Nurses Declare War on Tolerance of Workplace Violence

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preventing workplace violence`Motivated by reports of a 25 percent increase in the rates of violence against health care workers on the job in the past three years, the American Nurses Association is mad as hell and its members have decreed they’re not going to take it anymore.

The ANA announced its zero tolerance for violence and abusive behavior in a lengthy policy statement released in August 2015. It included detailed recommendations for instituting reform.

“The entire nursing profession must actively drive a cultural change to end incivility, bullying and violence in the workplace,” the ANA declared.

Workplace violence statistics

Already the primary victims of injuries incurred in accidents handled by the Occupational Health and Safety Administration (OSHA), health care workers also experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults in the United States causing days away from work, according to the Bureau of Labor Statistics.

Nearly 80 percent of nurses reported being attacked on the job in 2013, according to a study cited by Scientific American.

In 2011, the Emergency Nurses Association reported that more than half of the 6,504 emergency nurses it polled reported physical and/or verbal violence that had occurred during the previous workweek.

The problem isn’t getting better on its own. According to the Occupational Health Safety Network (OHSN), the overall rate of workplace violence in a study of 112 health care facilities rose from 4 percent to 5 percent per individual month of work per worker-month from 2012 to 2014.

Workplace violence in nursing

The nurses don’t excuse the public for being the perpetrators of most of the violence. Those who get physical are usually patients and their loved ones. Long waits, patients with histories of violence and other psychiatric patients are among the causes.

But the ANA noted that charges are pressed too infrequently. And that’s why the ANA’s real target is the blasé attitude of the powers that be, including hospital administrators.

“There is a top-to-bottom cultural assumption that violence is part of the job” for ER nurses and health care workers, says Lisa Wolf, who was the lead author of the Emergency Nurses’ Association’s “Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care,” which was published in January 2015.

In that article, “many nurses described responses from immediate supervisors that were well intentioned and supportive, only to be undercut by hospital administrative responses that discouraged nurses from pressing charges or public officials who would not charge the perpetrators.”

A 2009 report in The Journal of Nursing Administration reveals that only half of nurses at a regional hospital reported an incident of verbal or physical assault by a patient or family member. The report concludes that incidents are underreported for a number of reasons:

  • Hospitals’ lack of reporting policies.
  • A perception that assaults are part of the job.
  • Employee beliefs that reporting the incident won’t help and may even harm their careers.

“The entire nursing profession must actively drive a cultural change to end incivility, bullying and violence in the workplace.” -American Nurses Association

Preventing workplace violence in hospitals

Recognizing the sea change that needs to happen in health care workplaces, the ANA listed several recommendations for implementation.

Recommendations for nurses:

  • Actively participate in the development of the workplace violence prevention program.
  • Understand organizational policies and procedures related to workplace violence prevention and response. If no policies exist, actively participate in the development of relevant policies.
  • Actively participate in education associated with workplace violence prevention. Seek continuing education opportunities to learn more about violence prevention.
  • Understand the importance of using situational awareness to identify the potential for violence before it occurs.
  • Learn how to anticipate, prevent, and respond in crisis situations.
  • Be aware of and know how to use environmental controls to both prevent and reduce violent incidents.
  • Continually incorporate personal health and wellness strategies that will minimize workplace stressors.
  • Provide and be open to receiving constructive, timely, and respectful feedback from colleagues, health care consumers, family members, and other relevant stakeholders.

Recommendations for employers:

  • Ongoing leadership commitment is essential for creating and supporting a culture of safety and zero tolerance for all types of workplace violence.
  • Employers must foster a supportive work environment in which respectful communication is the norm, organizational policies are understood and followed, and professional codes are honored.
  • Employers must foster a nonpunitive work environment by encouraging reporting, never blaming employees for incidents, and recognizing that employees are not responsible for system failings over which they have no control.
  • Employers should develop a comprehensive violence prevention program that aligns with OSHA’s “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers.”

Workplace violence laws

Even if health care workers and their employers move quickly to enact these reforms, they’ll need help from the judiciary system.

Police and prosecutors “don’t necessarily feel that this is a big issue unless someone is hurt very severely, even though there are felony laws against it,” violence victim Rita Anderson told Scientific American. Anderson is an Arizona-based nurse who suffered a broken jaw when she was assaulted by a teenage female patient who “was just tired of waiting.”

Anderson sued unsuccessfully, but she assisted successfully in the passage of violence-against-nurses legislation in New York State. At least 30 states have acted to make violence against emergency nurses a felony. But as Anderson pointed out, even that isn’t enough.

Ultimately, it’s the political clout of nurses that is most likely to lead to change. There are nearly 3 million of them in the United States, and the demand for more is a crucial component of the future of health care. There is reason to believe their zero-tolerance proclamation will not be ignored.

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