Gayle Greer has worked at an inner-city hospital for 20 years — mostly in the ED. She’s been the ED charge nurse for five years. Recently, she’s been finding herself less able to cope with daily work stressors. The ED has been particularly short staffed for the last two years and it isn’t easy to ensure coverage. The hospital is cracking down on the use of travel nurses.
On a cold, wet, busy evening, a homeless man well known to the staff arrives smelling of alcohol and demanding something for his stomach pain, which is a nine on a scale of 10. Thinking the patient only wants a warm bed, food and pain medication, Greer directs a recent graduate nurse, Ed Trout, to clean the patient before the physician sees him. When Trout tells the patient he needs to clean him up a bit before the doctor comes in, the patient curses and pulls a knife out of his pants pocket and quickly slashes Trout, gouging his right cheek and just missing his eye. Greer is despondent when she learns what happened. She knew this patient could be aggressive, but he had never physically hurt staff before. She realizes she assigned an unpleasant patient to her newest nurse, without any guidance or tips. She thinks that maybe it is long past her time to retire.
Provision 6 of the ANA Code of Ethics for Nurses (2015) holds nurses responsible through individual and collective effort to establish, maintain and improve the ethical work environment of the work setting and conditions of employment that are conducive to safe, quality healthcare. “Nurse executives have a particular responsibility to ensure that employees are treated fairly and justly, and that nurses are involved in decisions related to their practice and work conditions. Unsafe or inappropriate activities or practices must not be condoned or allowed to persist,” according to page 24 of the code.
The Manitoba Nurses Union recently conducted a survey on post traumatic stress disorder in the nursing profession and discovered that violence plays the largest role in its development; 52% of nurses report being physically assaulted while 76% have been verbally abused. Even more alarming, a 2016 New England Journal of Medicine article stated that 100% of ED nurses reported verbal assault and 82.1% reported physical assault in the last year. While a number of studies focus on the incidence of workplace violence, much work still needs to be done on evidence-based studies of how to identify triggers for violence and keep ED staff safe. At present, there is great variability in the safety of EDs.
CONSIDER THE FOLLOWING SCENARIOS
Greer shares her guilt with a respected nurse colleague who also works the ED and has seen it all. They agree that work in the ED isn’t getting easier and both have been the targets of verbal and physical abuse. Greer’s colleague read the report about violence against healthcare workers in the U.S. (Phillips, JP, 2016) and shares with Greer the conclusion that additional data are needed to understand steps that might be taken to reduce the risk. Both remember a presentation at an annual nursing conference addressing safety issues for nurses and programs in specific hospitals that dramatically decreased physical violence against nurses. They decide to form a work group to get in touch with the presenters to learn what is working in other EDs. Greer feels energized for the first time in a long time and newly commits to working to create a safe environment for every ED worker. She apologizes to Trout and asks him if he wants to be part of the work group. She becomes committed to mentoring him to excellent ED nursing.
Greer can’t get over that Trout suffered this experience and facial scarring as a result of her inattention and failure to provide leadership to create a safer ED for all. She wants to retire but her husband was recently handed a pink slip when his employer needed to reduce its workforce. Greer keeps showing up to work but everyone is noticing that she seems detached from everyday realities and challenges. Morale is definitely plummeting. There are a number of nurse transfers to other units in the hospital and unfilled vacancies. Occasionally, Greer wonders about the committed nurse she used to be and who she has become. She decides to apply for an easier administrative position, knowing that short staffing, patient acuity, leadership’s concern about HCAHPS scores and finances will be present wherever she goes.
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: Author.
Manitoba Nurses Union. Helping Manitoba’s Wounded Healers. Trauma doesn’t end when the shift does.
Phillips, J.P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374, 1661-1669.