Nurses who fear for their safety at work have options.
That’s one of the messages of the American Nurses Association publication, “Not Part of the Job: How to Take a Stand Against Violence in the Work Setting,” written by Jane Lipscomb, PhD, RN, FAAN, and Matt London, MS.
With many healthcare organizations emphasizing a patient-satisfaction, customer-is-always-right culture, “staff feels some constraint in terms of advocating for their own safety,” said Lipscomb, a professor at the University of Maryland School of Nursing in Baltimore.
About 43% of registered nurses reported being verbally or physically threatened by a patient or patient’s family member, and 24% had been physically assaulted at work, according to ANA’s HealthyNurse Health Risk Appraisal, said Jaime Murphy Dawson, MPH, senior policy adviser, occupational health and safety, nursing practice and work environment at the American Nurses Association.
The book explains risk factors for violence in the workplace, worker rights and protections, guidelines for violence prevention programs, the importance of management commitment to and employees involvement in prevention, appropriate training and other issues.
“Jane Lipscomb and Matthew London do an excellent job outlining the elements of a comprehensive workplace violence prevention program,” Dawson said. “Best practices are provided to give workers strategies to reduce workplace violence in their work settings.”
A nurse’s job may be riskier depending on the setting, said London, an adjunct professor at the University of Maryland School of Nursing. Nurses who go to patients’ homes and are alone without support at that site can end up in unpredictable situations.
For example, Judith Scanlon, an RN intensive case manager in Buffalo, N.Y., was making a home visit to a patient with mental illness when she was killed by that patient in 1998. “Just the idea that someone was not able to control safety and security on the job really haunted me,” said Lipscomb, who has researched the case.
Violence occurs more often at institutional settings because that’s where patients who have mental health or addiction issues or histories of violence end up, Lipscomb said.
In other cases, the way care is delivered could prompt violence. For example, a family member of a patient who has had a long wait in an ED may get angry at the delay and act out, London noted.
Training not enough
Providing staff with training to prevent workplace violence “in and of itself is not sufficient,” Lipscomb said. That puts the onus on the worker to absorb the information and perform in an unpredictable setting, which is not an effective solution, she added.
Healthcare organizations need overall safety programs that create a culture of safety, and that requires leadership’s commitment, Lipscomb said.
One aspect of a comprehensive program is to ensure nurses have access to as much of the patients’ histories as possible because it’s common that some patients have a history of violence — as was true in the Scanlon case, Lipscomb said. Nurses need to advocate for that information.
The “Not Part of the Job” book gives nurses guidance to work with others and get what they need to develop a comprehensive safety program, London said, because the risk of violence in healthcare is widespread.
“Much of it is predictable, and much of it is preventable,” he said.
Karen Long is a freelance writer.