By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
We are experiencing a shocking number of physical assaults in our healthcare environments. In testimony given to Congress about pending legislation on workplace violence now in Congress, leaders from the American Nurses Association reported that one in four nurses had been physically assaulted on the job, but many of these incidences are never reported. The assaults now come primarily from patients and families.
Health Systems are grappling with the uneasy balance between patient satisfaction’s role in reimbursement and protecting the workforce. Many now have started Crisis Prevention Intervention training, but leaders tell me that staff still feel unequipped to deal with violent responses.
I remember the first time I was assaulted by a veteran patient in an emergency room. I was a young nurse and did not see it coming. I could have been badly injured without the quick response of colleagues. It was the 1970s. Our patient population in the VA was shifting, and we now saw many Vietnam veterans who either had PTSD or were drug dependent. The number of assaults against VA staff began to rise. It was a significant change from caring for our older World War 2 and Korean veterans who would never resort to physical violence against healthcare staff.
With these changes in the veteran population, VA staff had to change how we viewed our environment. Yes – medical centers were places of healing but not immune from the violence occurring in the outside world. Teams were taught violent behavior prevention and tactics about how to approach patients and where we should stand/sit in examination rooms. The training emphasized a need to be vigilant and maintain situational awareness of our surroundings, the potential threats, and dangerous situations.
The code green behavior codes were implemented as a way to get backup help if you needed it quickly. Much like TSA checks, security checkpoints were placed in many of our inner city hospitals. We did an inventory of all patients’ belongings upon admission. I once found a gun in the hat of an admitted veteran. I was trained to stop the inventory calmly and notify our VA police.
Developing staff situational awareness that violence could happen requires a change in mindset. We had to acknowledge, whether we wanted to or not, that threats existed in our work environment and we could be assaulted. Apathy, denial, and complacency can be deadly. We were urged to assume responsibility for our security. The VA police could not always provide all the protection needed. I likened the situational awareness we were taught to learning how to be a defensive driver where you have the discipline to keep yourself from slipping into tuned-out mode.
As I look at the number of young staff in our acute care environments, I worry about how situationally aware they are as they deliver care. Yes, there is more vigilance in emergency departments and behavioral health units, but what about other areas. Are we talking about the potential for violence in other areas or the rising anger we see from patients and families?
The disciplined part of practicing situational awareness refers to the conscious effort required to pay attention to gut feelings and surrounding events even while you are busy and distracted. It is easy to miss the signs of a patient or family member whose agitation has escalated and observe their behaviors while doing other things. As we orient this year’s new graduate class, we must be sure to talk about this increasing problem in healthcare environments. They must be taught the signs they should look out for and how to react and summon help.
© emergingrnleader.com 2022
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