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Recently, I posted this article discussing the issue of assaults against healthcare workers, particularly nurses, on my Facebook page.   It struck up some conversation and then ironically, it has come up this week in multiple discussions at work.  According to the Advisory Board, an organization dedicated to research and best practice in health care, “About 25 percent of nurses experienced workplace violence in the last year…The health care sector makes up just 9 percent of the overall U.S. workforce—but it experiences nearly as many violent injuries as all other industries combined.”

Many, including myself, would tell you that this is likely just the tip of the iceberg.   Nurses deal with inappropriate behaviors all the time and do not report them because it has become an expected part of the job.  By this I mean sexual or abusive comments, groping, kicking, spitting, hitting etc.  Unfortunately, the news only reports the most severe cases of assault where nurses are severely injured.

This issue is not new in the nursing profession.  Ask nurses of any age and they will likely have some story of a time when they experienced physical or verbal violence.  However, with changes to our healthcare system and insurance covered resources, the potential for violence in the healthcare setting is a daily reality.

Here are 15 tips for nurses and other care providers to protect themselves from assault and violent behavior:

 

  1. Be aware of and vigilant about your surroundings. It is easy for nurses to get caught up in the flow of their day.  You need to pay attention to patients, visitors, vendors and anyone else that may be in your work area.  Watch for behavior that seems off or  just not right.
  2. Practice active listening. We are dealing with people who are often in very stressful and challenging situations.  Emotions related to receiving a diagnosis, the fear of the unknown in regards to their health, and the financial strain that can be caused by a hospitalization or extensive testing, can be unpredictable.
  3. Get training in de-escalation and self defense. Many organizations offer this kind of training.  In fact, there are some states that have put requirements in place for such training.  If your organization does not offer this, take initiative to seek out classes.
  4. Be cognizant of your uniform. Long hair should always be pulled back to decrease the chance of it being pulled (not to mention that long hair falling over a patient is just gross).  Minimize wearing dangling jewelry as this can be pulled or used as a strangulation device.
  5. Learn body language and body positioning techniques. There are ways you can position yourself to still make someone feel that you are there to care for them, but yet allows you to quickly move out of harm’s way should that situation arise.
  6. Have a plan for patients known to have the potential for violence or verbal assault. There have been many times where I have told my staff to partner when dealing with certain individuals.  Usually these are the patients who may have a tendency to accuse caregivers of misconduct.  If patients have violent tendencies, security should always be involved.
  7. Be timely and consistent with medication regimens. This is particularly important for dementia patients and those with psychiatric disorders.
  8. Understand that there is always a reason behind bad behavior, but do not let these reasons prevent you from setting boundaries. This may be difficult with patients who have dementia or some sort of other cognitive impairment.  However, for the rest of the patient population, boundaries and a well understood plan of care are vital to providing safe care.
  9. For patients with dementia or cognitive impairment, engage the family or caregivers from their skilled nursing facility. Those who care for the individual on a daily basis will be able to provide you with techniques to help manage their behaviors.
  10. Be consistent with behavior management techniques from shift to shift. Inconsistency in behavior management can lead to manipulative behaviors setting staff up for unsafe situations.
  11. Know how and when to call a staff emergency. This is just as important as knowing how to initiate a code blue or rapid response call.
  12. Have mock situations where you practice working through scenarios dealing with violent behavior.
  13. Always, always, always listen to your gut. If something doesn’t fee right, let someone know.  Nurses have a good gut and that intuition is crucial to safety.
  14. Always report issues to leadership. An organization’s leadership team has a duty to put measures in place to keep its associates safe.  By reporting any kind of assault, no matter how minor you think it may be, the leadership team will be able to identify how processes and protocols can be improved to ensure safety.
  15. Safety should always trump everything else. Patient experience is a top priority, however, no one should ever tolerate abuse or assault for fear of a bad survey.

 

As mentioned above, healthcare organizations have a duty to provide a safe environment for their associates.  As providers, however, we should not wait until an event occurs before we are proactive in learning how to protect ourselves.  Unfortunately, this is a growing problem and we need to do all we can to keep ourselves and our other patients and families safe.

Do you have an experience you would like to share or thoughts on this topic?  Please feel free to share below.