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In
Harm's Way
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By
Leigh
Morgan The violence that permeates society at large doesn’t stop at the hospital walls. Indeed, a recent survey suggests that workplace abuse of healthcare professionals by patients is a common and widespread problem. A survey conducted by the Colorado Nurses Association (CNA) Task Force on Workplace Violence, which involved 586 nurses from more than 30 different practice areas in seven states, revealed that 32 percent had been victims of threats, sexual assaults, or physical violence while on the job. The survey also showed that 71 percent of those reporting abuse were staff nurses. “Abuse to nurses is increasing,” said Jean Proehl, MN, RN, president of the Emergency Nurses Association, and an emergency clinical nurse specialist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. “Society is more violent than it once was and the norms of acceptable behavior have changed.” The most common assaults against nurses do not result in serious injury, although injury does happen with alarming frequency, Proehl said. Typical assaults include spitting, hitting, kicking, hair pulling, and attacks with a an object or a weapon. Factors such as drug or alcohol impairment, psychiatric conditions, neurological problems, and a history of violence can increase the risk of patients striking out. “Emergency nurses are at risk because the patients’ families are stressed,” Proehl said. “Frequently, these are people who don’t know how to deal with anger, fear, or frustration in their daily lives.” Workplace violence occurs in every healthcare setting, not just urban hospitals or emergency departments, said Victoria Carroll, MSN, RN, director of the CNA task force that conducted the survey, and a clinical instructor at the University of Northern Colorado. “There are a lot of nonfatal assaults at the bedside,” Carroll said. “There are any number of reasons why it’s happening, but the bottom line is that nurses are being assaulted.” Reporting violence Despite the frequency of workplace violence, studies suggest that most incidents in hospitals and healthcare facilities go unreported, Carroll said. Stephanie Tabone, RN, director of practice for the Texas Nurses Association (TNA), said that while abuse is a serious problem, not every transgression will traumatize a nurse or prompt her to file a report: “It’s all well and good to say somebody in terrible pain isn’t supposed to behave like that, but if they bite you, is that violence? Sure. Are you sympathetic? Yes.” Misperceptions about what constitutes violence could also play a part in reporting trends, Carroll said. In the CNA survey, nurses were asked to define various abusive behaviors. Carroll said the definitions, which ranged from verbal abuse to armed assault, largely followed her expectations—with one surprise. “The behavior that was least identified as violence was sexual harassment,” Carroll said. “Most experts agree that [violence] starts as nonverbal threatening behavior, then escalates to verbal harassment, then to physical violence. So sexual harassment can escalate into sexual assault in the workplace.” Proehl said that nurses have a tendency to downplay abuse that does not cause serious injury. “Interestingly enough, nurses often think of being abused or assaulted as part of the job,” she said. “Police officers don’t think this way, why do we?” Self-protection Deborah Antai-Otong, MS, RN, a psychotherapist and psychiatric clinical nurse specialist program at the VA North Texas Healthcare System in Dallas, is working to challenge the notion that abuse is part of a nurse’s job. “We should expect a safe workplace. A lot of people who enter nursing are women, and we’re socialized to put other people’s needs before our own. I teach that nurses have to put their own safety first.” Compared with traditional nursing attitudes, empowered self-protection is a relatively new emphasis within the profession, said Deborah DiBenedetto, RN, president of the American Association of Occupational Health Nurses, and a contributor to the Occupational Safety and Health Administration’s violence prevention guidelines for healthcare workers. “You have to be proactive and aware of your own need for safety,” she said. “When we were back in nursing school, we didn’t learn this. The ingrained message nurses get is to keep taking care of their patient, so we keep taking care of others without taking care of ourselves.” Intervention Antai-Otong directs an employee support program at the VA North Texas Healthcare System to help workers handle the aftershocks of patient abuse and other trauma. She is also a member of the facility’s crisis intervention team, a group that includes RNs, advanced practice nurses, and other professionals trained to respond to workplace violence. People exposed to workplace violence without intervention are candidates for post-traumatic stress disorder, Antai-Ontong said. “It’s really important for nurses to be able to admit ‘I’m upset about this, I’m agitated, I can’t sleep.’ The more you talk about an incident, the more you normalize it,” she said. To protect employees from overt violence, most hospitals use a combination of training, security personnel, and high-tech safeguards such as video cameras, electronic locks, panic buttons, and personal alarm devices. While many hospitals also have bullet-proof glass in triage, only 1 percent use metal detectors, and very few post armed officers in emergency departments, Proehl said. Carroll, the CNA task force director, said she’s optimistic. “There is so much we can do. Everything from teaching anger-defusing strategies, to installing better lighting in the parking lot, to publishing a zero-tolerance policy for the hospital, can improve safety in the workplace.” |
