Workplace violence in nursing is not something new. In fact, even before the COVID-19 pandemic, nurses and other healthcare professionals faced unpredictable risks every day. In this blog, I share my story of workplace violence in nursing to spread awareness and educate colleagues on ways to get involved, stay safe and protect yourself, your colleagues, patients and families. Resources are included on how to learn more about this topic and protect yourself from workplace violence.
As nurses, we've all taken a CPR course. The first step is always "Scene Safety," but what does that really mean for those of us who work in the ICU? We know that if we see a medical emergency outside of work, we do not respond unless we first determine it is safe to do so. But what happens when our scene in the hospital becomes unsafe in the middle of providing care? What happens if our patient is the reason our location is not safe? I do not have all the answers, but I do have firsthand experience with what can happen and what it looks like to be a nurse who has experienced workplace violence in nursing. I also have the passion to share my story and advocate for change and prevention so that no one else has a story like mine.
Firsthand Experience
The day of my injury started like any other day; nothing felt out of place, until it was. The patient who assaulted me had acute altered mental status; they were oriented to self only and not aware of their surroundings. This patient was scared, physically strong and had one goal in mind ̶ to protect themself from perceived harm. Does this sound like a familiar situation? I have taken care of hundreds of patients who fit this description. They come with a range of diagnoses from dehydration, substance use and withdrawal to head injury, cardiac arrest and many others. They could easily be any patient in an intensive care setting on any given day. It is not to say that all ICU patients are dangerous, but we need to view them with a universal precaution-type approach to safety and recognize that almost all people are capable of physical violence. As nurses, we need to be aware and be prepared to take care of ourselves and our patients safely.
The day of my injury is crystal clear in my mind, although the details don't matter, as that day, and the scenario, were not out of the ordinary. The difference that day was instead of coming home after work and telling my husband, "I almost got hit again today," I called him from the ED saying, "I got punched in the face today, and I need you to pick me up. I am in so much pain and cannot drive myself home." That day changed my life forever.
After taking a couple of days off work, I returned to my last few shifts in the ICU. I had already accepted another job before my injury; this new job is a dream job of mine. Now, more than ever, it was a perfect transition as I started to struggle with feeling unsafe near patients with altered mental status. I had read about posttraumatic stress disorder (PTSD), burnout and compassion fatigue in healthcare providers, but I never thought it would impact my life. Over the next few years, I quickly learned just how much of a negative impact it would have. I also learned what it felt like to be a patient navigating the throes of finding specialists to diagnose and treat my injury, and how frightening and hopeless it can feel.
After I got hit, it took a few days for the gravity of my injury to sink in. I immediately knew something was wrong when every one of my teeth hurt, and I could not open my mouth without significant pain. I figured the pain would go away in a few days, and I would put it all behind me. "There's no way I could get hurt that bad working as a nurse," I thought to myself; I was wrong. It turns out that when I was hit, my jaw temporarily dislocated and reduced on its own; the impact of the hit damaged the bones and cartilage in the temporomandibular joints to the point they had to be reconstructed. I had to see a specialist surgeon across the country due to the high-risk nature of the surgery. I spent many months on a liquid diet and now have a permanent inability to eat anything but soft foods.
I have missed hundreds of hours of work for follow-up appointments, physical therapy, acupuncture, pain injections, medical facial massage, orthodontist treatment and therapy, and due to pain. I have gained incredible insight into how it feels to be cared for by thoughtful medical teams, including amazing nurses. I also have felt the support of my co-workers and leaders as they have seen me through changes in my career and helped me pivot into the nurse I am today with a job I absolutely love.
I share my experience to empower nurses to take their safety into their own hands. We are all aware of the risks of bloodborne pathogens and other diseases we may be exposed to on the job. These things don't concern us, because we are thoroughly educated and provided with resources to protect ourselves. I would love to see it be the norm when it comes to workplace violence as well. It means not only organizational changes in some places, but also changes in nursing education and personal practice. We know the risk of workplace violence is significant, but we also have so many tools available to help keep ourselves safe. My life is forever changed, but yours doesn't have to be.
Call to Action
My goal is to spread awareness that as healthcare professionals, whether nurses, providers, patient care techs, support staff or other professionals, we are at risk of having a near-miss become "the day my life changed forever." With this blog, I hope to inspire everyone to take ownership of their practice and use my story to advocate for a safer work environment. Some things can be changed at the organizational level, but we can do many things as individuals to get involved and promote change. We are experts at the bedside, and our perspective and experience are invaluable!
My call to action is to ask you to familiarize yourself with your workplace violence policies, procedures and guidelines. Do you have a workplace violence committee? If so, join it; if not, spearhead it! Find out if your facility offers self-defense classes or de-escalation training and how to participate. If they are not available, advocate for your organization to invest in them, while also attending classes in your community and online such as this free course from the CDC. Learn about your local and national laws regarding healthcare assault, and get involved in making changes to improve safety in your workplace.
As nurses, advocating for our patients is second nature, no matter our specialty. But I call on you to advocate for yourself as much as you do for your patients. We have so much power to learn how to protect ourselves and engage with our facilities to make sure that, when our workplace becomes unsafe, we are equipped with the knowledge and tools to keep ourselves safe.
Current Evidence
In reviewing current evidence-based practice, multiple things can be done to prevent workplace violence in nursing and other healthcare areas. The Journal of Emergency Nursing published a rapid evidence review that found workplace violence programs that promote nurse awareness, de-escalation and hands-on techniques are extremely valuable. The most valuable programs include a comprehensive approach with classes for staff and supporting policies and procedures, as well as a focus on the physical environment in which we work. I recently attended a healthcare design conference and learned about the importance of the built environment when it comes to safety. It is important to understand your surroundings, know your exit plan and avoid becoming trapped. Also, recognize what part of the environment an aggressor could use as a weapon and mitigate that if possible; know how to use parts of the environment as a barrier between you and a violent threat. Where we work matters just as much as how we work. The Center for Health Design also has a free webinar for nurses on workplace violence prevention.
Collaboration and Reporting
Collaboration with our safety teams is paramount, whether they are security officers, de-escalation teams or whoever else might respond to a violent patient/visitor/co-worker threat. As ICU nurses, we are not strangers to interprofessional communication and collaboration, but are we including our security professionals in our interdisciplinary rounds? Do we have a mental health professional on our response team for violent events? Do we simulate these events and include our security teams as part of the simulations? An online article published in American Nurse describes an approach similar to police strategy in which each hospital department is seen as its own neighborhood with its own unique qualities. The security team learns about each hospital neighborhood and its staff to better understand where and how to respond based on the special needs of each department. It is also important that we as nurses understand the roles of non-clinical team members, and vice versa. We know that in critical care, the outcomes are better when we communicate clearly and early. This is no different when considering healthcare violence and our security/crisis response teams. Early communication of potential risk and clear understanding of the roles of all team members is an important part of improving the outcomes of workplace violence.
We also need to ensure we are reporting each and every one of these events, not just the ones that result in significant injury. There is not much data on ICU violence specifically, although we know the numbers are grossly under-reported. To help our facilities justify investing in and implementing safety programs, we need to paint an accurate picture of what is going on. If it isn't charted, it didn't happen. This applies to us too!
Advice to Act On
- Take care of yourself the same way you take care of your patients.
- Learn as much as you can about workplace violence prevention, just like you learn about new procedures or patients' diagnoses.
- Know your workplace violence policies and procedures as well as you know your code blue policy.
- Get to know your security team and other support staff the same way you know your respiratory therapists and patient care techs.
- Be as involved as possible in your facility's workplace violence prevention committee, just like you involve yourself in a unit-based council and other committees.
- Seek further training in de-escalation and physical safety the same way you seek conferences and other learning opportunities.
The ultimate goal is to continue to care for patients with a high level of skill. What other advice do you recommend to keep yourself and others safe?
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