Reducing Healthcare Violence

There is no acceptable level of violence in healthcare.

Just over a week ago, the Texas Senate unanimously passed House Bill 705, which now goes to the governor to be signed. This bill, like several others over the past few years, addresses the issue of violence in health care by enhancing penalties for assaults committed against nurses and other healthcare workers who provide care in emergency departments. Other state-level bills also make assault against a healthcare employee a felony.

The purpose of my post today is not to debate the rights/wrongs or ethics connected with this type of legislation. What is concerning to me is that these types of laws are touted as “protecting” healthcare workers or “preventing violence,” when in fact they do neither.

If we truly care about “protecting” healthcare workers and reducing healthcare violence, why aren’t more laws passed requiring hospitals to create comprehensive workplace violence response policies and protocols?

Let’s take a look at a scenario. I’m an emergency room nurse. I have been assigned to care for a patient who has recently arrived in our ED and is experiencing hallucinations. During the course of care, this person is verbally abusive and strikes out at me, making contact with my nose. This person breaks my nose. This law or laws like it allow me to press charges against the patient for assault.

But how does that protect me?

How does that prevent violence?

Imagine that same scenario now in a hospital that trains all staff in de-escalation strategies, debriefing protocols, and personal safety techniques, as The Joint Commission, CMS, and that hospital policy require.

Now I’m better equipped to recognize the early warning signs of a potential crisis that could result in assaultive behavior. In addition to recognizing these early warning signs and using nonverbal and verbal de-escalation strategies, I have also been trained to block and move away from strikes.

Now, as I care for that individual, I’m able to prevent an assault because I’m careful with how I position myself to provide care. I recognize that this individual is in a heightened state of anxiety due to their hallucinations and I am caring and person-centered in my approach to helping them. I take the time to explain my actions and the procedure so they are less confused and less frightened, and we get through the procedure safely. I’m able to not take their abusive language personally. Crisis avoided.

OSHA, The Joint Commission, and CMS all address these specific issues in healthcare settings, but there seems to be a lack of accountability at many levels to ensure that all healthcare professionals are equipped with these valuable skills. How can workers provide safe, effective care if we have not accounted for their Care, Welfare, Safety, and Security^SM as part of the equation?

Comprehensive workplace violence prevention policies that address the entire workplace violence continuum are a must in healthcare. But violence in healthcare cannot simply be “engineered out.” We must equip staff with skills and strategies for preventing, managing, and debriefing about these very challenging situations.

There is no acceptable level of violence in healthcare. If your hospital does not already have a comprehensive approach to this issue, give us a call. We’d love to support you in your endeavor to make your facility safer.

Resources

• The Joint Commission (TJC)
  Learn more about how the Nonviolent Crisis Intervention^® training program aligns with The Joint Commission Standards on Restraint and Seclusion [PDF].
• Centers for Medicare & Medicaid Services (CMS)
  Find out how the Nonviolent Crisis Intervention^® training program aligns with the CMS Hospital Conditions of Participation: Patients’ Rights [PDF].