Michon Dohlman, MSN, RN Erin Larson, MSN, RN Maria Levy, BSN, RN Julie Stene , BSN, RN

Michon Dohlman, MSN, RNMichon Dohlman, MSN, RNErin Larson, MSN, RNErin Larson, MSN, RNMaria Levy, BSN, RNMaria Levy, BSN, RNJulie Stene, BSN, RNJulie Stene, BSN, RN

Michon Dohlman, MSN, RNMichon Dohlman, MSN, RNErin Larson, MSN, RNErin Larson, MSN, RNMaria Levy, BSN, RNMaria Levy, BSN, RNJulie Stene, BSN, RNJulie Stene, BSN, RN

Workplace Violence:

Giving Staff the Tools and Support to Report

Workplace Violence:


• Define workplace violence (WPV)

• Discuss short- and long-term effects of WPV on staff

• Discuss the WPV quality project presented for Saint Marys Emergency Department

• Identify the essential elements of the WPV reporting tool and the keys to a successful WPV reporting structure

Workplace ViolenceObjectives

DefinitionDefinition

OSHA:OSHA: Any act or threat of physical violence, harassment, Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that intimidation, or other threatening disruptive behavior that occurs at the work site. occurs at the work site.

ENA: ENA: An act of aggression, physical assault, emotional or An act of aggression, physical assault, emotional or verbal abuse, coercive or threatening behavior that occurs in verbal abuse, coercive or threatening behavior that occurs in the work setting and causes physical or emotional harm.the work setting and causes physical or emotional harm.

ExamplesExamples

Verbal threats, spit on/at, yelled at, biting, hair pulling, scratched, Verbal threats, spit on/at, yelled at, biting, hair pulling, scratched, being sworn at, being hit, pushed or shoved, etc.being sworn at, being hit, pushed or shoved, etc.

Workplace Violence

Emergency Nurses Association, 2013; US Department of Labor: OSHA, 2013

2013 Minnesota Statutes: 609.2231 Assault in the Fourth Degree:

Subd. 2. Firefighters and emergency medical personnel. Whoever assaults any of the following persons and inflicts demonstrable

bodily harm is guilty of a felony and may be sentenced to imprisonment for not more than two years or to payment of a fine of

not more than $4,000, or both:

(1) a member of a municipal or volunteer fire department or emergency medical services personnel unit in the performance of

the member's duties; or

(2) a physician, nurse, or other person providing health care services in a hospital emergency department

Workplace Violence

• Average annual rate of non-fatal violent crime by occupation:- Private sector 12.6 per 1,000 workers- Nurses 21.9 per 1,000 workers

• Study of 6,300 MN nurses: - Rate of both physical and non-physical attacks on nurses

was 52 per 100 nurses per year - Consequences for victims following non-physical violence was

more severe (anxiety, stress, quitting as a result)

• Routinely underreported:- Due to perception that assaults are “part of the job”

Workplace ViolenceStatistics

Gerberich et al., 2004

U.S. Department of Labor: Occupational Safety & Health Administration, 2004

Difficult to measure:

- Most studies done through surveys

- Using a convenience sample

- Based on remembered events (rely on memory)

Workplace ViolenceEffect on Staff

• 94% of nurses that experienced WPV met at least one symptom criteria for PTSD

• 17% (of the 94%) scored high enough to be diagnosed with PTSD

• 15% had scores associated with suppressed immune system function

Studies Show:


Gates, et al, 2011

↓ Productivity• Negative impact on managing the workload and

cognitive demands• Absenteeism and job changes

↓ Morale• Belief among nurses that violence against nurses is a

result of incompetence

↓ Quality• Patient care


Gates, et al, 2011;

Gillespie, 2008;

Kowalenko, et al, 2013

“If nothing else, the fact that nurses consider leavingand in some cases do leave a job because of violence should be impetus enough for hospital leadership to take the problem seriously.”

“It costs about $65,000 to replace a nurse.”


Pecci, 2014

Deena Brecher (ENA President):

Perception Perception ?? Reality Reality ??

We can only manage what we have measured


• The WPV committee

- Formed in Spring 2012

• Purpose:

- Assess the incidence of WPV in the ER

- Assess staff knowledge of what defines WPV

- Learn why staff felt unsafe yet had 0 WPV report

(perception vs. reality)

- Change the perception that WPV is “part of the

job”

Workplace Violence

• Nursing Nursing Surveyed in March, 2012 Surveyed in March, 2012

• Survey modeled after the ENA Emergency Department Survey modeled after the ENA Emergency Department Violence Surveillance StudyViolence Surveillance Study

• Interventions: staff education, development of the reporting Interventions: staff education, development of the reporting

tooltool

• Post-intervention Post-intervention Staff Staff surveyed one year later surveyed one year later

Workplace ViolenceWPV Assessment Survey

Initial Survey Results

Workplace Violence

Physical Abuse in the Past Month

26%

74%

1-10 times

0 times

Workplace ViolenceInitial Survey Results


Only 33% of assaulted staff

Reported it!!

WHY?


Survey question:

Do you feel that workplace violence frompatients and/or visitors is simply “part of the job”?

53% - Yes


Survey question:

Have you been instructed to report physical or verbal abuse regardless of severity?

47% - NO


• “ this has been an accepted way for so long”

• “I shouldn’t feel that way, but it has been going on enough that I am desensitized to it”

• “it is part of the job, up to a point”

• “there is more that can be done in order to keep ourselves and our patients safe”


Survey Quotes:

• Developed a simplified reporting tool (handout)

• Staff educated• Fliers in KEY places - even the bathroom• Included in weekly management report to all staff • Power Point presentation given at the department level

nursing practice committee meeting

• Included in yearly competency program

• “real-time” encouragement to report all incidents

Workplace Violence

Following the initial survey:

Workplace Violence

100% OF REPORTS SUBMITTED WERE FOLLOWED UP ON BY MANAGEMENT WITH STAFF CONTACT

Following the initial survey:

Picture of the reporting tool

Management Chart Review Flag to chart

“Flag” • Internal to the emergency department• Consists of a red folder with a brief description of the issue • Used for staff and patient safety• Prints out with every visit to the emergency department

Report received by management

Monitor

Workplace ViolenceIntervention

Workplace Violence

Post Intervention Results

0

10

20

30

40

50

60

# reports pre-intervention 2012

# reports post-intervention Sept-Dec

2012

# reports 2013

#9#0

#53

Workplace ViolencePost Intervention Results

marialevy

Is WPV a part of the job in the ED?

Response Initial Follow-up

Yes 53%

No 47%

Workplace ViolencePost Intervention Survey Results

Is WPV a part of the job in the ED?

Response Initial Follow-up

Yes 53% 24%

No 47% 76%

~55% Decrease


Staff comments on follow-up survey:

“it should not be considered part of the job by anyone”

“I feel now that it is NOT a part of my job and I will not tolerate it”

“I think it is because it does happen, but I don’t think it should be tolerated like it is”


• Staff education

• Simplified reporting tool

• Change the culture that WPV is “part of the job”

• SUPPORT FROM MANAGEMENT IS ESSENTIAL

Keys to Successful Reporting of WPV:

Workplace ViolenceSummary

Workplace Violence:


Workplace Violence:


Questions…?

Discussion…?

References

Emergency Nurses Association. (2010) Position statement:Violence in the emergency care setting. Retrieved fromhttp://www.ena.org/SiteCollectionDocuments/Position%20Statements/Violence_in_the_Emergency_Care_Setting_-_ENA_PS.pdf

Gates, D.M., Gillespie, G., Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29(2), 59-66.

Gerberich, S.G., Church, T.R., McGovern, P.M., Hansen, H.E., Nachreiner, N.M., Geisser, M.S., Ryan, A.D., Mongin, S.J., Watt, G.D. (2004). An epidemiological study of the magnitude and consequences of work related violence: The Minnesota nurses’ study. Occupational Environmental Medicine, 61, 495-503.

Gillespie, G. (2008). Consequences of violence exposures by emergency nurses. Journal of Aggression and Maltreatment, 16(4), 409-418.

Koalenko, T., Gates, D., Gillespie, G., Succop, P., Mentzel, T. (2012). Prospective study of violence against ED workers. American Journal of Emergency Medicine, 31, 197-205.

Pecci, A. (2014). ED violence racks up huge costs. Health Leaders Media. Retrieved from http://www.healthleadersmedia.com/page-1/NRS-300840/ED-Violence-Racks-Up-Huge-Costs

The Office of The Revisor of Statutes (2013) Minnesota Statues: Assault in the fourth degree (609.2231). Retrieved from https://www.revisor.mn.gov/statutes/?id=609.2231

U.S. Department of Labor: Occupational Safety & Health Administration. (2004). Guidelines for preventing workplace violence for health care & social service workers (OSHA 3148-01R 2004). Retrieved from https://www.osha.gov/Publications/OSHA3148/osha3148.html

U.S. Department of Labor: Occupational Safety & Health Administration. Workplace violence. Retrieved from https://www.osha.gov/SLTC/workplaceviolence/

Thank You