Violence in the work place

Ruby Vee, BSN · Dec 30, 2008

my question to all health care providers out there is this, what does your hospital do or don't do to protect its employees from violate patients or family members. what are their p&p? what are your thoughts?
i asked this because in the july- september edition of aen, in it talks about a new program called act-smart. my take on it is, let's blame the nurse for not communicating with his/her patient/family members correctly. i understand that you can not combat aggression with aggression. it just escalates to a place that you don't want to go. a fight is the last thing anybody wants to deal with at work. i think most nurses do know how to use effective communication with patients/family members. i got into this business to help and make people better. at what point are we aloud to protect ourselves from being abused verbally or physically. now i am not talking about taking out grandpa simpson because he took a swing at me because he is confused or has alzheimer's. i'm talking about people who know better, but choose to use violence

in this era of press-gainey and "customer service", most hospitals don't do anything to protect employees from violent patients or family members. i suspect that your take on act-smart is pretty on-target.

crb613, BSN, RN · Dec 30, 2008

I don't know if we have a policy or not to be honest. I did see something posted about effective communication....it

may be what you are talking about. I think most of us do our best to be kind, and diffuse a situation before it gets out of hand......sometime you can't! I call the police....I don't know if my hospital likes it or not. If things are looking like it might get violent....I am taking care of my patients,myself & my coworkers.

R*Star*RN, BSN, RN · Dec 30, 2008

Our hospital has us call a code when a patient gets violent. Specially trained nurses, usually men, come to the scene to de-escalate the situation. This seems to be working well.

Our security officers and local police refuse to interfere with patient violence because of some case that happened a few years ago (all very hush hush, not sure of specifics).

racing-mom4, BSN, RN · Dec 30, 2008

Code Strong is called--that brings up any avail staff including the ER doc (usually a male) as well as any avail paramedics/EMTs. It is amazing how calm a pt will become when all of a sudden thier room is filled with 10 or so staff members and usually one of them holding a Geodon shot!!

MaryAnn_RN · Dec 30, 2008

That is one thing about ICU, if there is any sign of trouble then we have things like Vitamin D, Vitamin H, mmmmmmmmm. Trouble is we can't give it to the visitors.

racing-mom4, BSN, RN · Dec 30, 2008

That is one thing about ICU, if there is any sign of trouble then we have things like Vitamin D, Vitamin H, mmmmmmmmm. Trouble is we can't give it to the visitors.

Wouldnt it be a dream if we could sedate the family too???

nerdtonurse?, BSN, RN · Dec 30, 2008

If you can't sue the hospital, or it doesn't affect the PG scores, they don't care what happens to you. And if you're a nurse and you did sue because someone hurt you (and the hospital knew of your concerns) I bet you my last nickel no hospital would ever hire you. I don't know why it's okay for people to treat us in ways that would get them a fast ride to the local jail anywhere else....

Mr Ian · Dec 30, 2008

I've scanned the article in question - available here if anyone else is interested:

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=812225

Though I'd actually agree with a lot of the authors comments and findings, it doesn't really engender ED nurses to really want to do anything about it when the prime focus is on nurses not taking time to communicate properly.

You don't get people on-side by telling them how crap they are.

It also doesn't seem like much when I read that the ACT-SMART programme is an 8 hour event. You cannot cover the issues in 8 hours - and on such a big topic, there is no time to debate the issues, such as I'm going to raise here.

1. Foremost, the organisation has a responsibility to provide a safe work place. Having protocols (Code "Strong" - made me laugh a little, sorry! Best management of violence I've seen is usually by women less than 100lbs and under 5 feet tall) and training staff in some techniques is a good thing but the techniques need only extend to self-defense and 'breakaway' (getting out of holds or grips). It's all well and good telling nurses how bad they are at handling aggressive patients and families but...

2. Nurses are there to nurse. Except in my old type of workplace - secure mental health - you're not expected to deal with violence as a clinical problem. Why are nurses being expected to deal with it? I don't see a politician have to handle an assailant all by themselves.

3. The article writes about the charged state of ED and all the high acuity - people doing life or death stuff and patients and their relatives having to deal with it. I agree that nurses improving their communication skills might improve the situation - but so would patients and their relatives containing their behaviour. Unless the nurse is directly responsible for the patient being there in the first place - the MoP (member of public) should be respectful to the place they are in.

As a general rule - hospitals are public places and the hospital can and should reserve the right to throw anyone who fails to act resepctfully out on their a$$. Disorderly conduct constituties a breach of the peace and police should be called.

I remember taking a 2-week liaison at the local ED (as many of our patients would self harm etc so having a nurse link was beneficial to the services) - but I wasn't employed and thus only allowed to observe. But one guy was giving the staff a hard time - 6 foot biker, drunk and a head injury from where his mate [sic] had dropped a concrete slab on it. He decided he wanted to go home while in clearly no fit state and before medical treatment etc etc....

As the nurses wanted to get the medic I said - It's ok, I'll sit here and 'observe' him.

He did try to get up and leave - and all I did was hold his hand ... well that's what it looked like to anyone watching :rolleyes: ... and he decided to stay and lie down a while longer.....

... and be nice to the nurses. :nurse:

Verbal de-escalation can help nurses to contain a situation - but really, why should they be?

ED is renowned for being an aggression hot-spot and every one of them should have specifically trained staff there to deal with crowd control.

Oh, and anyone ever gets assaulted - don't think twice about laying charges.

We have a right to a safe working environment.

jbluehorseh · Dec 30, 2008

i believe in most cases good communication can solve the problem. one of my biggest concerns about the article (act-smart) is that it does not address what happens when effective communication fails. meeting aggression with aggression (code strong) i don’t think is best route, but if that is the last option then it should be done by security and not nurses or others, so they can stay neutral. in other word how the hospital does protects us from the public.

mcknis · Dec 30, 2008

We call security or call a Code Violet (all trained male staff/psych staff respond to the area where needed to deescalate the pt/family) when the need arises. I have no problem calling the local PD for more serious times. When we have inmates, a guard is with them at all times and security make more rounds when they are around. I have no fear when i come to work, although I am always watching my back, and make sure not to take crap from pts or family.

Not_A_Hat_Person, RN · Dec 30, 2008

In the ED where I volunteer has visible security guards (mostly big young males) with their own desk, and panic buttons. If an incident happens, they can call a Code Grey.