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Something Needs to Change
Workplace violence is something that some people will experience.
Workplace violence is something that almost all nurses and many other healthcare workers will experience. These incidents of violence are not just from confused patients; many times it is family members or friends threatening the wellbeing of the staff. As understanding as we are, assault should not be tolerated.
The Chicago Tribune reported on the rate of violence toward nurses, but even though it was pointed out in the article, it was not emphasized. Nurses do not have the time or support necessary to report these acts of violence or threats. It is partly culture: we understand that people are sick and under stress, so we excuse bad behavior on their behalf and choose to look the other way. It is partly a lack of staffing and support within the hospital: paperwork takes time away from patients, managers would have to find others to care for patients while the attacked person receives care or a debriefing. Even more importantly, pressing charges would require reporting to governmental agencies and would bring down a hospital’s reputation (and reimbursement through HCAHPS).
Currently, there are two Nurse ratio bills in committee: one in the House (H.R. 2392) and one in the Senate (S.1063). These bills are just the beginning of safer care for the patients and for the rest of the medical staff. This needed change would allow nurses more time to interact with their patients, provide education, provide care, and to receive their own debriefings after incidents or threats. Given the nurse staffing and mandatory overtime in some states, this law would protect the recipients of the care as well as the providers.
Ratio laws are only one small component.
Nurse lives matter. It needs to be reinforced on a cultural scale. Yes, nurses are the most trusted profession. However, this trust needs to flow between the providers and the patients. To provide the level of care that patients need, the staff needs to protected from family, friends, and sometimes the patients themselves. Additionally, more hospitals need to report incidents of violence. In order to do this, nurses must be convinced to hold others accountable for their actions.
We are all under stress. However, we do not punch people, slap people, corner them in rooms, take them hostage. We don’t. We don’t tolerate that in society, we don’t tolerate that in our homes, we don’t tolerate it in public.
So why do we tolerate it in a healthcare setting?
Nurses need to be supported in reporting violent acts, not only to their supervisors but to the police and pressing charges when appropriate.
#nurselivesmatter
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Published in Healthcare
This is a tragic and unforgiveable reality. The video is very powerful. Nurses have signed up to serve, heal and help. We have to find a way to protect you. We must. Thanks, TRN.
It is too easy to assume that our experiences are the experiences of others, and clearly that is not the case. Thank you for this.
Thank you, Susan. I have seen and heard of some pretty egregious attacks and to my knowledge, no charges were ever leveled. Sometimes the police was called, but anything more than an incident report had not been filed (to my knowledge). We are willing to excuse many, many bad behaviors, but there is a line that needs to be enforced.
It takes supervisors, hospitals, the police, and the public to make this happen.
Everyone needs to speak up and take responsibility. The nurses need to speak up. Police need to act. Everyone needs to do his or her job. Every time. No excuses.
Maybe if the hospitals took better care of the nurses, they would have more nurses available.
That is part of it. Nurses are leaving bedside care because there’s nothing preventing unsafe ratios, abuse is common, and many have mandatory overtime. Add in that older nurses are retiring and patients are even sicker, you have a recipe for disaster.
And this is one reason why I left bedside nursing. I loved caring for my patients, but the verbal abuse, implied and actual threats used to infuriate my husband. And dealing with prisoners? Or taking care of “John Doe” gang members? No thanks. I did have one resident physician come to my defense against a particularly nasty male patient. Let’s just say the guy didn’t say another word against me the rest of my shift.
It seems as though an electronic security system would be easy to design for schools and hospitals. It would have to be invisible to students and patients, but given how tiny electronic devices are these days, that seems doable too.
In our emergency room on Cape Cod, there are two armed police officers on duty at all times–one in the waiting room and one in the clinical area.
It’s infuriating that the hospital chief executives and school superintendents have neglected to have such systems installed throughout schools and hospitals.
My hospital is very lucky in that some of the units have cameras in the rooms. Now that we wear trackers, we have a panic button we can press. That said, I’m not sure anyone would know how to respond.
I’ve heard some stories, even from the doctors. Having security is nice, but more often than not, these people get away with it because there’s no one there in the moment it happens. We have hidden alarms in case of a hostage situation…
But that’s the extreme. In the day to day, people feel entitled to verbally or physically abuse the staff. It’s not okay. Scratching people and biting, throwing blood…? This is not okay.
No, it certainly is not okay. I’m so sorry patients behave so badly. I don’t what to say. I can’t imagine mistreating someone who was trying to help me.
Thanks. Right now, I’d like to see that become some legislation for federal nurse staffing ratios (I prefer the House bill). I’m also a little bit conflicted, but I think I’d also support assault of medical workers becoming an aggravated offense.
Stun guns?
Might not react well with medical equipment. ⚡
Yep.
Hmmm. I agree the situation needs to be addressed. You mention that one of the reasons attacks on nurses are often not reported is that the government would have to be notified, and that would mean poor ratings and/or reduced reimbursement levels. Then in the next paragraph you get behind government-specified nurse/patient ratios. Which is it? More government interference, or less?
RushBabe got to it first, but you are confounding two issues here. Violence against staff is one thing, and should never be tolerated. That’s a problem that needs to be confronted head on, as such.
Ratio requirements are also know as featherbedding, and while it’s difficult to see it in the mirror, this is the same kind of governmental imposition that has been taken advantage of time and time again by unions, to the damage of industries and professions. And in this case, an industry that we are all pretty much forced to use by biology and regulation. Sorry, no support from here.
My wife is a home-health physical therapist. She’s required to go into homes and housing projects ranging from inner city to the backwoods. Mostly she doesn’t talk about it, but I know some of the conditions are unbelievable. She’s far braver than I am.
That is in no way inconsistent. I pay my taxes. I want the federal government to do things on a federal level that protect people. Believe it or not, there are actually cases where the government should actually get involved, otherwise we would still probably have children working in risky manual labor.
Disagree if you like, but it is hardly inconsistent to want a consistent law of the land for the protection of patients and staff.
I have never heard of “featherbedding” and frankly, I can barely imagine a situation where 4 telemetry patients is consisdered “easy”. Unions, particularly nurses unions, can be vile, but this is one case where they are right.
Additionally, you don’t *have* to go to the hospital or use services. No one will force you.
Ratios contribute to dangerous situations all the time. Nurses are rushed. Rushing leads to problems for payients. Frustrated patients become violent patients. Frustrated families are more often violent families. It’s just a fact.
On my floor, I have seen days where 4:1 was barely cutting it. Maybe you don’t think you need ratios, but given how hospitals behave, without law and consequences they will not do what is best. They will do what they can get away with.
But how much of this is also governed by state, federal, and even local regulations? I’ve seen articles about the state’s granting license for a hospital to expand by so many beds. How much is because what Medicare/Medicaid and insurance companies require and will and will not pay for? When everything was a bit more local and everything was out of pocket, the situation was much different. Trying to tweak one piece of the puzzle is not going to help, only further warp the system.
The medical system is a disaster because it’s so centralized and consolidated. #GOSPLAN
That has more to do with what the state will do. I believe it is the states granting licenses based upon population in areas. Medicare and Medicaid reimbursement is also based upon population, but also indigent population/at-risk population cared for in a specific areas.
Additionally, smaller hospitals are exempt from certain federal laws because they practice in particularly small rural areas, etc. They can’t be expected to meet the same stringent standards when they don’t have the population to support it. I would expect that any federal ratio law would also adhere to this. I suspect that hospitals under 100 beds, for example, would not have to conform in the same ways.
Some parts of it, yes. I don’t think nursing ratios are a part that is too centralized, given that only one state has any formal nursing ratios. If anything, the biggest problem with consolidation comes with provider choice and insurance choice or choice of no insurance at all. None of those have anything directly to do with nursing ratios.
For example, it is said…
“[X Hospital] will only change when someone dies or someone sues.”
This is a reality in nursing and in hospitals. Ask anyone. It is a common phrase. It is even a part of my hospital’s yearly nursing quality questionnaire. I suspect it is a part of others’. “Do you feel that…when someone dies or someone sues?” “How much do you feel that?”
I can tell you right now that my hospital only recently began fully adhering to the state law because they were so thoroughly sued and fined. Now, they make sure they are constantly in compliance.
In return, our hospital has been voted within the top 100 hospitals in the US in many different specialties and has become a magnet facility for nursing. One of the other major motivators (other than having Medicare certification pulled), was the horrid thought that the nurses might unionize. It was such a serious threat that we were required to take a 2-4 hour legal class in unions, organizing, and how union contracts work. And we were paid to do so.
We all want to believe that the market will drive the system and that people will do what is good because they are decent. But we also know that they don’t much, much of the time, particularly when people can be manipulated and exploited.
Sorry for the delayed responses. I was working today and received my quarterly “old lady ass-kicking” and have a few face scratches (that were so sharp, I didn’t even feel until I got home) for my trouble.
Confused patients, however, get a pass. I am just pointing out: this is our lives. Daily. It is frequent, it is regular, and it is common. We have our own hierarchy of “wrongness”. It depends. Were people in pain? Were they on drugs? Were they demented? I only give passes to the demented.
Do you do CPI, SAMA or a similar program at your hospital?
What’s that?
Break those down for me, please. Those acronyms probably don’t mean the same to me that they do to you. CPI, for example, is a mental health agency.
CPI is Crisis Prevention Institute; SAMA is Satori Alternatives to Managing Aggression. They are companies that provide training to recognize, avoid, and mitigate aggressive behavior, along with providing physical training to protect yourself.
Okay, CPI is the one that I am vaguely familiar with. We are taught de-escalation techniques, but ultimately, the physical protection training isn’t there. We did have some active shooter training mostly about finding points of refuge, places we can lock ourselves and hide. To this date, I am not aware of any formal training by any particular institute.