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Cline believes the statistics don't begin to show the
extent of violence in the nursing profession today.
Threats of violence, verbal abuse or sexual harassment
and spitting create a dangerous, stressful work environment.
She finds it disturbing to have to tell nursing students
what they'll endure.
"I look out at this sea of faces out there, and
I have to tell them that no matter where they'll work,
there's a possibility of being attacked," Cline
said. "It makes me sad."
Cline believes hospitals aren't doing enough to keep
staff safe. Nurses need better training and support
in the form of security guards and devices. She blames
staffing shortages for increasing the risks to nurses.
"If I don't have anyone to call for help on my
side of the ward, my chances of getting more serious
injuries grow," she said.
Others blame the increase in violence on an increasingly
violent society.
"If you have a violent patient, you have a violent
patient," said Dorel Harms, vice president professional
services, California Healthcare Association, a trade
group for hospitals. "It doesn't make any difference
how many nurses are there."
Paula Eddy, RN, nurse manager of the emergency department
at Highland Hospital, part of the Alameda County Medical
Center in Oakland, Calif., points to the shortcomings
of an overcrowded health care system for the increasing
violence. Her department has seen a 10 percent increase
in patients this year.
"People are uninsured and their numbers are growing
daily," Eddy said. "They use the emergency
department as their doctor. People get angry because
they have to wait. You can't have family members with
you because there's no room for them. I absolutely understand
why they're unhappy."
The department has a low turnover rate of nurses, Eddy
said, and that means a seasoned staff that understands
how to handle the anger. The county hospital also has
sheriff's deputies and security guards on the premises.
Next year, the department, housed in a 6,000-square-foot
space originally designed as a clinic, is moving to
a new 26,000-square-foot facility. That new location
will have many new security features, including a system
of surveillance cameras. The doors will have key access
cards.
Gone are the days when visitors and patients could
easily come and go at a hospital.
As a preventive measure, Kaweah Delta Hospital in Visalia,
Calif., like many hospitals nationwide, has been increasing
security.
There's zero tolerance for abuse or threats of abuse
against any employee, said Kristine Yahn, MBA, RN, senior
vice president of patient care and chief nurse executive.
"If a patient is continually acting out, we will
have them removed from the facility," Yahn said.
"We'll call the police. The boundaries get drawn
pretty early if anyone gets out of line."
Security guards are in the emergency department 24
hours a day and, six months ago, the hospital shortened
visiting hours.
When they end at 8 p.m., a newly installed locked door
closes off access between the emergency department and
the rest of the hospital. At one point, Yahn said, the
hospital installed glass partitions in the ER, but later
removed them.
"Most people who come in the door are not coming
to commit violence," Yahn said. "I just don't
think we can turn a hospital into a prison."
A nurse can sense when a patient might act out, Yahn
said, when the person is being uncooperative and the
body language is threatening. Yet, sometimes, there
is no way to predict pending violence. Recently, a female
patient decided to barricade herself in her room. She
slammed the door into a nurse manager and gave her a
black eye.
"I hope our staff knows we're going to support
them," Yahn said. "Sometimes, I think the
staff tries to work things out on their own for too
long."
That tendency of nurses to go it alone can be a big
mistake. "You never want to do anything alone,"
said Charles, who gives violence management training
seminars.
Nurses and doctors need to learn to act early and decisively
to control patients. They need to call for assistance
and not be afraid to display force if they can't calm
a patient. "When people get hurt is when they waffle,"
Charles said.
Two years after Reed's attack, she still thinks about
being hit, especially if a psych patient has been brought
in and people are screaming. She's more cautious now,
but she tries not to let her experience change the way
she treats people. Her physical injuries healed and
her attacker did go to jail.
"He was sentenced to three months," Reed
said. "Not long enough."
Contact Donna Hemmila at dhemmila@prodigy.net
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