Workplace Violence Dana Bartlett, BSN, MSN, MA, CSPI Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Rocky Mountain Poison Control Center. ABSTRACT Workplace violence is a complex and widespread issue that has received increased attention from the public, mental health experts, law enforcement, and healthcare professionals. Workplace violence in healthcare can include violence from the patient, relatives and friends of patients, and it also includes workplace bullying. Pain, anxiety, loss of control, powerlessness, and disorientation may result in aggressive incidents against healthcare workers. Violence in emergency departments may result due to varied reasons, including access to weapons and crowded and emotional situations occurring in emergency settings. Some healthcare organizations have implemented a code for violence that evokes a rapid response. The incidence of occurrences, type of violent incidents and prevention of violence are discussed. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Workplace violence in healthcare can take many forms. It is a widespread and complex issue. Healthcare workers need to be informed and appropriately trained to recognize warning signs and to act to prevent harm to self, co-workers and others, including harm to patients during the delivery of healthcare. Course Purpose To provide health clinicians with knowledge on how to recognize and understand the implications of workplace violence upon clinicians and the health environment, and of available resources to report violence and to seek help. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC - all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. ___________ percent of all nonfatal injuries from occupational assaults and violent acts occur in healthcare and social service settings. a. Twenty-five b. Sixty-nine c. Fifteen d. Thirty-three 2. True or False: Workplace Type I incidents involve offenders in a relationship with either the victim or the establishments. a. True b. False 3. Healthcare workers are at increased risk for workplace violence from a patient’s relatives or friends because a. prevalence of firearms among the public. b. hospitals do not discharge patients timely. c. availability of drugs or money at pharmacies. d. of frustration with a perceived lack of care or communication. 4. True or False: A manager issuing a threat to report an employee or making threats about the employee’s performance evaluation is not considered workplace violence because these threats are part of a manager’s legitimate role. a. True b. False 5. If a violent situation seems imminent or is occurring in the workplace, de-escalation techniques are used to a. physically restrain the violent person. b. control the situation using chemical restraints. c. calm a violent person by talking to the person. d. All of the above 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Violent occurrences in healthcare settings have pushed the issue of workplace violence to the forefront of the health community and other agencies taxed with ensuring staff and patient safety.1-3 Health clinicians care for their patients and envision making a difference in their patient’s health status, decision-making abilities, and health outcomes. Workplace violence also includes workplace bullying; this may not be as dramatic as violent incidents, but it is pervasive and has a very harmful effect on employees and organizations. Violence is a serious and unanticipated risk for health clinicians, and the incidence of workplace violence, the causes and consequences, and strategies that can prevent and deal with occurrences of workplace violence are highlighted in the following sections. What Is Workplace Violence? In September 2010, the Baltimore city police and tactical team rushed to Johns Hopkins Medical Center to subdue a gunman on the eighth floor of the hospital. Patients and healthcare workers in the hospital and vicinity were immediately evacuated when the alert was sounded. The suspect became emotionally distraught after a surgeon updated him on the status of his mother’s grave condition. After hearing the news, the gunman allegedly fired a semiautomatic handgun and shot the physician in the abdomen, seriously wounding him. Workplace violence in healthcare can take many forms. Violence from relatives and friends of patients may occur because of frustration with a perceived lack of care or communication. Pain, anxiety, loss of control, powerlessness, and disorientation may result in aggressive incidents from patients to health clinicians. Violence in Emergency Departments (EDs) may 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com result from the crowded and emotional situations that can occur in EDs when people are ill or in pain. In addition, ED patients could be involved with crimes, weapons and violent behaviors that could put the ED employee at an increased risk of workplace violence. There is a wide range of acts that fall under the rubric of workplace violence, including violent behavior and threats of violence, as well as any conduct that can result in injury, damaged property, induce a sense of fear, and otherwise interfere with the normal course of work. Threats, harassment, intimidation, bullying, stalking, intimate partner violence, physical or sexual assaults, and homicides can also be considered workplace violence. Workplace violence can also occur between employees in the form of bullying and incivility. The World Health Organization (WHO) defines workplace violence as “Incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, wellbeing or health.”4 Also, the National Institute of Occupational Safety and Health (NIOSH) defines workplace violence in the following way. “Workplace violence is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty.”5 The National Institute of Occupational Safety and Health classifies workplace violence into four categories, Types I-IV.6 Types II and III are the most common in healthcare settings: 1) Type I involves criminal intent, and the perpetrators of Type I workplace violence do not have a relationship to the business or its employees, 2) Type II involves a customer, client, or patient, the individual has a relationship with the business and the employees, and he/she becomes violent while receiving services, 3) Type III violence is worker-on-worker violence, i.e., an employee who attacks or threatens another employee, and 4) Type IV violence occurs when the perpetrator and 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com the victim have a personal relationship, the violence happens in the workplace, but the attacker has no formal relationship to the business. Table 1 provides explanations and examples of violence that can occur at work. Table 1 – Types of Violence Type of Violence Description Verbal Outbursts of yelling and screaming; use of exaggerated or angry tone of voice, cursing, derogatory, foul, condescending, or inappropriate language, or use of racial/ethnic slurs. It is not always what but how it is said, and when and where a comment is made. Nonverbal Includes eye rolling, raising eyebrows, making a face, turning away from a person, or physically excluding someone. Although these nonverbal behaviors are not spoken, they are seen and felt as abusive. Passive behaviors The absence of an action rather than an overtly identifiable action that directly