Violence in Nursing: How To Create a Safer Work Environment
From staffing and security measures to risk identification and response plans, administrators have no shortage of tactics available to make hospitals safer.
I've talked at length about the stress and risk of burnout from working in healthcare during the pandemic. One major issue in healthcare that I feel doesn't get enough attention is the persistent threat of violence, particularly against nurses. According to data from Press Ganey, a healthcare data analytics company, there were roughly 57 assaults on nursing personnel per day in the U.S. between April and June 2022 — more than two per hour, every hour, every day.
"While under 20% of workplace injuries happen to healthcare workers, healthcare workers suffer 50% of all assaults," according to the Occupational Safety and Health Administration (pg. 3). And while the incidence of violence might have been exacerbated by the pandemic, it certainly wasn't created by it. Violence against nurses has been a trend years in the making:
• The Bureau of Labor Statistics reported that healthcare and social service workers are five times as likely to suffer a workplace injury than workers overall — numbers that have been rising for more than a decade.
• According to the AFL-CIO, workplace violence in healthcare in the private sector rose 52% between 2010 and 2019 and 95% for hospitals in particular (pg. 44).
• A meta-analysis of 22 healthcare studies conducted between 2010 and 2020 found "a significant violent incident within every setting," ranging from verbal and physical abuse to sexual assault.
Making Healthcare Safer
Nurses have always been on the front lines of patients' healthcare experiences. What can executives do to protect them?
Create a safer working environment. This might seem obvious, but executives should acknowledge that healthcare facilities, which should be seen as places of healing and protection for the vulnerable, are increasingly places of violence and need to be staffed accordingly. From staffing and security measures to risk identification and response plans, administrators have no shortage of tactics available to make hospitals safer.
As we consider threats to our nurses' safety, it should be acknowledged that the source of the violence isn't always the patient — sometimes it's a patient visitor like it was in January 2022 when a Louisiana hospital visitor knocked a nurse unconscious.
Make caregiver safety a core value. Build a culture of communication, and make it clear that violence on the job will not be tolerated. Threats or so-called minor acts of violence are often brushed aside under the guise of "no harm done" (which likely means the number of incidents of aggression against nurses is being undercounted). With robust safety and reporting systems, swift action by the administration and a culture that encourages victims of violence to speak out, hospital administrators can eliminate some of the internal obstacles to creating a safer work environment.
Teach the warning signs.Training front-line staff and security on the conditions that can lead to violence, de-escalation techniques and emergency management can stop an attack before it starts. The American Association of Medical Colleges shared a storyof how UC Davis Medical Center came to create a Behavioral Escalation Support Team (BEST) — care providers who were trained in mental healthcare and conflict de-escalation — to help calm patients who were aggravated and risked becoming violent.
Understand the causes of violent patient outbursts. From fear over their medical conditions to grief and frustration over a lack of medical attention, there are all kinds of reasons a patient might become violent. While these reasons don't excuse violence, they might offer opportunities to improve care and prevent future violent incidents.
Push for federal legislation. Congress has already passed laws that specifically address violence against airline employees — legislation that has helped create a safer traveling environment today. Similar legislation, such as the Safety from Violence for Healthcare Employees (SAVE) Act currently being debated in Congress, could offer similar protections for healthcare workers.
Managing a healthcare facility requires making difficult choices and balancing priorities. That said, the safety and well-being of your staff have to be your top concern. Any other organizational objective can only be achieved if your facility is safe and your personnel are protected. Simply put, you need to get this right.
Previously published on Newsweek.