Editor’s Note: To raise further awareness on all forms of hospital violence, The Joint Commission is proud to participate in American Hospital Association’s #HAVHope Day on June 7.
By Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, associate nurse executive, The Joint Commission
The U.S. Government Accountability Office found that health care workers in hospitals are five times more likely to experience injuries from workplace violence and require days off from work than workers in other private industries.
As awareness of workplace violence in the health care sector increases, the most forward-thinking health care leaders have made preventing violence a top priority. The Joint Commission believes leadership plays an important role in preventing workplace violence. As a result, there are several Joint Commission Leadership (LD) standards related to workplace safety.
Below are a few leadership actions that protect health care workers from workplace violence.
Provide Adequate Staffing, Resources, and Tools to Assess for and Mitigate Workplace Violence.
Innovative resources and tools include:
- tracking mechanism to flag a patient with a violent history in the electronic health record
- behavioral emergency response teams (similar to rapid response teams)
Create a Robust Reporting Culture. Leaders must constantly emphasize to health care workers that it is imperative to report all violent events that led to harm or could have led to harm. This blog post explains the basics of creating a reporting culture.
It is widely accepted that workplace violence is underreported, and leaders may need to combat their own organization-specific barriers to reporting.
Common obstacles include:
- inadequate or unknown definition of workplace violence (Hint: It includes verbal violence.)
- belief that violence is “part of the job”
- lack of time to report
- reporting systems that are difficult to access or use
If any of those pieces are missing, you will likely not get a complete reporting of these events
While verbal violence is listed, it can be challenging to classify. There are some grey areas that may not be counted as “workplace violence” but should be captured as data points in case matters escalate. These include:
If staff report violence, they must know:
- there won’t be any retribution
- the issue will be addressed
- they will receive feedback on what was done to correct the issue
In cases of workplace violence, leaders should do a deep dive to investigate the root causes, including:
- staff preparation for the violence
- appropriateness of staff response
- state of staff education on workplace violence
Know the Organization’s Risk for Violence. The first step is acknowledging that workplace violence is occurring everywhere, not just in urban emergency departments or among certain segments of the population. Read this blog post about increases in workplace violence in outpatient settings.
Thoroughly assess and vet the organization to determine the extent of workplace violence or the potential of violence. In a perfect world, leaders continually take a pulse of the reported violence rate within their organization as well as within individual units or departments. If this reporting culture is in the process of being developed, leaders may start by distributing an electronic survey for staff to complete to determine where problems with potential violence exist.
Establish Constant Training and Awareness. Leaders should provide training and assessment tools so staff can evaluate for the potential of violence. For example, we know that patients with an altered mental status from causes such as dementia, intoxication, or decompensated mental illness are those most likely to become violent.
The Occupational Safety and Health Administration (OSHA) recommends that training to prevent workplace violence should occur at least annually, but high-risk settings may need more frequent training.
Keep lines of communication open with staff by reinforcing this message in daily huddles or employee newsletters.
Practice De-escalation. A proactive plan for addressing patients, visitors, or staff who show risk factors or warning signs for violence should include de-escalation techniques, which is the first-line response to potential violence and aggression in health care settings.
There’s no one-size-fits-all de-escalation strategy. Read this blog post about popular interventions. Remember, the American Psychiatric Nurses Association (APNA) views coercive measures, including the use of restraints, seclusion, or unwanted intravenous sedation medications, as a last resort to handling violent patients.
Work in Teams. When there is a potential for violence, health care workers should never work alone. This may include picking one “spokesperson” to connect with the patient while the rest of the team monitors. Set clear policies and procedures about each person’s role and responsibility.
While roles may be different, staff responding to violent events should receive similar training. Team training works best when it occurs face to face rather than remotely or online training. The most effective training is training that occurs with the teams that will be responding together, including nurses, physicians, and security, and using simulation training.
Health care leaders must work hand in hand with health care workers to prevent workplace violence, but it starts with leaders setting the priority for zero harm due to violence and providing the resources, training, and support to accomplish this goal. For more resources, please review The Joint Commission’s workplace violence resource center, developed in conjunction with OSHA.
Lisa DiBlasi Moorehead, EdD, MSN, RN is the Associate Nurse Executive in the division of Accreditation and Certification Operations at The Joint Commission. Previously, Dr. DiBlasi Moorehead was a field director at The Joint Commission for the Hospital, Critical Access Hospital, and Nursing Care Center accreditation programs. Since 2010, she has been a Hospital Accreditation Program Surveyor. Prior to joining The Joint Commission, Dr. DiBlasi Moorehead was responsible for accreditation and regulatory compliance and related performance improvement activities for a five-hospital system in Louisville, Kentucky. She has also held leadership positions in nursing, quality and education during her more than 30 years in health care.