Violence & Safety in the Working Environment - Part 2

Geary: 00:00:06

Good morning and welcome to go crazy at the nurses' round table.

Geary: 00:00:11

I'm Gary.

Geary: 00:00:12

I'm Kara.

Geary: 00:00:13

What are we gonna go crazy with today?

Geary: 00:00:15

Today, we're gonna continue our discussion over the work environment, and

Geary: 00:00:19

we're gonna specifically talk more about the violence and safety in the workplace.

Geary: 00:00:23

What does that look like?

Geary: 00:00:24

I agree.

Geary: 00:00:25

I that will continue.

Geary: 00:00:26

so today we are talking about workplace violence with the

Geary: 00:00:30

continuation of our conversation on nurses working environment.

Geary: 00:00:34

you were doing research regarding this topic?

Geary: 00:00:37

Yeah.

Geary: 00:00:37

What did you come up

Kara: 00:00:38

with?

Kara: 00:00:38

So I was reading a little bit about it and we, we've heard several news

Kara: 00:00:42

stories about nurses getting shot or

Kara: 00:00:45

people are a little bit.

Kara: 00:00:47

Tolerant of each other and a

Geary: 00:00:49

lot more bold, a little bit.

Geary: 00:00:51

. Uhhuh.

Kara: 00:00:52

That's an understatement, right?

Kara: 00:00:53

Yes.

Kara: 00:00:53

COVID I think heightened a lot of people's, heightened everybody's stress,

Kara: 00:00:57

but then it also made a lot of people, a lot less trusting of people at each other

Kara: 00:01:02

in general, in the healthcare environment.

Kara: 00:01:04

But I was re reading a little bit, and according to the Bureau of Labor

Kara: 00:01:07

Statistics, The rate of injuries from violent attacks against medical

Kara: 00:01:10

professionals grew by 63% from 2011 to 2018, and now that's right

Kara: 00:01:15

before Covid, but I don't think the pandemic has made it better.

Kara: 00:01:19

That's an incredible jump.

Kara: 00:01:20

That's a

Geary: 00:01:21

huge jump in crime statistics against nurses.

Geary: 00:01:24

Is that just against nurses or against healthcare workers in general?

Geary: 00:01:27

It's against nurses

Kara: 00:01:28

and healthcare workers in general.

Kara: 00:01:30

Okay.

Kara: 00:01:30

I There was an incidence in Tulsa.

Kara: 00:01:32

where a surgeon was shot to death or shot.

Kara: 00:01:34

Yeah.

Kara: 00:01:35

He was shot to death because he had, because the patient had continued

Kara: 00:01:38

back pain after an operation.

Kara: 00:01:40

That's horrible.

Kara: 00:01:41

Well, We don't often think about that when we go to work.

Kara: 00:01:43

What if this patient doesn't like how my, what my treatment plan is, or how I carry

Kara: 00:01:47

out my treatment plan and they attack me.

Kara: 00:01:49

, what are the consequences of.

Kara: 00:01:50

Our daily work environment, sometimes If the outcome isn't satisfactory,

Geary: 00:01:55

that's true there, but there are so many common hazards to healthcare workers.

Geary: 00:02:00

But I think right now violence is probably at the top of the charts

Geary: 00:02:05

as far as a hazard for nursing and.

Geary: 00:02:09

Healthcare workers in general.

Geary: 00:02:11

I was listening to an ANA webcast and they were talking about physical hazards

Geary: 00:02:16

one of the things they pointed out were different general physical hazards

Geary: 00:02:21

over exertions slips, trips, and falls.

Geary: 00:02:24

And they had workplace violence as the third most common health

Geary: 00:02:28

hazard for healthcare workers.

Geary: 00:02:31

But I think, it's come to the forefront of what's happening.

Geary: 00:02:36

, violence against healthcare workers and nurses That they're definitely, and it's

Geary: 00:02:40

already noted that it's under reported.

Geary: 00:02:42

. what we see and what we know.

Geary: 00:02:44

There's more out there than that.

Geary: 00:02:45

What else did you find out?

Geary: 00:02:47

Oh,

Kara: 00:02:48

I was looking, I was, thinking broad spectrum, right?

Kara: 00:02:50

Like workplace environment hazards response time.

Kara: 00:02:53

How long does it take security to get to you, or how long does it take

Kara: 00:02:57

your response team to get to you?

Kara: 00:02:58

Some facilities have developed response teams to deescalate situations.

Kara: 00:03:02

Oh yes.

Kara: 00:03:02

So you call a response team and then they come to deescalate it.

Kara: 00:03:06

But there was an incident in Louisiana in January where a man was unsatisfied

Kara: 00:03:11

with the outcome of his parents who were in the intensive care unit,

Kara: 00:03:13

and he punched a nurse unconscious.

Kara: 00:03:15

What is the repercussion for him?

Kara: 00:03:18

Is she okay?

Kara: 00:03:19

Who covers her medical bills now that she's been knocked out in the workplace?

Kara: 00:03:25

And then at the same time, is she gonna be scared to come back to work?

Kara: 00:03:28

Is she gonna even wanna come back into that unit?

Kara: 00:03:30

How's, what's the trauma follow up after that?

Kara: 00:03:32

Also, I wonder what and is he?

Kara: 00:03:33

Is, does she press charges?

Kara: 00:03:35

Does he go to jail?

Kara: 00:03:36

Yes.

Kara: 00:03:36

And what we don't often hear about the repercussion, like

Kara: 00:03:39

what happens to this person?

Kara: 00:03:40

What is the consequence of their behavior?

Kara: 00:03:42

Even if it's just irate, even if you're in a clinic and you have an

Kara: 00:03:45

irate family member come in screaming and yelling and bowling you into a

Kara: 00:03:48

certain type of treatment, right?

Kara: 00:03:50

What is the consequence of their action, right?

Kara: 00:03:52

Do we fire them from being able to come back to that clinic?

Kara: 00:03:55

Do we say, you're no longer welcome here.

Kara: 00:03:57

Can we refuse?

Kara: 00:03:58

That's the other thing, you know as a nurse, are you able to

Kara: 00:04:01

say, I'm not taking care of you?

Kara: 00:04:03

We hear all the time in when you're working in the building, right?

Kara: 00:04:05

The family fired this nurse, they don't want her back.

Kara: 00:04:08

Or they don't want that tech back, or they don't want that doctor back.

Kara: 00:04:10

Yes.

Kara: 00:04:10

What if I don't wanna take care of you either, right?

Kara: 00:04:13

What if I don't wanna be subjected to your kind of abuse,

Kara: 00:04:16

aggression, or abuse or verbal?

Kara: 00:04:18

Verbal, derogatory statements constantly, right?

Kara: 00:04:20

What if I don't want to come in here and risk being punched in the face

Kara: 00:04:23

because I woke you up the wrong way,

Geary: 00:04:25

right?

Geary: 00:04:25

If you've already displayed violent behavior and then the nurse comes in and

Geary: 00:04:30

says, I don't want to take that assignment because that patient was abusive with

Kara: 00:04:35

me yesterday, or They're threatening my license, they're

Kara: 00:04:38

a threat to my license now.

Kara: 00:04:39

, because now they're making it seem as though my care isn't adequate, or

Kara: 00:04:43

everything that I'm doing isn't enough.

Kara: 00:04:45

And now when I do it, are you gonna sue me or are you gonna threaten my license?

Kara: 00:04:50

Then I was reading more about social media and how that

Kara: 00:04:52

people really attack each other.

Kara: 00:04:54

We know people attack each other on social media all the time, you can

Kara: 00:04:57

destroy a surgeon or a physician or nurses, anyone's reputation.

Kara: 00:05:02

Oh, definitely.

Kara: 00:05:02

Just by saying, oh, he didn't do a good job.

Kara: 00:05:04

He didn't do a good job.

Kara: 00:05:05

Don't ever go back here again.

Kara: 00:05:07

And who looks

Geary: 00:05:08

into that?

Geary: 00:05:08

That's just the tip of the iceberg with everything that's going on out there.

Geary: 00:05:13

The bullying that can be done or the repercussions.

Geary: 00:05:16

If you say something on social media that doesn't agree with a narrative

Geary: 00:05:23

of or what the general view is, there can be severe repercussions.

Geary: 00:05:30

There can be.

Geary: 00:05:32

You yourself end up being bullied, and so you have to be very careful.

Geary: 00:05:37

I think social media can, it's a double edged sword, right?

Geary: 00:05:41

, it can be used for good.

Geary: 00:05:43

There are so many good things that have come out from being

Geary: 00:05:46

able to connect with your friends and family that live so far away.

Geary: 00:05:50

The good aspects.

Geary: 00:05:51

So let's say the good aspects of Facebook are you get to see

Geary: 00:05:55

those pictures of the baby of your new niece or nephew instantly.

Geary: 00:06:00

Or you get to connect and talk to someone from high school or from wherever.

Geary: 00:06:04

Those kind of connections that we're able to achieve.

Geary: 00:06:08

Now, those are great, but then there's the other side of that is

Geary: 00:06:14

the people that get upset with you.

Geary: 00:06:16

A patient or anybody, they weren't satisfied with the care you provided,

Geary: 00:06:21

and then they find you on Facebook or they go look for you on any of the

Geary: 00:06:26

other social media platforms and they start harassing you or trolling you.

Geary: 00:06:31

, that type of thing.

Geary: 00:06:33

That's a certain type of violence as well.

Geary: 00:06:35

And how do we deal?

Kara: 00:06:36

Exactly.

Kara: 00:06:37

I know some hospitals are installing or investing in more secure technology,

Kara: 00:06:43

so they have cameras up everywhere.

Kara: 00:06:44

Even some places have like nurses wearing cameras, like I guess pinned to them.

Kara: 00:06:49

, so if someone is getting overly aggressive or they've been flagged as an aggressive

Kara: 00:06:52

family member or an aggressive patient, they can say this is all being recorded.

Kara: 00:06:55

Kind of like the same thing for police officers.

Kara: 00:06:57

There has to be a level of accountability and we're not saying.

Kara: 00:07:00

Medical professionals aren't responsible for their behavior either, or our

Kara: 00:07:04

response, cuz none of us are perfect.

Kara: 00:07:06

But the accountability goes both ways, right?

Kara: 00:07:08

You're expecting a service, you expect to be treated a certain way when

Kara: 00:07:12

you're coming in for the service that you're paying for, but then at the same

Kara: 00:07:15

time, it doesn't give you the right to overstep and act any way you want.

Kara: 00:07:19

To get that service and.

Kara: 00:07:22

I waiver back and forth because I think, okay, now we've entered into

Kara: 00:07:26

this age of where we have to flag aggressive patients or flag family

Kara: 00:07:30

members or people who you think might are gonna go in this direction, right?

Kara: 00:07:34

. And so there's a targeted response where your management is notified,

Kara: 00:07:37

the charge nurse or whoever is notified, like who we're gonna have

Kara: 00:07:39

to deal with this family a certain way or this patient a certain way.

Kara: 00:07:43

Yes.

Kara: 00:07:44

But then I think people who are around and watch that, like I think in ER

Kara: 00:07:47

settings and in clinic, Did people in the waiting room watch this person

Kara: 00:07:52

was acting out and they were screaming and yelling and they got what they

Kara: 00:07:54

wanted, or they got to be seen, or in some way seen they got heard faster.

Kara: 00:07:58

. So then people come in with that attitude like I can start out nice, but

Kara: 00:08:02

if I need to get rough, I will to get

Geary: 00:08:04

what I want.

Geary: 00:08:04

What is the

Kara: 00:08:05

behavior?

Kara: 00:08:05

Because that gets a response.

Kara: 00:08:06

And so are we training society as a whole to be more aggressive, to

Kara: 00:08:11

get a better, to get what they want?

Kara: 00:08:13

Learned

Geary: 00:08:14

behavior of, if I throw a.

Geary: 00:08:16

Is that going to help me get seen by the physician sooner?

Geary: 00:08:21

, whether I'm in the office, at the doctor's office, or I'm at the

Geary: 00:08:26

emergency room or in the clinic because everybody knows about hcaps.

Geary: 00:08:31

All of your scores, everybody has to, everybody wants to get a good score.

Geary: 00:08:35

And if you have an irate patient or family member who can influence the

Geary: 00:08:41

scores that You're going to want to give them that attention and calm them

Geary: 00:08:45

down and make sure everything goes well.

Geary: 00:08:47

So that they give you a 10, a nine or a 10, right?

Geary: 00:08:50

Cause anything less than that is a zero, right?

Geary: 00:08:53

So I think that plays into a narrative.

Geary: 00:08:58

I

Kara: 00:08:58

think that we should do.

Kara: 00:08:59

the same way that we have as we have debriefing, right?

Kara: 00:09:02

, like someone dies, you lose a patient on any floor.

Kara: 00:09:05

There should be a debriefing moment.

Kara: 00:09:06

And I think a lot of places have moved towards talking

Kara: 00:09:09

about what did we do right?

Kara: 00:09:10

What did we do wrong?

Kara: 00:09:11

How does everybody feel about this situation?

Kara: 00:09:13

, did we do everything we could do?

Kara: 00:09:15

Could we have responded better?

Kara: 00:09:16

And so you do that in the instance of a death.

Kara: 00:09:18

And I think when there is.

Kara: 00:09:20

a work environment hazard that's happened, or violence issue or a safety issue.

Kara: 00:09:25

Where something has been breached.

Kara: 00:09:26

Somehow our level of security was breached.

Kara: 00:09:29

We should have a debriefing on that.

Kara: 00:09:31

And I think everybody involved, whether, some level of, Hey, how

Kara: 00:09:34

do you feel like we handled that?

Kara: 00:09:36

Do you think that the security response time was fast enough?

Kara: 00:09:38

Are you okay?

Kara: 00:09:39

Is this gonna affect you when you come back to work?

Kara: 00:09:42

I don't know how I, I have yet to see that.

Kara: 00:09:44

I've had a couple of experiences.

Kara: 00:09:46

personally, it's 2:00 AM in the morning.

Kara: 00:09:48

The halls are dark, everybody's asleep, and I'm in a pediatric unit and a

Kara: 00:09:52

psych patient somehow ended up in my facility fully in a psychotic break.

Kara: 00:09:57

His head was covered up with a towel.

Kara: 00:09:58

We don't know how he got there.

Kara: 00:10:00

He's just sitting in the middle of our, in like inside the unit waiting room.

Kara: 00:10:03

Not speaking to anyone.

Kara: 00:10:05

We don't know if he's aggressive and it's me and one other female employee.

Kara: 00:10:08

There to navigate this situation, right?

Kara: 00:10:11

Security's in the basement somewhere, dealing with the ER

Kara: 00:10:14

because they never stop, right?

Kara: 00:10:15

, hit our distress button, but it's still up to me to guide this man

Kara: 00:10:19

safely out of the unit and then try to figure out how he got there.

Kara: 00:10:23

. And so for me it meant a lot that the head of security leader called

Kara: 00:10:26

me later couple days and said, Hey, you were the one who was there.

Kara: 00:10:30

How do you feel about this situ?

Kara: 00:10:32

What do you think we could have done better?

Kara: 00:10:34

Right when, and what had happened was our behavioral unit wasn't locked down

Kara: 00:10:38

yet, so he just walked right out of the unit that he was supposed to be.

Kara: 00:10:42

Restricted to.

Kara: 00:10:43

Found an in facility inpatient elevator and went straight up to the

Kara: 00:10:46

first floor that he could get off on.

Kara: 00:10:48

Oh, okay.

Kara: 00:10:49

That could have been potentially hazardous for any one of our little

Kara: 00:10:51

kids who was there unaccompanied.

Kara: 00:10:53

Not to mention the staff if we had have approached him aggressively, . Cause

Kara: 00:10:55

we don't know what he's there for.

Kara: 00:10:56

But follow up is so important and I.

Kara: 00:10:59

There's, I don't see a lot of discussion on that about

Geary: 00:11:02

the follow up.

Geary: 00:11:02

I agree.

Geary: 00:11:03

I do think that those debriefings are very helpful and also nurses and

Geary: 00:11:09

the general support staff as well have ideas, and they're on the floor

Geary: 00:11:14

24 7, so they may see something that upper management or leadership is not

Geary: 00:11:21

seen as far as how we can make the environment safer because what's our.

Geary: 00:11:27

Our goal is to make the environment safer.

Geary: 00:11:29

So if there is that type of violent attack or that type of shooting or that

Geary: 00:11:35

type of physical violence against a nurse that happens, how can we make it better?

Geary: 00:11:40

What can we do to prevent this type of event from happening?

Geary: 00:11:46

And if it's, I think that recent shooting that happened, it was a

Geary: 00:11:52

family member or friend or something.

Geary: 00:11:55

Was able to get into the unit.

Geary: 00:11:56

Can we look at that policy again?

Geary: 00:11:58

Let's look at that visitation policy again, and let's see if there's something

Geary: 00:12:04

that we could have done and then moving forward, what can we do to change that?

Geary: 00:12:08

Because if you're going to put the staff at risk, it's better to make the

Geary: 00:12:14

changes and that just goes towards.

Geary: 00:12:18

Behavior in general.

Geary: 00:12:20

If you have good behavior that's going to be rewarded with the more

Geary: 00:12:25

availability of visitation or something more opening of our hospital policy or

Geary: 00:12:29

our facility policy, no matter where we are to be able to allow more visitors.

Geary: 00:12:34

But if this type of event is happening, then we need to protect our staff because

Geary: 00:12:40

we need to think about the patient,

Geary: 00:12:41

and how that's going to affect the entire patient population.

Geary: 00:12:45

If nurses are afraid to come to work because they're worried

Geary: 00:12:48

about their safety, then you know that damages the whole system.

Geary: 00:12:53

which ultimately damages the patients as well,

Kara: 00:12:56

think moving forward to, we do safety, we have safety checks

Kara: 00:12:59

right in place for kids in school.

Kara: 00:13:02

They have to go through drills and what happens if this happens?

Kara: 00:13:04

Do we need to have safety plans?

Kara: 00:13:06

We do have safety plans, but do we go over them as a facility?

Kara: 00:13:10

, where's your exit?

Kara: 00:13:11

How are you getting out?

Kara: 00:13:12

What is your responsibility to your patients, right?

Kara: 00:13:15

, if there's an active shooter or if there's a bomb threat, we go over them.

Kara: 00:13:18

What?

Kara: 00:13:18

Once every few years, but maybe we should do them more frequently.

Kara: 00:13:22

Where are the panic buttons located?

Kara: 00:13:23

Does everybody in the unit even we have so many travelers

Kara: 00:13:27

and so such high turnover.

Kara: 00:13:28

Does everybody know the steps to take, to even get to a panic button?

Kara: 00:13:33

, or where the fire exit is, or where the stairs are, or.

Kara: 00:13:36

Et cetera.

Kara: 00:13:36

It goes on and on.

Kara: 00:13:37

And then who do I go to for help if I feel like it's been linear?

Kara: 00:13:42

If it's been my coworker, I've been subjected to a coworker who backed me into

Kara: 00:13:46

a room and was yelling in my face and.

Kara: 00:13:48

. , almost in a physical al altercation.

Kara: 00:13:50

, I was so shook up, I didn't know what to do.

Kara: 00:13:52

Do I'm in charge right now, and this has happened to me.

Kara: 00:13:55

Do I call security to deal with my coworker?

Kara: 00:13:57

Do I go right?

Kara: 00:13:58

Where's my manager after hours, they're not there?

Kara: 00:14:01

How do I handle this situation?

Kara: 00:14:02

Who do I go to get something done or to, how do we

Geary: 00:14:05

deescalate?

Geary: 00:14:06

I do think that's something that, the generation arriving now, or the

Geary: 00:14:10

nurses and staff that are working now.

Geary: 00:14:13

I don't know that they encountered that type of confrontation as much as some

Geary: 00:14:19

of the more experienced nurses and staff have, because when I first started in

Geary: 00:14:24

nursing, I did encounter that as well.

Geary: 00:14:27

I did have a senior person.

Geary: 00:14:30

And it was actually more than one senior person just get in my face and say, turn

Geary: 00:14:35

that alarm off, or make those alarms stop going off, or that type of thing.

Geary: 00:14:40

Just in my face saying, go do that right now.

Geary: 00:14:43

I think that type of behavior is not acceptable.

Geary: 00:14:46

when I first became a nurse, that type of behavior was allowed.

Geary: 00:14:49

However, now, That wouldn't even be tolerated.

Geary: 00:14:53

That would not be tolerated.

Geary: 00:14:55

A nurse would definitely, I think in nurse would go running to a leader,

Geary: 00:15:00

a manager or director or something.

Geary: 00:15:03

If anyone approached them and got in their face, if any manager or coworker

Geary: 00:15:09

got in their face and yelled at them for something, I think they would be quick to.

Geary: 00:15:14

What do you think about that?

Geary: 00:15:15

Do you think nurses are more willing to report things like that, or you think

Geary: 00:15:18

they're still not under reporting?

Geary: 00:15:20

I think

Kara: 00:15:20

it's still under report.

Kara: 00:15:21

Okay.

Kara: 00:15:21

I think it depends, obviously on the person that's being bullied or the

Kara: 00:15:26

person that's being attacked, right?

Kara: 00:15:27

, like what their personal experiences are.

Kara: 00:15:29

, are they gonna be paralyzed with fear?

Kara: 00:15:30

Is have they had over overcome other traumas?

Kara: 00:15:33

Is this a familiar situation?

Kara: 00:15:34

, do they know their rights?

Kara: 00:15:35

, know, like a lot of it comes down to, do you know your rights?

Kara: 00:15:38

, and I think as nurses are, we come into this position, , I'm here to serve

Kara: 00:15:42

you and I'm here to take care of you.

Kara: 00:15:43

And we set ourselves aside to do this job right, because this is

Kara: 00:15:47

part of our work to care and to love and to, give these services.

Kara: 00:15:51

. a lot of times we don't realize our rights, even when it comes to the patients

Kara: 00:15:53

and the family members, violating them with their, demands and attitudes and.

Kara: 00:15:58

verbal aggression.

Geary: 00:16:00

No, I definitely agree.

Geary: 00:16:01

I think that it's just very important for nurses to be aware of the process

Geary: 00:16:06

and of their facilities policies, whether it's physical safety, knowing, , in

Geary: 00:16:12

general, policies address the issue when nurses and staff are onboarded,

Geary: 00:16:17

All right, that's all the time we have for today.

Geary: 00:16:19

We'd love to continue to hear your thoughts and opinions.

Geary: 00:16:21

And remember whatever life hates you today, don't go

Kara: 00:16:24

crazy..

Kara: 00:16:24

So email us, drop us a line at, go crazy at the nurses round table.com and