Episode 13: Violence in the Workplace

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation resources and hope. One episode at a time. So today on Nurse Dot podcast.

Terry Foster

When did it become acceptable for a visitor to get in your face and threaten you? That's never acceptable. When we talked about nurses pressing charges, I do encourage nurses to pursue that. I'm like, Don't think that that's part of the job.

Cara Lunsford

Joining us today, Terry Foster, a registered nurse with 47 years of emergency room experience at a health system in Edgewood, Kentucky. And the president of the Emergency Nurses Association, Terry, is currently holding a position of clinical nurse specialist and has spoken at conferences in all 50 states, primarily around emergency and critical care nursing, but also speaks about nursing humor, compassion fatigue, stress management.

And for today's episode, Violence in the Workplace. I'm your host, Carolyn Stafford, registered nurse and VP of community at Nurse AECOM, Terry Foster. There wasn't anyone better that I could think to talk to than the president of the Emergency Nurses Association. Somebody who had worked in emergency nursing for 45 years. To talk about what nurses are experiencing maybe now more than ever.

Or was it always this way? Have you seen violence in the workplace since you started 45 years ago?

Terry Foster

Well, there's a couple of ways I can answer that. And I would say emphatically nothing like what it is today. When I started many years ago, periodically, we might have a family member, a patient, a visitor or whatever who would kind of act out, and they were squelched pretty quickly. However, along with that 45 years ago, it was sort of deemed as that just comes with the territory.

I remember actually before I was a nurse, I was a clerk and I remember a drunk guy kicking a nurse who was pregnant and knocked her against a wall. She was like seven months pregnant and they didn't really know if the baby would be okay. And it did. But I do remember that being an issue, and there were no charges pressed or anything like that at all.

So through the years, I would say it's become increasingly a volatile situation in a lot of emergency departments. I work in a system where we have six emergency departments and I kind of have all of the types of the E.R. as suburban, large emergency department, three community hospitals, a critical access hospital in a rural area of Kentucky, and then also an inner city freestanding emergency department.

So that's where, you know, we can see violence in all of these departments as well. We do have security at our hospital, and I think they try really hard and we work really well with them. But our security guards are not armed. They have stun guns and most hospital security officers are not armed, as my understanding. And so we also do not have a metal detector in our emergency department.

And that's been talked about a lot a lot of emergency departments do. And actually, they're very surprised that the number of weapons that they take from patients or visitors as they try to enter the department. And most of the visitors and patients are not upset that they have to turn over that weapon. They understand that. But getting back to kind of the current status of violence in the emergency department, I can remember maybe about six years ago at an Emergency Nurses Association conference, one of the officers said in this room of maybe about 500 emergency nurses.

Would you please raise your hand if you have been a victim of violence in your emergency department? And I can take care. I think 99% of the nurses raised their hand. It was a stunning moment. The air went out of that room. I mean, we've all been saying that, but it was just like, oh, my gosh. And you look around and there were nurses in there in their seventies.

There were young new nurses in their twenties. And I hope this doesn't sound sexist. I'm a father of a nurse, but I look at these maybe young, smaller female nurses, and I just think, oh, my gosh, like, I see my daughter and her. There just seems to be an escalated incidence of incivility amongst visitors, amongst patients and the public.

You know, we see sometimes on social media or on the news, a lot of times on the news, you see somebody going off on an airline. You know, somebody is videotaping this person just going, throwing stuff and punching a flight attendant and all that kind of stuff. Are you see somebody in a restaurant picking up something and throwing it at some poor server who's making minimum wage or things like that, or picking up chairs and throwing them in a McDonald's in our emergency department.

We can't tape doing that. Sometimes it's taped on security systems, but we can't take out our phone and tape that. So I think the public doesn't have a true idea of the incidents that occurs in the emergency department with the frequency that it does. And that's what really scares me. Sometimes I can help to de-escalate that situation. And I do feel like there's a maturity aspect there.

You know, just come on. Hey, buddy, let's deal with this here. Where do we go? Maybe got off on the wrong foot here. Let's start over. How can I help here? And sometimes people sort of give pause to that, and then kind of start over. But there are some people that I can't de-escalate that. And it and it's escalating even more.

And that's a situation where you know, is it a patient? Is it a family member? If it's a family member, where I was obviously going to call security or police, but I'm going to make every attempt I can to resolve their issue, calm them down. If your kid's in pain, you're anxious. If your you know, your mother's in and congestive heart failure anxious, you're acting out.

I get that. But when it becomes a safety thing, then all bets are off there. And then if it's a patient, what is the reason for that volatility? Is this person confused and disoriented? Is it mental illness? Is it a high fever? Is an electrolyte imbalance. Is it just, you know where this person is just, you know, has bipolar schizophrenia?

They're hallucinating, all this kind of things. Then those are things I can address as a nurse in concert with a physician, as well as, you know, maybe a psychiatric social worker. Maybe I'll have security there as a as a stand down, just a show of force there to help us out in case they would potentially go off or or become violent.

Cara Lunsford

What stands out to me there that you just said is the number of people that you would bring in in the event that you had a patient that was potentially dangerous, where you were concerned and for your own safety. You know, I heard you say, like I'd bring the doctor, I'd bring a social worker, I'd bring potentially another nurse in the room with me, security and all of these things.

And to what you're just saying, it's like as we start to thin out this workforce and all these different resources that have been available to us maybe in the past now with this short staffing and saying, well, you know, maybe we don't need as CNA or an 11, we'll just have nurses and we don't have enough nurses. To me, that's one of the major problems because, yes, of course, it's part of our job that we're going to have patients who are potentially dangerous and we have to have the tools and the resources to be able to care for those people safely.

Terry Foster

So I agree 100%. And I think it's very much a factor in the tenure in nursing where if you feel threatened at work, you have to feel safe. You think of Maslow's hierarchy of needs that goes for nurses as well. And I always think about this like if I was walking through a grocery store and someone just came up to me and started threatening me in my face and cursing a B and spitting on me, and they took a swing at me and they hit me.

I can call the police. That person is hopefully put in handcuffs and charge and things like that. Why? Because the fact IB again, do I lose that right? And a lot of us do. And it's not just nurses, it's physicians, it's Texas, it's EMS, it's firefighters. And of course, it's police officers, too. And again, I think we have more of an understanding and a compassion when it is an older person who's confused or or somebody who's delusional.

Those kind of things like I have more understanding for that. And I don't think that's our biggest problem. It's just more where, hey, I was here first. You took that lady back, you said taking me back to a bar and they start throwing stuff and start attacking staff or we've actually had patients attack other patients before, which is pretty scary, You know, for things like that to happen.

People have gone off in the waiting room, go off in the department. That's very scary. And it's not just the emergency department. The past two shootings of nurses. One was a nurse practitioner that was shot and killed in an office, a psychiatric nurse practitioner. And then in Texas, two nurses that work in OB were shot and killed on a postpartum for my daughter's A.P. nurse.

I mean, that just really hit home for me. But interestingly enough, in most hospitals, security is called to the emergency department, to most. In the second place they're called the most is the maternity unit labor delivery, the nursery, the nephew and a postpartum fourth. Because a slang way for saying this is baby mama drama, baby daddy drama that every nurse knows what I'm talking about when I say that.

Or there's a tremendous amount in some places of issues where are children having to be removed? Is there chemical dependency? Is there abuse going on? And in that whole volatile situation where where you thought about, you know, years ago, oh, it's cute, baby in a mom and dad and and everything's hunky dory. Not so much you know it's it can be a very tense and potentially volatile place to work.

So in nursing school, which was 16 or 17 years ago, one of the psych professor, she said it's all psych. She said every department you're in, it is psych. And you are dealing with people, their emotions, their issues, everything and whatever's happening in their life. You can just kind of blow that up 1050 fold because now they're sick and in pain.

So it just magnifies anything that is already happening in their life. And we know that society in general is stressed. We have major, major stressors that are affecting people, economic stressors, disparities. And and then you take that person who already probably has not great coping mechanisms to begin with. And now you put them in a waiting room where they're waiting five, six, 10 hours to be seen.

Their tolerance just starts to drop and drop and drop. So it's not a matter of if it's going to happen. It's a matter of when it's going to happen.

Terry Foster

I agree. It's so funny you said that about your nursing instructor. What she said, because a number of years ago I spoke up for a lot of conference nursing conferences and this was like maybe a med surge nursing conference, maybe med search and critical care and I did a breakout session called Every Nurse is a Psych Nurse because you have that, A.B., you have it on medicine, you have it in the ICU every place.

And and it was more about how to handle things when a patient escalates on a med search floor and how to sort of de-escalate that. What are precipitating factors, what are warning signs are about to go all this kind of things. And the lecture went very well. I do remember I got a really rough letter from a psychiatric nurse who said to me and she signed the letter and everything.

She was like, Every nurse is not a psych nurse, you know, this is what we have to learn. And I can't remember if I called her or I wrote her back and I knew what she meant. And maybe I should have tweaked the title a little bit. I didn't mean like, you know, we could all work psych and have no problem because we couldn't.

I just meant that we had those patients all over the hospitals. Matter of fact, at our hospital, we developed a bar that's behavioral assessment response team, like a food team or rapid response that a med search nurse or a clinic nurse or whatever can access this team and have security and a supervisor and a like a technician and things like that who respond to help to de-escalate those situations because they occur all over the hospital.

Cara Lunsford

So, yeah, and, and I totally knew what you meant. I understand with that nurses saying that if you have a specialty, it's like, Oh, my specialty is pediatric oncology. If somebody said, Well, everybody's a pediatric oncology nurse, you be like, Well, no, that's not true, because you could go your whole life and never take care of a pediatric oncology patient ever.

But that is not true of nurses when it comes to treating psych patients, because we will absolutely 100% come in contact with some kind of psych in our daily. Daily? Absolutely daily. You cannot get away from this needing to be a part of your your skill set. This is a skill set that every single nurse has to learn.

De-escalation, self-defense, protecting themselves, knowing like that certain things like you don't want to go into a room by yourself.

Terry Foster

Absolutely.

Cara Lunsford

If you if those if those hairs on the back of your neck are going up and you're like, your life doesn't feel right, like you don't go in there.

Terry Foster

It's interesting. I always tell nurses to go with their intuition because sometimes they'll say, I knew that guy was going to go off. Well, if you knew that you needed to say something about that and not that they didn't, but you can, you just sense it. And so, you know, give us a heads up on that situation. If you're wrong, fine.

That's great. But most of the time we do. And with that clinical experience comes that intuition. It's not something you necessarily feel your first day of nursing school, but with experience. And I always tell nurses that I work with, do not let the patient or family get between you and the door. You always have that protective mechanism. And then one of the things that you mentioned is, you know, you think about how many illnesses are stress related.

And I think about that, you know, like I mean, hypertension, heart disease, strokes, all this and any GI problems exacerbated by stress. You know, any kind of pain, chronic pain, unmanaged pain, all of those things, you know, thyroid conditions, stress exacerbates that. And so what patients do we see in the hospital, all of those types of patients and, you know, their coping skills, as you say, go out the window.

They really do. So I try to keep that understand banding and support there as best I can. But also when we talked about nurses pressing charges, I do encourage nurses to pursue that. I'm I don't think that that's part of the job. Fill out that report. If it's a police report, have security involved, document that and and are you okay to still be working or to return to work?

I need to check in with you mentally, but also physically. Are you able to do that? Because those things worry me. I think a lot of nurses have a bad back to begin with, you know, stuff like that. It did some physical altercation worse in that situation with you. So I'm I'm always aware of that try to.

Cara Lunsford

Be I really love that you say that because I think we have to constantly remind nurses to honor themselves and take care of themselves and prioritize themselves and to really for a second just think, what do I need? What is my body need? What would I tell my patient right now if this happened to someone else? If this happened to someone I love, one of my family members or one of my patients, what would I tell them to do?

Most of the time, it's not the same thing we would do because we're like, Oh, I'll just stick it out. I don't want to go. I don't want to leave my my colleagues and stuff like that. And you know what? The best thing we can do for this profession is really to take care of ourselves and take our own advice.

Because if you can leave for a day, you might have just bought yourself an extra year of working in this profession as opposed to if you are just like, Oh, you know, I'll just I'll muscle through it. It's like, No, you're not going to get any bad at the end of this. That's life, you know, I'm the biggest martyr.

You know, you have to draw those boundaries, do the reporting like you mentioned, like make sure you file a report that's self-love, that's protecting yourself and saying this is not okay, this cannot happen to me and should not happen to any of my colleagues.

Terry Foster

And I agree.

Cara Lunsford

Yeah.

Terry Foster

It's also protecting your coworkers, because if you're documenting the incidents of that, the word gets out and there's data and the data helps support changes a lot of times. And when did it become acceptable for that to happen, for a visitor to get in your face and threaten you, that's never acceptable. Actually, I think we have very good administrative support for that.

Where I work at, some nurses don't have that or they've been discouraged and then unfortunately I don't think it happens too often. But I know that sometimes the law enforcement has discouraged the nurse from doing that. Most of time police officers are enforcement and nurses were very hand in hand. But I've heard those situations and that's very frustrating.

Cara Lunsford

Coming up in our next segment.

Terry Foster

We see patients. I always say that nobody else wants, you know, their family doesn't want and the nursing home doesn't want them. And in those places we regularly see patients who the jail doesn't want to.

Cara Lunsford

Welcome to a segment we call the Dark Spot, where you will hear more of your voice and a little less of mine. You can visit nurse dot com forward slash podcast to share stories, feedback and requests. As a valued listener, you will also receive discounts on nurse dot com courses and C use by using code nurse dot at the checkout.

Oh.

Erin Ang

So one thing that I've noticed right away from when I started nursing up until now, it's kind of on the line of violence, but it's lateral violence within the workplace, bullying in the workplace. One of my research papers at school was about that because I've experienced that a lot. Being a younger nurse and a younger looking nurse and a women full environment.

I think that's one of the big, big problems that there's not really a solution to. And I hate that it makes me really angry, especially when you're on the outside watching it. I'm like, I don't know what to do and I know how to help. They make it seem so normal in school. They're like, Oh yeah, nurses eat their young.

And I'm like, I don't think that's real. That can't be real. And right away it happened and it happened with a boss. It happened with a lot of people. And I'm just like, What's going on here? I love whenever new nurses come, I'm like, I am happy and ready to help you. If you have any questions you can ask me like, Hey, don't be afraid.

And like everything's going to be okay. And that's what the nursing community needs. After everything we've gone through, especially during COVID, we don't need to put each other down. We have to get together and help each other out.

Cara Lunsford

Do you find that or do you have an opinion on this about private hospital versus county public hospitals and what we find to be permissible and and what we don't? And if they are a insurance caring individual versus, you know, are you part of the county system? I went to county for my schooling my schooling for two years of county.

So, I mean, it was like it was rough.

Terry Foster

I think I know what you're saying. And I would say that I have not seen that case. I do see two completely different situations. I think county hospitals, inner city hospitals are a more guttural place to work and you see the lowest of the low. But I think nurses in that area sometimes, unfortunately get desensitized to that. And it's just like, Oh yeah, he's freaking out, he's throwing this.

He picked up an oxygen tank or whatever like that. That behavior is acceptable, however, and there's institutions a lot of times they have armed police departments and the emergency departments. I've been to a couple different departments or a couple of different hospitals that I've spoken at or visited or whatever and seen that. And I think that definite show of force is is very much in place and very much a deterrent where sometimes in suburbia areas and stuff.

I do think it stands out a little more. You know, when somebody comes in to this sort of country club, hospital area or whatever and acts out and things like that, but really it's everywhere. It's critical access, it's freestanding, it's clinics, it's physician's offices, it's emergency departments everywhere. I think it's all of those areas. And but I kind of know what you're asking, and I've never seen where they said, well, this guy's a rich guy.

We're not going to press charges or whatever. No, I mean, he assaulted a nurse or a physician. We're going after him. You know, I don't care if he's rich or not. We're not going after him to suing at the hospital. We're charging him because you can't do that to our staff.

Cara Lunsford

Yeah, I think that's really important to highlight that, you know, sometimes we feel like, okay, this became very customer service story and it's like the customer's always right. And so you kind of lose some of your negotiating power with them or your ability to find diplomacy with the person because they're like, I'm right. My satisfaction, the patient satisfaction is what matters.

I know that that's true. And reimbursement is also tied to patient satisfaction scores, you know, and it's like, I don't know how many patients are super aware of that, but we are certainly aware of that as health care practitioners that this is something we're supposed to be mindful of, is keep them happy. And I think sometimes in the county hospital, what I witnessed was a little bit like maybe some of these people didn't even have family, they didn't have support, they certainly didn't have advocates.

And so if you felt threatened as a nurse, you just throw that person for point restraints and you're like, We're good. Yeah. And they may or may not be in them longer than they should be.

Terry Foster

Right? I know exactly what you're saying. And I think in those areas, often we see patients always say that nobody else wants, you know, their family doesn't want and the nursing home doesn't want them. And in those places we regularly see patients who the jail doesn't want. I mean, think about that station and like that. The jail won't even take you in.

Terry Foster

They're brought to an emergency department. Also, on the flip side, we're talking about or I kind of mentioned the country club hospital. It can be intimidating to have a patient who's who comes in. It's like if you don't do this, I've got I've got my lawyer on the phone, I've got my here. Okay. And there's a nurse. His name is Jerry Foster.

You know, those kind of things. Or they'll videotape you which they're not allowed to do. Of course, I can say you're not allowed to videotape me, but you know, I'm not going to get in a confrontation, take their phone, and I'm going to remain very professional like that, or they'll say, I'm going to call my doctor or I know who to call.

I know I'm going to call the joint commission or I'm going to call the state or I'm going to take patients. Sometimes or their families to know how to access that stuff and use that as a threatening behavior where I'm going to take care of you no matter what. I'm going to try to take care of you. Whether you're calling somebody or threatening somebody or or whatever, I want to take care of you and get this get this resolved.

So I don't in a nice way. I don't care if you're I call those areas. I'm still going to take care of you.

Cara Lunsford

Look, everybody gets upset when they go into a hospital or they feel like they have to defend their loved one or advocate for their loved one. And I'm just going to say that age old thing that everyone says, it's like you catch more flies with honey than you do with vinegar. And I guarantee you and this is not for the people who have some sort of mental illness or we're not talking about those people.

We're just talking about the regular people that are visiting a hospital. And they're either there because they're a patient or they're there because they're a family member or friend of a patient. The best thing that you can do for you or your loved one to get the best care possible is to be super kind to the staff. And I really want to encourage people, you know, if you want great care for your loved one, like just come in, bring a box of donuts, like bricks, whatever.

Just like what can I do to help you? How can I make your shift better? Is there something I can do? Can I run out to the store and grab you guys some snacks or something? These small acts of kindness, they go such a long way.

Terry Foster

I agree 100%. My mother passed away about nine years ago and she was in a nursing home the last two years of her life, which is really difficult as a as a nurse to have to put your mom in a nursing home. But she required 24 hour care, letting those they had nurse nurses there, mainly LPN spent a lot of nursing assistance and I would say to them, What is your favorite drink?

You know? And they would tell me, Oh, I don't know. And I'd say, No, What? What do you think? Bourbon, wine, whatever. I would try. I would add something hidden, bring them in a bottle, obviously, to take home, or I'd give them a gift card. And I felt like that was just one extra thing that they would remember to check my mom or whatever and say, This family's real nice.

And they were wonderful and I didn't have to do that. But that was really a neat thing, I think, for them. And then even after she died care, I made some lasagna meals and would take it down there. And again, they're making minimum wage to clean up, you know what? And stuff. And I won't mention one of those things.

When I talked about the families, the nurse, I think one of the best things to discuss, I'm a nurse who is a family member. Not that you need to do that, but, you know, this may not be your specialty. Whatever illness your family has, if it's cardiac or neuro or whatever. But if you're a nurse in a family, everybody thinks you know everything about it.

And I always say, I always say, Oh, you're a nurse. And then I'll say the patient, okay, we're going to do nurse talk. I said, okay. And they go, Yeah. And I'll say, Hey, this is what a CBC looks like. The scan showed this the E.R. doc I trust with my life. What else do you need to know?

And they're like, Thank you. You know, it just you just sort of that connection that we we could do nurse talk, you know, and go do this and do that. I think that's so helpful. And even if the family's not a nurse and an authentic person, what you see is what you get. But we can all schmooze, We can all fake it.

What do you need, Mischelle? You're upset, aren't you? Okay, I'm sorry. Let's figure out what's going on here. Or to the family. And I. I want to help them. I want to. But we can schmooze and we can make it a little bit better. I remember. I don't know. A while back, I heard a nurse about ready to lose it with the patient.

I walked by and I was like, Can I help you? And she said, Yeah, I'll take care of her. And walked out. And then the next hour, taking care for trying to get her discharged. She was on my last nerve and I did everything I could have. I got her discharged, which she was absolutely unreasonable, but I just I put it on for an hour and that nurse apologized to me later on tonight.

I was like, You don't have to apologize. I understood you took care of her for 6 hours. I had her for one hour. I swooped in for one hour and she thinks I'm all wonderful. And I didn't let her put you down either. But I know how to do that. And I didn't have a patient assignment, so I was able to kind of come in and do that.

So that's how.

Cara Lunsford

We have to come together. In your opinion, someone who's been in this industry and for 45 years, in your opinion.

Terry Foster

You don't have to laugh when you say that. Okay. It's amazing. Okay. Yeah. All right.

Cara Lunsford

It's amazing. I don't even know how you stayed in here for 45 years. It almost seems unimaginable, I think, for a lot of nurses that do listen to this. They're just like 45 years. They're only in it for five. And they're like, I can't even imagine making it another four decades.

Terry Foster

And it was different when I started. I mean, just let's put that out there.

Cara Lunsford

Okay? Actually, because I know I have to let you go soon, so I want to ask you to questions.

Terry Foster

Okay?

Cara Lunsford

All right. Yeah. One being a male nurse, what was this, like, 40 years ago? How often did people think you were the doctor?

Terry Foster

A lot of times. I think my most frequently asked question was, are you the doctor? And I would say, No, I'm the nurse. And I remember one time we had a female physician and some kind of drunk guy said, Are you are you the doctor? And I said, No, I'm I'm a nurse. And he was made some kind of, Oh, well, okay.

I guess I don't know if he said I got a gay nurse just kind of put down like that. And the female physician walked in and he goes, And what am I supposed to call you that? Oh, honey. And she said, You can call me doctor. And I was like, Yes, I read. She just said he was like, Whoa, crap.

I was like, Yeah, he better shut up, buddy. So I was like, Either it was like, it was really good how she delivered. It was just sort of like, just sort of like, just put him in a spot, you know? So it was great.

Cara Lunsford

I love that. I wanted to get your perception on that, just because you've been in the industry for so long. And lastly, in your opinion, what do you think the major solution is to this kind of crisis that we're experiencing with this escalation of of violence? Like how how are we going to protect the sustainability of this practice?

What can we do?

Terry Foster

I would say I don't know that it's actually one answer. I do think any type of violent act like that at all, the word needs to get out that you will be charged with doing that. I think having administrative support for that, you cert, they certainly have the Emergency Nurses Association support about, you know that No tolerance for violence.

If I knew of an emergency nurse that was assaulted, she could call me. My my phone number is on the A side or whatever. I would support them, help them defend them, whatever I can do. And I mean that very sincerely. But also our association would as well. I hope managers are there to just support those. And I think the more that they support nurses who point out this behavior, hopefully it will set a tone.

But it's also with physicians. American College of Emergency Physicians. I actually was in a brief meeting with them about two weeks ago with a couple of the officers there. They mirrored the same concerns that we have as well about the violence against emergency care workers. And I don't care if you're if you're acting out on the registration clerk or a nurse or a doctor.

That's that's that we're a team. That's all of us. And we're just not tolerating that and supporting people who do say, I'm not tolerating it. I hope and I pray that it gets better. I did.

Cara Lunsford

Thank you so much. This has been just an incredible interview, Terry. I feel like I could interview you for another 2 hours about a variety of things, so I have to have you back on.

Terry Foster

I have to urinate so you can't interview me for two more hours. I'm 65. I have a bladder the size of a watermelon. Okay, that's full. That sounded a little dirty to me.

Cara Lunsford

Did it ever? Why not? Why not? Why not just finish it off with a little bit of dirt? Yeah.

Terry Foster

Oh, she's so scary. Oh, well, thank you so much. I appreciate it, but I would love to talk to you again. Seriously, I would just love that you have a spirit about you, and I would just love that. And so thank you, Fred. I'll see you later.

Cara Lunsford

Thank you. See you later. Bye bye.