Protecting Nurses From Workplace Violence

Violence in the Healthcare Workplace Today

Today, professional nurses are on the frontlines of healthcare and, unfortunately, the war metaphor is all-too accurate in many cases. Indeed, hospitals can be dangerous places for all healthcare employees but nurses in particular are vulnerable to violence because of the frequent one-on-one contact they have with patients who may be suffering from a wide range of medical conditions that might trigger a violent episode. To determine how this problem is adversely affecting nursing practices, this paper provides a review of the literature concerning workplace violence and nurses, how this problem could be solved if resources and cooperation were unlimited and a discussion concerning how other professions have addressed this problem. Finally, a description of what resources would be needed to creatively address this problem is followed by a summary of the research and important findings about nurses and workplace violence in the conclusion.

Review and Analysis

Explore how and why this problem is affecting nursing practice

Violence against nurses is a serious problem in the United States, and healthcare workers have accounted for fully 66% of all nonfatal workplace violence injuries over the past decade. According to the editors of American Nurse (2013), "These workers face the risk of both physical violence and non-physical violence, such as verbal abuse, on the job" (p. 4).

The National Institute for Occupational Safety and Health (NIOSH) has defined workplace violence as being "any physical assault, threatening behavior or verbal abuse occurring in the workplace" (Workplace violence, 2014, para. 1). In this context, workplace violence also includes covert or overt actions that span the continuum from verbal abuse to murder (Workplace violence, 2014).

Moreover, there are no federal standards in place for protecting nurses in the workplace, although some states have recognized the problem and taken steps to enact laws to protect nurses and other healthcare workers (Workplace violence, 2014). These states have already or are in the process of developing legislation that will require the creation of comprehensive prevention programs for healthcare workers and enhanced penalties for convictions for assault on nurses or others in the healthcare workplace (Workplace violence, 2014).

A breakdown of current state laws concerning workplace violence and nurses specifically is provided below:

Requires employer run workplace violence programs; New York's legislation is limited to public employers only: CA, CT, IL, MD, NJ, OR. NY.

Establish or increase penalties for assault of nurses. Note: Penalties apply only to mental health personnel (KS); public health personnel (MS); emergency room personnel, which includes nurses (LA): AL, AK, AR, AZ, CA, CO, CT, FL, HI, ID, IL, IA, KS, LA, MI, MS, MT, NE, NV, NJ, NM, NY, NC, OH, OK, RI, TN, VT, VA, WV and WY.

Authorizes hospitals to post warnings regarding violent behaviors: OH.

Hawaii passed a resolution urging employers to develop and implement standards of conduct and policies for managers and employees to reduce workplace bullying and promote healthful and safe work environments.

In addition, the Joint Commission has also developed standards for protecting nurses in the workplace, including the following:

Joint Commission Standard LD.03.01.01 Leaders create and maintain a culture of safety and quality throughout the (organization).

A4. Leaders develop a code of conduct that defines acceptable behavior and behaviors that undermine a culture of safety.

A5. Leaders create and implement a process for managing behaviors that undermine a culture of safety (applicable to ambulatory care, critical access hospital, home care, hospital, laboratory, long-term care, Medicare-Medicaid, certification-based long-term care, and office-based surgery programs and behavioral health care programs) (Workplace violence, 2014, para. 3).

How would you solve this problem if you had all the resources and cooperation you need to solve it?

If resources were unlimited, all nurses working in hospitals in the United States would be provided state-of-the-art martial arts training, with one or two private around-the-clock security guards to provide them personal protection in all hospital settings. In addition, all nursing staff members would be provided with Tasers, pepper spray, and bullet-proof vests made from the lightest-weight materials available. In jurisdictions where it was legal, nurses would be armed with a handgun and provided with extensive training concerning how to use it for self-defense purposes.

Based on the review of the literature, how has it been solved in other workplaces or professional organizations?

Both public and private sector organizations have implemented "zero-tolerance" policies which are regarded as being the most important step concerning workplace violence (Bruce & Nowlin, 2011). In addition, pre-employment screening tools that include psychological testing, background checks and credentialing can all help reduce the incidence of violence in professional organizations. Finally, worker training problems have been implemented by public and private sector organizations in an effort to reduce violence in the workplace (Bruce & Nowlin, 2011).

What resources would you draw upon to creatively address this problem?

Patients and their families as well as visitors arrive at hospitals in all types of physical and mental distress, and suggesting that it is possible to complete eliminate workplace violence against nurses would be disingenuous. Nevertheless, there are some steps that hospitals can take to help protect their nursing staff creatively, including training nurses how to respond to violence and ensuring that a culture of zero tolerance for violence is in place. In the past, there was a paucity of training materials available to help nurses respond effectively to violence in the workplace, but a new toolkit is available that can overcome this gap. In this regard, the American Nurses Association, in collaboration with the National Institute for Occupational Safety and Health, distributes a training kit, "Workplace Violence Prevention for Nurses," that can help educate nurses concerning the threat as well as how to respond to these situations (Tool to help prevent workplace violence, 2013). The complete 13-part self-paced training course for nurses is available on the NIOSH Web site at www.cdc.gov / niosh/topics/violence/training_ nurses.html and each unit requires approximately 15 minutes to complete (Tool to help prevent workplace violence, 2013).