Workplace violence is on the rise. Globally, every hour, two nurses are assaulted by a patient at work. And that number is based on the reported incidents. As we already know, workplace violence is highly underreported. Therefore, healthcare organizations have an ethical responsibility to their employees to keep them as safe as they can by making sure they are warned early of potential violence. This is the second in a 3-part series looking at how to address abuse from patients and their families. First, we discussed how to address abuse by intervening early. In this second part, we discuss how to reduce patient abuse by warning others early.
Workplace violence was witnessed by:
- 72% of CNOs/CNEs
- 57% of directors
- 51% of managers
29% of nurses experienced workplace violence at least one time between August 2021 and June 2022.
Betty, a nursing assistant was pulled to a unit and assigned a patient who kicked her when she walked into their room. During a debriefing after the incident, it was brought to light that this was a patient who had been agitated and who the staff complained about at the nurses’ station and in the breakroom. However, nobody warned Betty about it.
What happened to Betty happens way more than it should.
Rarely does physical violence happen unexpectedly. Physical violence is usually preceded by verbal violence. Therefore, as soon as a patient starts to become agitated, starts threatening the staff, or becomes increasingly demanding, it’s time to give others a heads-up so that anyone caring for that patient can take the necessary precautions.
How to Reduce Patient Abuse by Using a Reporting Framework.
When a patient’s care is transferred to someone else or to another department, there is a potential for information to get lost. That’s why it’s important to hardwire patient/family conduct into your reporting framework.
Three key opportunities to include patient and family conduct when transferring care are:
- during shift-to-shift report
- to anyone outside the department providing care
- when transferring a patient to a different department
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During shift-to-shift report
Most healthcare professionals utilize a structured report that includes things like, history, body systems, pertinent labs, etc. However, there should be a line item about patient and family behavior in your official reporting framework. For example, the section could be titled, “Patient and Family Conduct”. Staff can be instructed to say, “no issues” or can inform the incoming nurse “the patient is agitated and angry” and then objectively describe the incidents.
“This patient has a history of___”, and/or “this patient has been agitated and cursing.”
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When someone else is providing care
It’s important to alert everyone who’s providing care in your department about specific patients’ conduct, especially those pulled from another unit. Think about working in neurology caring for stroke patients; physical, occupational, and speech therapists practically live in that department. Likewise, respiratory therapists in a critical care department. These are healthcare professionals who spend a lot of time in your department but may not be privy to the same information your staff has on patients.
When they arrive, be sure to give them a heads up on any patient who has been showing signs of increasing aggression. Ask them to be careful when they walk in the room or ask that they bring somebody with them.
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When transferring a patient to another department.
When transferring a patient from one unit to another unit, conduct needs to be a part of the handoff report. They need to be warned so that they’re not blindsided if the patient becomes violent.
Other opportunities to reduce patient abuse by warning others.
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Huddles
Most healthcare professionals huddle daily. If there is a patient in your department who’s becoming increasingly agitated, include a “heads up” in your huddles. That way, even if it’s not someone’s patient but they are walking past their room, they have been informed the patient may potentially become abusive and can be on high alert if they are providing care nearby on the unit.
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Rounding
Leaders are expected to round on the patients in their department. Let’s say you have to round on 5 patients a day. Sometimes you’re lucky if you get to round on one patient a day. If that’s the case, make it a priority to round on the patient who is increasingly becoming agitated.
Don’t forget about your security people! Give your security guards a “heads up” and ask them to round in your department more frequently while that patient is there.
Remember, it’s rare that a patient becomes physically violent without a warning. Identifying the potential for violence and then warning others can dramatically reduce patient abuse and keep your employees safe. Making warning others early an expectation can keep them safe from workplace violence!
