Transcript No Slide Title

Workplace Violence:
Giving Staff the Tools and Support to Report
Michon Dohlman, MSN, RN
Erin Larson, MSN, RN
Maria Levy, BSN, RN
Julie Stene, BSN, RN
Workplace Violence
Objectives
• Define workplace violence (WPV)
• Discuss short- and long-term effects of WPV on staff
• Discuss the WPV quality project presented for Saint Marys
Emergency Department
• Identify the essential elements of the WPV reporting tool and
the keys to a successful WPV reporting structure
Workplace Violence
Definition
OSHA: Any act or threat of physical violence, harassment,
intimidation, or other threatening disruptive behavior that
occurs at the work site.
ENA: An act of aggression, physical assault, emotional or
verbal abuse, coercive or threatening behavior that occurs in
the work setting and causes physical or emotional harm.
Examples
Verbal threats, spit on/at, yelled at, biting, hair pulling, scratched,
being sworn at, being hit, pushed or shoved, etc.
Emergency Nurses Association, 2013;
US Department of Labor: OSHA, 2013
Workplace Violence
2013 Minnesota Statutes:
609.2231 Assault in the Fourth Degree:
Subd. 2. Firefighters and emergency medical personnel. Whoever
assaults any of the following persons and inflicts demonstrable
bodily harm is guilty of a felony and may be sentenced to
imprisonment for not more than two years or to payment of a fine of
not more than $4,000, or both:
(1) a member of a municipal or volunteer fire department or
emergency medical services personnel unit in the performance of
the member's duties; or
(2) a physician, nurse, or other person providing health care
services in a hospital emergency department
Workplace Violence
Statistics
• Average annual rate of non-fatal violent crime by occupation:
- Private sector 12.6 per 1,000 workers
- Nurses 21.9 per 1,000 workers
• Study of 6,300 MN nurses:
- Rate of both physical and non-physical attacks on nurses
was 52 per 100 nurses per year
- Consequences for victims following non-physical violence was
more severe (anxiety, stress, quitting as a result)
• Routinely underreported:
- Due to perception that assaults are “part of the job”
Gerberich et al., 2004
U.S. Department of Labor: Occupational Safety & Health
Administration, 2004
Workplace Violence
Effect on Staff
Difficult to measure:
- Most studies done through surveys
- Using a convenience sample
- Based on remembered events (rely on memory)
Workplace Violence
Effect on Staff
Studies Show:
• 94% of nurses that experienced WPV met at least one
symptom criteria for PTSD
• 17% (of the 94%) scored high enough to be diagnosed
with PTSD
• 15% had scores associated with suppressed immune
system function
Gates, et al, 2011
Workplace Violence
Effect on Staff
↓ Productivity
• Negative impact on managing the workload and
cognitive demands
• Absenteeism and job changes
↓ Morale
• Belief among nurses that violence against nurses is a
result of incompetence
↓ Quality
• Patient care
Gates, et al, 2011;
Gillespie, 2008;
Kowalenko, et al, 2013
Workplace Violence
Effect on Staff
Deena Brecher (ENA President):
“If nothing else, the fact that nurses consider leaving
and in some cases do leave a job because of violence
should be impetus enough for hospital leadership to take
the problem seriously.”
“It costs about $65,000 to replace a nurse.”
Pecci, 2014
Workplace Violence
Effect on Staff
We can only manage what we have measured
Perception ?
Reality ?
Workplace Violence
• The WPV committee
- Formed in Spring 2012
• Purpose:
- Assess the incidence of WPV in the ER
- Assess staff knowledge of what defines WPV
- Learn why staff felt unsafe yet had 0 WPV report
(perception vs. reality)
- Change the perception that WPV is “part of the job”
Workplace Violence
WPV Assessment Survey
• Nursing  Surveyed in March, 2012
• Survey modeled after the ENA Emergency Department
Violence Surveillance Study
• Interventions: staff education, development of the reporting
tool
• Post-intervention  Staff surveyed one year later
Workplace Violence
Initial Survey Results
Workplace Violence
Initial Survey Results
Physical Abuse in the Past Month
26%
1-10 times
0 times
74%
Workplace Violence
Initial Survey Results
Workplace Violence
Initial Survey Results
Only 33% of assaulted staff
Reported it!!
WHY?
Workplace Violence
Initial Survey Results
Survey question:
Do you feel that workplace violence from
patients and/or visitors is simply “part of the job”?
53% - Yes
Workplace Violence
Initial Survey Results
Survey question:
Have you been instructed to report physical or verbal abuse
regardless of severity?
47% - NO
Workplace Violence
Initial Survey Results
Survey Quotes:
• “ this has been an accepted way for so long”
• “I shouldn’t feel that way, but it has been going on
enough that I am desensitized to it”
• “it is part of the job, up to a point”
• “there is more that can be done in order to keep
ourselves and our patients safe”
Workplace Violence
Following the initial survey:
• Developed a simplified reporting tool (handout)
• Staff educated
• Fliers in KEY places - even the bathroom
• Included in weekly management report to all staff
• Power Point presentation given at the department level
nursing practice committee meeting
• Included in yearly competency program
• “real-time” encouragement to report all incidents
Workplace Violence
Following the initial survey:
100% OF REPORTS SUBMITTED WERE FOLLOWED UP ON
BY MANAGEMENT WITH STAFF CONTACT
Picture of the reporting tool
Workplace Violence
Intervention
Report received by management
Flag to chart
Management
Chart Review
Monitor
“Flag”
• Internal to the emergency department
• Consists of a red folder with a brief description of the issue
• Used for staff and patient safety
• Prints out with every visit to the emergency department
Workplace Violence
Post Intervention Results
Workplace Violence
Post Intervention Results
60
#53
50
40
30
20
10
#9
#0
0
# reports preintervention 2012
# reports postintervention Sept-Dec
2012
# reports 2013
Workplace Violence
Post Intervention Survey Results
Is WPV a part of the job in the ED?
Response
Initial
Yes
53%
No
47%
Follow-up
Workplace Violence
Post Intervention Survey Results
Is WPV a part of the job in the ED?
Response
Initial
Follow-up
Yes
53%
24%
No
47%
76%
~55% Decrease
Workplace Violence
Post Intervention Survey Results
Staff comments on follow-up survey:
“it should not be considered part of the job by anyone”
“I feel now that it is NOT a part of my job and I will
not tolerate it”
“I think it is because it does happen,
but I don’t think it should be tolerated like it is”
Workplace Violence
Summary
Keys to Successful Reporting of WPV:
• Staff education
• Simplified reporting tool
• Change the culture that WPV is “part of the job”
• SUPPORT FROM MANAGEMENT IS ESSENTIAL
Workplace Violence:
Giving Staff the Tools and Support to Report
Questions…?
Discussion…?
References
Emergency Nurses Association. (2010) Position statement:Violence in the emergency care setting.
Retrieved from
http://www.ena.org/SiteCollectionDocuments/Position%20Statements/Violence_in_the_Emergency_Care_
Setting_-_ENA_PS.pdf
Gates, D.M., Gillespie, G., Succop, P. (2011). Violence against nurses and its impact on stress and
productivity. Nursing Economics, 29(2), 59-66.
Gerberich, S.G., Church, T.R., McGovern, P.M., Hansen, H.E., Nachreiner, N.M., Geisser, M.S., Ryan,
A.D., Mongin, S.J., Watt, G.D. (2004). An epidemiological study of the magnitude and consequences of
work related violence: The Minnesota nurses’ study. Occupational Environmental Medicine, 61, 495-503.
Gillespie, G. (2008). Consequences of violence exposures by emergency nurses. Journal of Aggression
and Maltreatment, 16(4), 409-418.
Koalenko, T., Gates, D., Gillespie, G., Succop, P., Mentzel, T. (2012). Prospective study of
violence against ED workers. American Journal of Emergency Medicine, 31, 197-205.
Pecci, A. (2014). ED violence racks up huge costs. Health Leaders Media. Retrieved from
http://www.healthleadersmedia.com/page-1/NRS-300840/ED-Violence-Racks-Up-Huge-Costs
The Office of The Revisor of Statutes (2013) Minnesota Statues: Assault in the fourth degree
(609.2231). Retrieved from https://www.revisor.mn.gov/statutes/?id=609.2231
U.S. Department of Labor: Occupational Safety & Health Administration. (2004). Guidelines
for preventing workplace violence for health care & social service workers (OSHA 3148-01R
2004). Retrieved from https://www.osha.gov/Publications/OSHA3148/osha3148.html
U.S. Department of Labor: Occupational Safety & Health Administration. Workplace violence.
Retrieved from https://www.osha.gov/SLTC/workplaceviolence/
Thank You