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“What if we hire more security at night?”
This suggestion is a natural conclusion that many people suggest when discussing violence in hospitals. This particular person was Congressman Dutch Ruppersberger (D-MD), and we were speaking in the weeks following a (false alarm) active shooter incident at Walter Reed National Military Medical Center. Around 2:00 pm on November 28, 2018, an active shooter alert was called at the hospital. This alert and the panic that went with it lasted an hour and a half while occupants of the building sheltered in place.
The disruption from this event was caused by an error in the usage of a mass notification system. During the lockdown, though, no one knew it was a false alarm, not even law enforcement. Given the recent history of mass shootings and active shooters in hospitals, the possibility of something like this being real likely was questioned by no one. In retrospect, it seems reasonable to assume a larger number of security officers with tighter, more thorough security methods, might prevent mass shootings in hospitals.
There is, however, a pressing issue when it comes to workplace violence in healthcare: even if security is called, assaults often happen before security arrives. When they arrive, the damage is already done. One recent story shared with us by a Silent No More members illustrates this well. A nurse in the ED was hoping to get labs from a sleeping patient. The nurse decided to pull blood from the patient’s IV instead of waking the patient for a needle stick. A patient care tech (PCT) was there to assist. As the automatic cuff inflated, the patient awakened and kicked the PCT in the face using both feet. As the nurse attempted to block the next kick, the patient bit her. The patient held onto the nurse with her biting teeth, then grabbed the PCT by her hair.
In the aftermath of that assault, it became known that this patient had a history of violence toward staff and law enforcement. This patient was alert and oriented, and not psychologically impaired by a medical condition. This event could not be predicted when it happened. Adding security would not have changed this. This situation required something altogether different.
So, then, what is necessary? What does work?
The unfortunate truth is that little research data specific to violence in healthcare workplaces exists on this topic. What is clear is that change will require collaborative, multimodality approaches. This is not only about reducing some risk factors. This is not only about hiring more security. This will not only be about legislation. Change requires multiple things.
I am a large believer in looking at each assault and determining from its details what can be done differently next time. I had my own similar experience, much like the above story. A sleeping frequent flyer patient with dementia had a systolic blood pressure over 200. He had been refusing all medications the entire admission, so I took the opportunity while he was sleeping to try an IV anti-hypertensive. I did not realize his IV was clotted off, which woke him up. I was punched in my head before I even knew he was awake.
The similarities between this and the other nurse’s story is clear: a patient was awakened by surprise, and we failed to recognize that in our focus on what we were doing. This is not something that has been overlooked since. Our eyes remain on the patient at all times. The root causes were clear, and we now are safer in our practice.
Determining post-assault what can be done differently, is one of the best tools that a nurse has. However, this cannot be used as an opportunity to blame the victim. Too often, stories submitted to Silent No More Foundation are filled with retaliatory actions taken toward nurses who have been assaulted. This is not okay. Nurses need support when a traumatic event happens.
Employers can provide self-defense training. This can be very helpful, especially if the self-defense program has experience with self-defense in healthcare. Nurses are in the unique position of being responsible for the safety of the violent patient, in addition to our own. A self-defense training program that recognizes the unique challenges we face can be very empowering. A nurse should know up front the level of force they can use and how to use it if a violent episode becomes inevitable.
Another key factor in deterring assaults is to ensure we do not give our patients or their family members weapons that can be used against us. One brief Google search of nurses being strangled by stethoscopes that hung on their necks will return pages of relevant results. We place syringes on ourselves and on our computers, even when they are not needed. What’s worse, we walk away from those syringes or leave them in rooms where patients have access. We also do not consider our position in the room. Do you have a clear path for escape? If a patient makes you uncomfortable, do you bring someone into the room with you? Another personal safety measure: do you communicate risks to the next shift so they can protect themselves, too?
Advocate for Change
Increasingly, resources are being presented through organizations and OSHA with limited data to support their recommendations. It is important that nurses advocate for the changes necessary for the prevention of workplace violence. If there is one thing to urge no matter your employer’s response to these guidelines, it is that each nurse pay attention vigilantly to the patient’s behaviors and movements at all times. Ensure weapons are not attached to you or left in the room. Bring someone with you if a patient is at risk for violence.
Always prioritize your own safety. If you would like to learn more, find Silent No More Foundation. Protecting workers from assault is our mission.
Silent No More Foundation began in June 2017 as collectively healthcare workers all over the country united to say we will be silent no more about violence in healthcare workplaces. Since then, we have collaborated on and impacted legislation, connected victims to resources, developed education, spoken at US and international events, empowered thousands of healthcare workers to inspire change for safer workplaces, and more! Silent No More is on a mission to protect healthcare workers before, during, and after and assault in the workplace through education, awareness, advocacy, and legislation. Want to be part of the movement? Find us on Facebook and join the conversation!