishable as determined by law
  • Development of programs to support nurses
    who report assaults and assistance with the
    process
  • Development of workplace standards through
    OSHA, OHA, and the Ohio Department of Health,
    and
  • Development of materials to educate nurses
    to their rights and legal remedies.

22
Workplace Violence Information Resources
  • ONA's Nursing Practice Statement on Workplace
    Violence (Members Only)
  •  
  • Behaviors that Undermine a Culture of
    Safety (Joint Commission Sentinel Event)
  •  
  • The Center for American Nurses Position Statement
    on Lateral Violence and Bullying in Nursing Work
    Environments
  •  
  • Guidelines for Preventing Workplace violence for
    Health Care Social Services Workers
  •  
  • Violence Against Nurses The Silent
    Epidemic (Independent Study)
  •  
  • NIOSH Occupational Hazards in Hospitals Exposure
    to Stress

23
Resources
  • OSHA (2002) has information on preventing and
    controlling workplace violence in a fact sheet on
    workplace violence, available at
    http//www.osha.gov/OshDoc/data_General_Facts/fact
    sheetworkplace-violence.pdf. OSHA guarantees all
    workers a safe healthful workplace.
  • Employers must provide a safe workplace using
    written policies, employee training, proper
    staffing, and follow-up of any incidents.

24
Resources
  • The Center for American Nurses (Carroll, 2003)
    has a two page print-out on their website
    http//www.centerforamericannurses.org entitled
    Guidelines for Preventing Workplace Violence for
    Health Care and Social Service Workers. The four
    main components are
  • 1. Management commitment and employee
  • involvement
  • 2. Workplace analysis
  • 3. Hazard prevention and control
  • 4. Safety and health training

25
Resources
  • The American Nurses Associations has a bulleted
    brochure that they allow the Constituent Member
    Associations to print with their logo. It is
    titled Workplace Violence, Can You Close the
    Door on It? (ONA, 1996). It includes information
    on Know your Patients, Steps to a Safer Work
    Place, and Addressing Workplace Violence.

26
Related Files
  • Workplace Violence Data Collection Form (Adobe
    PDF File) Preventing Workplace Violence Brochure
    (Adobe PDF File) Workplace Violence in the Health
    Care Setting (Adobe PDF File) Occupational
    Hazards in Hospitals (Adobe PDF File) Nurses and
    Workplace Violence Fact Sheet (Adobe PDF
    File) NIOSH Occupational Hazards in Hospitals
    Exposure to Stress (Adobe PDF File) The Center's
    Position Statement on Lateral Violence and
    Bullying (Adobe PDF File)

27
APNA Task Force on WPV
  • 2007 survey by APNA, Safety was one of the top
    issues for front line providers
  • I was honored to chair this task force May 2007
  • Call to members Response of 150 persons
  • 25 members selected for steering committee
  • Expert Consultant Panel
  • 3 areas Psychiatric (inpatient, outpatient,
  • forensic, state-funded), other health
    care
  • settings (EDs and homecare), schools
    and
  • universities.

28
APNA Task Force on WPV
  • ROL from 1970 to 1990 most articles described
    characteristics of units where violence occurred
    described staff response to assault.
  • Pressing need for research describing successful
    violence prevention interventions

29
APNA Task Force on WPV
  • ROL using key words of psychiatric, nursing,
    violence in the data bases in CINAHL, PsycINFO,
    and Academic Search Premier.

30
What is Horizontal Violence (HV)?
  • Bullying is repetitive horizontal or lateral
    violence and it can be detrimental to a persons
    physical or mental well-being

  • ( Center for Am. Nurses)
  • DISRUPTIVE BEHAVIOR behavior that interferes
    with effective communication among healthcare
    providers and negatively impacts performance
    outcomes. Bullying is repetitive horizontal or
    lateral violence and it can be detrimental to a
    persons physical or mental well-being

  • ( Center for Am. Nurses)

31
Bullying
32
Horizontal Violence
  • Now receiving more attention
  • JAHCO addresses disruptive behavior
  • (July 9, 2008)
  • JAHCO uses the term zero tolerance

33
Horizontal Violence
  • Horizontal Violence, a term used to identify
    violence that occurs between peers, is seen when
    nurses bully their coworkers.
  • Behaviors exhibited with horizontal violence may
    include criticizing, sabotaging, undermining,
    infighting, blaming, scapegoating, intimidation
    and bickering.

34
Horizontal Violence
  • The 10 most frequent forms of horizontal violence
    are nonverbal innuendo, verbal affront,
    undermining activities, withholding information,
    sabotage, infighting scapegoating,
    backbiting,failure to respect privacy, and broken
    confidences (Griffin, 2004).

35
Examples of bullying behaviors (Hastie,
2002Workplace Bullying Institute, 2003)
  • Being accused of errors made by someone else
  • Nonverbal intimidation, included being stared at
    or glared at
  • Being belittled
  • Having thoughts or feelings ignored
  • Being excluded from activities
  • or conversations

36
Who is the Bully?
Colleague? Supervisor?
Physician?
37
Horizontal Violence
  • Use of cue cards scripting for responses
  • Educate nurses students about it
  • Create an infrastructure to support managers and
    staff
  • Assertiveness training
  • Appraisal of risky situations
  • Communication skills Training

38
Interventions
  • Nsg Curriculum to include
  • awareness-raising empowering strategies
  • Educate Nurses emphasizing non-hierarchical
    leadership supportive relationships.

39
The cycle of Violence
  • Each of us tolerates the behaviors of others a
    bit differently. However, if the behavior is
    offensive to you, or undermines you and your job
    in any way, it needs to be reported to your
    manager.
  • Speaking up is difficult, especially if one has
    to face the bully everyday in the work
    environment. Fear of retaliation from the
    perpetrator.

40
Intimidation
41
Remember the Bully
42
Complications of WPV
43
Develop a New Culture in Nursing
  • To gain self-confidence, nurses need to
    articulate clearly confidently their common
    vision of nursing and its future
  • (Buresh Gordon
    2000)
  • Nurses must PAY IT FORWARD praise each
    other for jobs well done
  • VALUE each other the work of others
  • New staff need mentored in a kind, nurturing
    manner

44
Create A New Culture in Nursing
  • Mentor new hires and new grads
  • Appreciate diverse points of views
  • Value the differences in colleagues from various
    generations. It is not a burden it is an
    advantage.

45
Creating a New Culture in Nursing
  • Express pride in being a nurse
  • Accept and celebrate compliments about good
    patient care
  • Actively compliment others for work well done
  • Look for and acknowledge improvements to the
    system
  • Be an ambassador to those outside the profession
    about the true contribution nurses make to
    quality patient care.

46
Interventions for Horizontal Violence
  • Gain control
  • Get help from your employer
  • Make a plan for action
  • Take action
  • Confront the aggressor
  • Make a formal written complaint
  • Take legal action

47
Be Savvy if necessary
  • Solicit support from family friends
  • Consult an outside physician or therapist
  • Solicit witness statements
  • Confront the bully
  • File the internal complaint
  • Preparing of the case against the bully
  • Rule of 2meeting presenting your case
  • Taking your case public

48
Interventions for Horizontal Violence
  • Replace your own internalized misperception with
    a belief that we are gifted, dedicated and highly
    skilled professionals who have struggled against
    great odds
  • Resist messages from coworkers or superiors that
    denigrate your professionalism or that of the
    nursing profession
  • Be a supportive colleague

49
Interventions with Horizontal Violence
  • Direct concerns about workplace negativity
    clearly and concisely to appropriate individuals.
  • Develop an understanding that rocking the boat
    can be the first step in the service of positive
    change.
  • Start confronting problems, not people

50
Interventions for Horizontal Violence
  • Support, insight, and connection can help nurses
    change the cycle that impinges their own
    empowerment .
  • Develop a positive personal and professional
    identity
  • Develop Assertive Behaviors

51
Develop self-Assertive Behaviors
  • Practice physical cues that confirm confidence
    and help regain control of the situation, i.e.
  • ensuring facial expressions correspond with
  • message
  • learn to ignore distractions
  • listen effectively to the other
  • understanding the other persons message
  • before responding
  • stand straight
  • use good eye contact
  • use relaxed natural gestures
  • Use level, well-modulated voice
  • Speak clearly

52
Self-Assertive Behaviors
  • Avoid reciprocating with aggressive behavior
  • Handle situations diplomatically using active
    listening skills.
  • Inform the abuser of his/her feelings
  • Let the abuser know that the abuse will not be
    tolerated
  • Say NO and use I statements.

53
Self-Assertive Behaviors
  • I did not appreciate the language you used
    today, Please do not use it again.
  • State what behavior is unacceptable

54
  • Assertiveness is not about throwing your weight
    around. Its about articulating your thoughts,
    feelings, and opinions in a clear, honest, and
    straightforward manner.

55
Create a New Culture in Nursing
  • Defuse intense anger
  • Resolve to release anger
  • Consult an expert if conflict is festering in the
    workplace
  • Exhibit care and compassion for your colleagues
  • Compliment rather than complain
  • Cultivate team spirit

56
Obstacles to Reporting
  • Inurnment due to chronic protected exposure to
    violent individuals
  • Underreporting
  • Few effective regulations
  • Attitude perception that Violence is just part
    of the job
  • 32 of assaulted employees and 8 who
    experienced nonphysical violence reported that
    violence was part of the job.

57
Obstacles to reporting
  • Peer pressure not to report ( lANZA, 1988)
  • Ambiguity in defining violence ( Lanza, 1988)
  • Excusing the behavior of ill patients (Mayhew,
    2000)
  • Organizational culture, including onus on the
    victim to be proactive make the complaint the
    employers belief that it would be too costly to
    institute protective measures for the staff

58
Obstacles
  • Stigma of victimization, including embarrassment,
    shame, isolation, fear of judgment
  • Fear of job loss
  • Fear of blame of provoking the assault or being
    negligent
  • Victims self-blame
  • Time-consuming, ineffective, or gender-biased
    reporting mechanisms

59
Obstacles
  • No benefit, either personal or organizational, of
    reporting
  • Unhelpful experience with prior reporting

60
Obstacles to reporting
  • Typically, acts of physical violence that do not
    result in injury or are nonphysical are not
    reported (Findorff, McGovern Sinclair, 2005)
  • 43 of physical violence 61 of nonphysical
    violence was unreported.
  • Estimated that 1 in 5 violent events in
    psychiatric settings are reported (Mayhew, 2000)

61
Types of WPV
  • Physical
  • Sexual
  • Verbal
  • Horizontal violence
  • stalking

62
Difficulty with Definitions
  • Inconsistent definitions
  • Suggest use of Typology of WPV by NIOSH
  • 2006)

63
Table 1. Typology of workplace violence Type
Description
  • I Criminal intent The perpetrator has no
    legitimate relationship to the business or its
    employee, and is usually committing a crime in
    conjunction with the violence. These crimes can
    include robbery, shoplifting, trespassing, and
    terrorism. The vast majority of workplace
    homicides (85) fall into this category.
  • II Customer/client The perpetrator has a
    legitimate relationship with the business and
    becomes violent while being served by the
    business. This category includes customers,
    clients, patients, students, inmates, and any
    other group for which the business provides
    services. It is believed that a large portion of
    customer/client incidents occur in the health
    care industry, in settings such as nursing homes
    or psychiatric facilities the victims are often
    patient caregivers. Police officers, prison
    staff, flight attendants, and teachers are some
    other examples of workers who may be exposed to
    this kind of workplace violence, which accounts
    for approximately 3 of all workplace homicides.
  • III Worker-on-worker The perpetrator is an
    employee or past employee of the business who
    attacks or threatens another employee(s) or past
    employee(s) in the workplace. Worker-on-worker
    fatalities account for approximately 7 of all
    workplace homicides.
  • IV Personal relationship The perpetrator
    usually does not have a relationship with the
    business but has a personal relationship with the
    intended victim. This category includes victims
    of domestic violence assaulted or threatened
    while at work, and accounts for about 5 of all
    workplace homicides.
  • Note From NIOSH, 2006.

64
Consequences of Violence
  • About ½ of assaulted staff have minor injuries (
    Hunter Carmel, 1992.
  • Emotional consequences (anxiety, depression,
    insomnia, burnout exhaustion, etc.)
  • Bullying is associated with fear, demoralization,
    HTN, panic attacks, low morale, negative
    relationships at work.
  • PTSD, depression
  • Can lead to suicide
  • Burn-out leaving the nursing profession

65
Financial Costs
  • NIOSH reported employees lost 160 days due to
    patient violence (2002)
  • Pres. Of the Federal Nurses Assoc. estimates cost
    of violence at 4.3 million annually or 250,000
    per incident, excluding emotional
  • Costs include increased staff turnover,
    recruitment, retention costs
  • Increased staff absence from work

66
Financial Costs
  • Reduced efficiency performance at work
  • Reduced staff morale
  • Higher incidence of pt. complaints
  • Falling reputation for the organization.

67
Overview of Psychiatric Settings
  • mental health professionals experience assault
    robbery at the alarming rate of 79.5 (Lanza
    Campbell, 1991).
  • Workplace violence has been linked to decreased
    job performance and job satisfaction, as well as
    increased absenteeism and mental health
    issuesamong doctors, nurses, and other health
    care professionals (Bartholomew, 2006).

68
Overview of ED
  • Nurses working in emergency rooms (Lyneham, 2000)
    and in services for the elderly (Gates,Fitzwater
    Meyers 1999) are at high risk for interacting
    with violent patients.
  • The potential for violence may stem from
    frustration of waiting time for appointments and
    patient clinical characteristics, such as
    intoxication and dementia (McKenna, 2003).
  • Length of wait time in Emergency Departments
    should be kept to a minimum.

69
WPV in ED
  • Position Paper to be on APNA website soon
  • www.apna.org

70
Overview of Homecare
  • To be released soon on APNA website
  • www. Apna.org

71
Colleges Universities
  • Position Paper will be on www.apna.org website
    soon

72
Interventions to decrease WPV
  • Every health care organization should have a
    comprehensive plan for WPV including horizontal
    violence.
  • Survey staff attitudes about intimidation
    lateral violence.
  • Create a code of conduct have staff sign the
    code at hire annually
  • Hold frank discussions about WPV
  • Establish a standard, assertive communication
    process

73
Interventions
  • Create a conflict resolution process stated in a
    professionalism policy include a chain of
    command for resolution
  • Encourage 1-on-1 conflict resolution provide a
    mechanism for confidential reporting
  • Enforce a zero tolerance policy (full punishment
    for an infraction) (Hader, 2008 Joint
    Commission, 2008).

74
Interventions
  • Provide ongoing education to reinforce the
    organizations commitment to ensuring a caring
    respectful environment
  • Lead by example reward outstanding role
    models(Schaffner, Stanley, Hough, 2006).
  • Utilize a screening risk assessment tool in
    combination with traditional clinical assessment
    techniques for violence risk. (Otto,2008).

75
Recommendations for Nurses
76
Recommendations for Nurses
  • Develop healthy nurse-client relationships
  • Use structured assessment tools with traditional
    assessment techniques to identify risks.
  • Recognize factors that may predispose patients to
    becoming violent including
  • -history of violence, especially recent
  • -head injuries, CVA, organic or clinical
  • brain
    injury
  • -hypoxia

77
Recommendations for Nurses
  • -endocrine disorders hypoglycemia or

  • hyper
  • -seizures
  • -psychotic disorders
  • -hs of PTSD
  • -S.E. of prescribed medication
  • -intoxication or drug OD, or drug or ETOH
  • withdrawal
  • - dementia or senility
  • - disorders of childhood adolescence

78
Recommendations for Organizations
  • Implement preventive measures based on training
    educational programs
  • Examine incidents of violence in the workplace to
    Identify underlying causes impact on
    individuals
  • Establish protocols to assist staff victims
    administrators in navigating complex issues
    occurring after a violent event

79
Recommendations
  • Encourage group discussions for victims of
    violence
  • Design intervention strategies to address
    specific types of violence ( physical
    nonphysical)
  • Stress the importance of reporting physical
    nonphysical incidents of violence
  • Develop policies procedures for safety in the
    event of a weapon threat, i.e. lockdown
    procedures practice them

80
Recommendations
  • Be informed aware of ones legal rights
  • Take all threats seriously, even verbal threats
    follow up on them
  • Check patients for contraband
  • Familiarize staff with takedown procedures
    practice them regularly (even though rarely used)
  • Have a system in place for reporting all threats
    by phone take immediate measures involving
    local police

81
Recommendations
  • There should be a post-incident evaluation and
    counseling plan for any violent incident.

82
Recommendations for staff education
  • Define workplace violence , types, causes
    consequences
  • Discuss work-related violence prevention
    management policies procedures
  • Recognize early signs of escalation, identify
    patient staff factors that increase risk
  • Conduct personal safety training
  • Explain legal unethical concepts related to WPV

83
Recommendations for research
  • Develop consensus-based definitions
  • Study effet of relationships on reducing
    incidence of violence
  • Evaluate outcomes related to staff training
  • Assess outcomes of use of structured assessment
    tools in combination eith traditional assessment
    techniques to identify risk

84
Recommendations for Research
  • Identify which techniques help contain violent
    individuals with the greatest degree of safety
  • Examine staff characteristics environmental
    factors that increase the risk of aggression
    violence
  • Explore effect of nurse-patient relationships
  • Develop a uniform standard instrument for
    measuring aggression violence that will
    identify type mode of aggression severity

85
Recommendations for Research
  • Test effectiveness of proactive strategies such
    as establishment of work environments that are
    not conducive to violent behavior
  • Include longer follow-up periods in studies

86
Recommendations for Horizontal Violence
  • Create a work environment that facilities
    supports colleagiality effective communication
    IPR
  • Develop clear organizational guidelines for
    leaders employees to be accountable for
    workplace behaviorIntervene when witnessing
    victimization bullying of colleagues
  • Discuss concerns of horizontal violence at staff
    meetings

87
Recommendations for Horizontal Violence
  • Educate new nurses on horizontal violence
    provide cognitive rehearsal techniques
  • Coach nurses to develop their conflict management
    conflict resolution skills
  • Provide ongoing education to reinforce
    organizations commitment to ensuring a caring
    respectful environment

88
Recommendations for Horizontal Violence
  • Teach students that horizontal violence is not
    acceptable
  • Educate about horizontal violence, how to
    Identify it confront it
  • Mentor students, building self-esteem self
    worth
  • Equip students with assertiveness tools with
    conflict resolution healthy communication
    techniques.

89
Recommendations for Professional Nursing
organizations
  • Continue to advocate for a safe work environment
    for all nurses
  • Continue to recommend research ed
  • Acknowledge horizontal violence, including
    bullying
  • Increase awareness of this issue
  • Use the standard definition for workplace
    aggression violence

90
  • Lobby for legislation that would increase assault
    of a health care worker to felony status
  • Request that OSHA guidelines become mandatory for
    health care workplaces

91
Recommendations to employers of Nurses
  • Establish Maintain a comprehensive program for
    Prevention management of all types of workplace
    violence
  • Analyze workplace security perform risk
    assessments
  • Improve screening of potential employees
  • Select staff preceptors
  • Make ongoing formal ed. _at_wpv compulsory

92
Employers
  • Reward outstanding role models
  • Track all assaults
  • Ensure anonymity in reporting
  • Ensure time-out areas quiet places
  • adequate staffing
  • specialist security staff
  • covert distress messages coded


  • responses

93
Utilize security feature
  • Personal alarms panic buttons
  • Bulletproof glass
  • Adequate lighting
  • Metal detectors
  • Two-way communication systems
  • Closed-circuit TVs
  • Controlled access to security monitoring of
    entrances, exists high risk areas

94
Recommendations
  • Create a culture of a Just Culture with regard
    to unacceptable behavior
  • Employees working with high-risk patients should
    not do rounds alone it is recommended staff be
    in pairs, especially on psychiatric inpatient
    units and in Emergency Rooms.

95
Recommendations
  • Educate staff _at_ warning signs
  • Educate methods of coping with violence
  • Report protocol
  • Instruct _at_ counseling
  • Provide legal information
  • Provide risk assessment
  • Develop a risk management plan

96
More Resources
  • www.bullyinginstitute.org
  • www.osha.gov
  • www.cdc.gov/niosh
  • www.nursingworld.org/can

97
THANKS!!!!!
  • Questions???
  • Any sharing of personal experiences??

98
Thanks!!!
  • You are a Great Audience!!!
  • LETs END VIOLENCE in the WP
  • And Everywhere!!!
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