Nurses, doctors and other frontline medical workers are the heroes of the ongoing COVID-19 pandemic. And like any hero, they put their lives on the line every day to save and protect the most vulnerable. The risk of contracting COVID-19 has emphasized the daily risks our providers take. But even before the pandemic, health care heroes have been fighting another villain: workplace violence.
A 2016 report from the Texas Department of State Health Services (DSHS) indicated over half of Texas’ nurses were subject to violence in their career. Another 82% of Texas nurses reported verbal abuse. Nationwide, the rate of violence for health care workers increased more than 60% between 2011 and 2018. The Occupational Safety and Health Administration (OSHA) has found the rate of serious violent incidents in health care is over four times greater than for those in other industries.
“Nurses and care providers unfortunately deal with the threat of physical and verbal abuse from patients on a regular basis. Health care leaders and lawmakers in Texas are aware that this is a real problem and are working on safety solutions. I’ve seen our member hospitals implementing excellent training programs and protocol to continue to make hospitals a safer place,” said Jennifer Banda, J.D., vice president of advocacy, public policy and political strategy at the Texas Hospital Association.
“Nurses and care providers deal with the threat of physical and verbal abuse from patients daily. Health care leaders and lawmakers in Texas are aware that this is a real problem and are working on safety solutions. I’ve seen our member hospitals implementing excellent training programs and protocol to make hospitals a safer place.”JENNIFER BANDA, PRESIDENT OF ADVOCACY, PUBLIC POLICY, AND POLITICAL STRATEGY AT TEXAS HOSPITAL ASSOCIATION
These troubling statistics can have implications that reach far beyond a physical injury. According to a 2020 study from the National Institutes of Health (NIH), the psychological consequences can be more severe. Workplace violence correlates with burnout and turnover – further contributing to existing physician and nurse shortages. These consequences also lead to decreased productivity and affect patient care.
Taking Proactive Steps to Reduce Violence
Training providers in non-violent, de-escalation techniques is key to preventing workplace violence. Offering courses that identify patient behavior and how staff should respond to those behaviors play a significant role in prevention strategies.
“Our job is to provide the training and resources for our staff to recognize a person’s behavior level and respond appropriately based on that behavior,” said Phil LeClair, director of security services at Baylor St. Luke’s Medical Center in Houston.
Baylor St. Luke’s Medical Center offers an all-inclusive workplace violence prevention program that focuses on non-violent crisis intervention.
“Our course is taught by a clinical nurse with support from the security leadership and teaches providers how to respond to certain patient behaviors by way of verbal de-escalation. The class has both classroom lectures and practical physical activities to demonstrate the importance of personal space and the importance of staying safe and respectful of the individual they are treating,” said LeClair.
While behavioral health and emergency departments bear the brunt of the issue, workplace violence impacts all hospital floors.
“At Parkland, all of our emergency department and behavioral health staff take part in de-escalation training. And because there is often spillover of patients that are at a higher risk of becoming violent, leaders in the Med Surg and OBGYN units have started to implement the same training,” said Karen Garvey, vice president of quality and clinical risk management at Parkland Health & Hospital System in Dallas.
As another proactive step, Parkland places alerts in the medical records of patients who have exhibited aggression toward staff. These flags make providers aware that the patient may become aggressive and proactively create a safety care plan. These flags, however, don’t always permanently stay on a patient’s record. “We have a committee that reviews these flags each month to see if they need to remain in place. We don’t want to profile patients or unnecessarily have them kept in place when they are no longer needed,” said Garvey.
Making Staff and Patient Safety a Priority
Training care providers to take proactive steps to reduce instances of violence is only half the battle. Even with prevention and de-escalation training, these events still occur. Hospitals are taking additional steps to ensure the safety of their campuses.
LeClair says that part of Baylor St. Luke’s de-escalation training emphasizes that staff should feel comfortable calling security when needed. “The key is for health care workers not to become part of the problem by teaching them how to protect themselves and remove themselves from harm’s way. We ensure that our staff knows they can call security if they feel an escalation is about to occur,” said LeClair.
“The key is for health care workers not to become part of the problem by teaching them how to protect and remove themselves from harm’s way. We ensure that our staff know they can call security if they feel an escalation is about to occur.”PHIL LECLAIR, DIRECTOR OF SECURITY SERVICES AT BAYLOR ST. LUKE’S MEDICAL CENTER
In addition to an internal police force who are very patient centric, Parkland has some officers specially trained in mental health response. Parkland also created a behavioral health emergency response team (BERT) in 2017 that can respond throughout the acute care hospital.
“They respond to instances of violence and assess the patient,” said Garvey. “The most common intervention is to redirect the patient. The second highest is providing emergency psychiatric medication.”
Wearable alarms, photo courtesy of Parkland Health & Hospital System.
Parkland is a recipient of the Texas Center for Nursing Workforce Studies’ grant to prevent violence against nurses. They use a portion of the grant’s funds to provide wearable alarms to providers in the hospital. These alarms are available to nurses of all practice areas, health unit coordinators and techs who have regular patient contact.
“All patient rooms have panic buttons, but if the patient is in between the provider and the button, there isn’t much the provider can do. Some floors also have halls that are two football fields long, which can make it challenging for help to arrive quickly. These devices notify their peers due to its piercing alarm to let them know someone need help,” said Garvey “These alarms have been successful in preventing staff injury due to the quick responses of others arriving at the scene.”
Creating Public Awareness
Academic studies, hospital executives and care providers agree there is a lack of awareness with the general public that violence against providers is an issue.
“When my friends or family ask me about what I do at work, I tell them I do a lot of things related to patient and staff safety. I’ve told them to do a Google search on workplace violence in hospitals. They are often horrified that our health care providers have to deal with this. In my role, I try to be a voice of the reality of what is happening. Every hospital is fighting their own battle with the escalating violence. We need to have external communications to the public to say that this is not an OK thing,” said Garvey.
“When my friends or family ask me about what I do at work, I tell them I do a lot of things related to patient and staff safety. I’ve told them to do a Google search on workplace violence in hospitals. They are often horrified that our health care providers have to deal with this. In my role, I try to be a voice of the reality of what is happening. Every hospital is fighting their own battle with the escalating violence. We need to have external communications to the public to say that this is not an OK thing.”KAREN GARVEY, VICE PRESIDENT OF QUALITY AND CLINICAL RISK MANAGEMENT AT PARKLAND HEALTH & HOSPITAL SYSTEM
LeClair echoes the lack of public awareness on the issue. “The general public has the perception that a patient comes to the hospital when they are sick, gets treated by doctors and nurses, and then is discharged from the hospital,” said LeClair. “In reality, patients come into the hospital often feeling uneasy, scared and anxious. These feelings of fear and anxiety can escalate into verbal or physical abuse from the patient to provider.”
The lack of public awareness often extends to nursing and medical schools. Proactively preventing and responding to instances of patient violence is not something that schools teach. Parkland uses part of their Texas Center for Nursing Workforce Studies grant to reach out to and work with nursing schools. “We don’t want to instill a fear in students, but we do need to make them aware that this is an issue they’ll likely have to deal with,” said Garvey.
Advocating for Protection
While there are currently no federal laws that specifically target workplace violence in health care, there is a pending bill in the Texas legislature that would require violence prevention plans. HB 326, introduced by State Reps. Donna Howard (D-Austin), Stephanie Klick (R-Fort Worth), Drew Darby (R-San Angelo), Four Price (R-Amarillo) and Ina Minjarez (D-San Antonio) would require health care providers to create committees to prevent workplace violence and to offer medical treatment and other services after a violent incident.
Rep. Howard is a nurse and was a victim of workplace violence when working in an Austin hospital. “[Nurses and doctors] are there to take care of us. And I think we have a responsibility to take care of them,” Rep. Howard told The Texas Tribune about the importance of HB 326 in February 2021.
“Our hospitals are doing amazing things to prevent workplace violence. Most of them are already taking the steps the bill lays out, but that’s OK. This bill isn’t just for hospitals. Its goal is to set a baseline for all different types of health care facilities,” said Banda.
Baylor St. Luke’s Medical Center is one of many hospitals that has already introduced a comprehensive Workplace Violence Prevention Program. A multi-disciplinary team reviews policies and procedures and develops after-action plans from reported incidents consisting of workplace violence.
Photo courtesy of Parkland Health & Hospital System.
Advocating for workplace safety must occur inside the walls of the hospital as well. The Institute for Healthcare Improvement (IHI) reports that the perception from doctors and nurses is that it’s just “part of the job” to face abuse from patients. Other times, providers accept it as part of diagnoses – particularly with Alzheimer’s and behavioral health patients. Hospitals are working to break that stigma and encourage providers to report instances of abuse.
“We have been emphasizing the need to report instances of workplace violence so that we can understand what’s happening. We’ve seen improvement in reporting hospital-wide,” said Garvey. “We’re using this data to drive change and protect our workforce.”