Michon Dohlman, MSN, RN Erin Larson, MSN, RN Maria Levy, BSN,
RN Julie Stene, BSN, RN Michon Dohlman, MSN, RN Erin Larson, MSN,
RN Maria Levy, BSN, RN Julie Stene, BSN, RN Workplace Violence:
Giving Staff the Tools and Support to Report Workplace Violence:
Giving Staff the Tools and Support to Report
Slide 2
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 Violence Objectives
Slide 3
Definition OSHA: Any act or threat of physical violence,
harassment, intimidation, or other threatening disruptive behavior
that occurs at the work site. ENA: An act of aggression, physical
assault, emotional or verbal abuse, coercive or threatening
behavior that occurs in the work setting and causes physical or
emotional harm. Examples Verbal threats, spit on/at, yelled at,
biting, hair pulling, scratched, being sworn at, being hit, pushed
or shoved, etc. Workplace Violence Emergency Nurses Association,
2013; US Department of Labor: OSHA, 2013
Slide 4
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
Slide 5
Slide 6
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 Violence Statistics Gerberich et al., 2004 U.S.
Department of Labor: Occupational Safety & Health
Administration, 2004
Slide 7
Difficult to measure: - Most studies done through surveys -
Using a convenience sample - Based on remembered events (rely on
memory) Workplace Violence Effect on Staff
Slide 8
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: Workplace Violence Effect on
Staff Gates, et al, 2011
Slide 9
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 Workplace Violence Effect on Staff Gates, et
al, 2011; Gillespie, 2008; Kowalenko, et al, 2013
Slide 10
If nothing else, the fact that nurses consider leaving and 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. Workplace Violence Effect
on Staff Pecci, 2014 Deena Brecher (ENA President):
Slide 11
Perception ? Reality ? We can only manage what we have measured
Workplace Violence Effect on Staff
Slide 12
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
Slide 13
Nursing Surveyed in March, 2012Nursing Surveyed in March, 2012
Survey modeled after the ENA Emergency Department Violence
Surveillance StudySurvey modeled after the ENA Emergency Department
Violence Surveillance Study Interventions: staff education,
development of the reporting toolInterventions: staff education,
development of the reporting tool Post-intervention Staff surveyed
one year laterPost-intervention Staff surveyed one year later
Workplace Violence WPV Assessment Survey
Slide 14
Initial Survey Results Workplace Violence
Slide 15
Initial Survey Results
Slide 16
Workplace Violence Initial Survey Results
Slide 17
Only 33% of assaulted staff Reported it!! WHY? Workplace
Violence Initial Survey Results
Slide 18
Survey question: Do you feel that workplace violence from
patients and/or visitors is simply part of the job? 53% - Yes
Workplace Violence Initial Survey Results
Slide 19
Survey question: Have you been instructed to report physical or
verbal abuse regardless of severity? 47% - NO Workplace Violence
Initial Survey Results
Slide 20
this has been an accepted way for so long I shouldnt 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 Workplace Violence
Initial Survey Results Survey Quotes:
Slide 21
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:
Slide 22
Workplace Violence 100% OF REPORTS SUBMITTED WERE FOLLOWED UP
ON BY MANAGEMENT WITH STAFF CONTACT Following the initial
survey:
Slide 23
Slide 24
Slide 25
Picture of the reporting tool
Slide 26
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 Violence Intervention
Slide 27
Workplace Violence Post Intervention Results
Slide 28
Workplace Violence Post Intervention Results
Slide 29
Slide 30
Is WPV a part of the job in the ED? ResponseInitialFollow-up
Yes53% No47% Workplace Violence Post Intervention Survey
Results
Slide 31
Is WPV a part of the job in the ED? ResponseInitialFollow-up
Yes53%24% No47%76% ~55% Decrease Workplace Violence Post
Intervention Survey Results
Slide 32
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 dont think it should be tolerated like it is
Workplace Violence Post Intervention Survey Results
Slide 33
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 Violence
Summary
Slide 34
Workplace Violence: Giving Staff the Tools and Support to
Report Workplace Violence: Giving Staff the Tools and Support to
Report Questions? Discussion?
Slide 35
References Emergency Nurses Association. (2010) Position
statement:Violence in the emergency care setting. Retrieved from
http://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.
Slide 36
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=609.2231https://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.htmlhttps://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/https://www.osha.gov/SLTC/workplaceviolence/