read more]]> Nurses are the victims of violence on the job more than any other profession. It comes at the hands of patients and family members, and leaves both emotional and physical scars. But all too often, the physical assault is only the beginning of the trauma for the nurse. Despite many good intentions, most health care settings in the country lack systems and protocol to properly handle acts of violence in the workplace. As a result, nurses are often made to blame for the assault because the incident often surfaces areas of concern around staffing and security within the hospital. They are often shunned by administration and co-workers alike because violence is a sensitive subject and there is a long-standing misperception that violence is part of a nurse’s duty and should not be reported. It’s violence dressed up in different clothes and NFN is working hard to make sure violence against nurses in all forms is no longer a part of the job.

Earlier this year, we told you the story of NFN member Kelly McLean, a nurse at Erie County Medical Center (ECMC) who was beaten unconscious in August 2010 by a patient in the hospital’s acute psychiatry unit when the unit was understaffed.

After the assault, NFN and its member New York Nurses Association were immediately by Kelly’s side, ensuring there was a proper evaluation of the incident and she received the justice she deserved. The District Attorney prosecuted Kelly’s assailant right away and a judge sentenced him to two years in prison. And, ECMC sprung to action as well, looking into the assault and working to institute changes that would better protect nurses and other health care workers in the future.

After 16 weeks of recovery, Kelly returned to work in December 2010 as part of her healing process. But because there are no standards in place for preventing and reporting violence in the workplace, she became the victim of violence once again despite the efforts of many well-intentioned people at the hospital. Here now is her story of violence after the initial assault.

One important factor in the recovery of nurses from a violent attack in the workplace is to be included in drafting changes to policy and protocol so that incidents like this can be prevented in the future. While Kelly was still hospitalized from her injuries, she was informed that she would be a part of a root cause analysis that the hospital was undertaking so that she would have a voice in the safety improvements at the hospital.

Prior to Kelly’s return to work, she received a letter from the hospital stating that her own medical records had been breached two months prior and that the employee who committed the breach was fired from the hospital. With her attacker now serving two years in prison, and knowing that he had angry family and friends, Kelly was extremely nervous about who would want to access information like her home address, emergency contact, social security number, and, especially, what they would do with that information. Hospital protocol, however, stipulated that they could not disclose the identity of the person who accessed her records. Says Kelly, “I felt completely vulnerable. How could a person who illegally accessed my personal information have any right to privacy?”

When Kelly returned to work on medical restriction, she no longer felt safe in the psychiatry unit and, therefore, chose a new position in the hospital’s detox unit. Unfortunately, she was unaware that nurses in the detox unit are also responsible for floating to other units when they are short-staffed or in emergency situations, including the acute psychiatry unit. Had the correct protocols been put in place and the staff been sufficiently trained in placing nurses who experienced an attack, they may have flagged this potential issue and suggested another position for Kelly.

Kelly was pleased to find that the hospital hired a private security company as an added safety measure for staff and patients. She recently learned, however, that after only approximately ten months, the guard shifts are being phased out after the local Office of Mental Health inquired about the need for such guards. This is another example of how good intentions can fall short if there is not a shared understanding or there are not policies in place for effectively handling incidents of violence.

The hospital required Kelly to attend re-orientation classes to learn about her new unit and re-engage in the work she loves to do. While parts of the re-orientation process were helpful to Kelly to ensure she could continue providing the highest quality care to her patients, she also found herself in classes with new nurse graduates covering basic competencies, as opposed to re-certification classes with her peers. When she questioned the decision, she was told that because she was assaulted, the hospital wanted to make sure that she was successful at her job this next time and felt a repeat of the original classes were necessary. Kelly says of the revelation, “I was very upset by this. I felt that I was being blamed for what happened to me, and I know I did everything right. I was completely overpowered by a patient and woke up in the ER. My incident is known amongst both old and new staff. Without knowing who I was, a new student brought up my incident as an example that the defense strategies they were teaching us don’t always work and asked how nurses can protect themselves in those scenarios, which the teacher dismissed, saying these strategies are designed to prevent those things from ever happening.”

While Kelly continues to love nursing and caring for patients, the experiences that she’s had in the past year have been frustrating and demoralizing. Says Kelly, “I’ve spoken up. I’ve requested meetings to help move the issue of nurse safety forward, but I feel like I’ve barely gained any ground. NFN has been by my side from the beginning, and I’m confident we will move forward together to work for the safety of nurses.”

Reducing violence against nurses in all forms is one of NFN’s two national policy priorities. Our goal is to elevate the national conversation about violence and institute national legislation that would put proper policies and protocol in place to protect nurses and other health care workers from ever experiencing violence as well as systems for reporting and dealing with violence if an assault does occur. These incidences not only affect the nurse, they affect patient care and our health care system as good nurses leave the profession or are reluctant to start.

The subject of violence was the theme of our most recent Labor Academy in Chicago, where Kelly bravely spoke to attendees about her experience. Read more about the Academy including other members’ stories and resources for you and your workplace.

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Susan Walters, RN, speaks to NFN's Labor Academy about her experience with violence and steps nurses can take to reduce violence against them and their peers. Courtesy Casey Campbell.

Susan Walters, RN, has been an Emergency Room nurse for 36 years and has experienced violent assault in the workplace on more than one occasion during that time. Through her membership in National Federation of Nurses (NFN) and the Oregon Nurses Association, Susan continues to work tirelessly to make sure that no other nurse anywhere in the country is a victim of violence on the job.

Working at a busy, centrally-located hospital in Portland OR, violence has always been a factor in Susan’s workplace. After witnessing several instances of violence and aggression exhibited toward the hospital staff, Susan and hospital security officers–who had training in behavioral health–formulated a training based on best practices for effective patient care, environmental awareness in a hospital setting and appropriate self-defense methods should it become necessary.

As a result of their collaboration, the hospital began holding annual nurse trainings that highlighted how to pick up on cues of potential patient violence, being aware of patient history and flagging past offenders for the safety other staff members.

Since training began in 1995, the hospital has seen a decrease in violence and aggression toward nurses and other hospital staff. The improvements inspired Susan to become a very vocal advocate for this training and, in 2007, the Oregon Nurses Association, in partnership with NFN, was successful in proposing legislation about providing this training to all nurses, home health workers and other health care professionals who can find themselves in vulnerable positions with a patient.

Susan is a member of Emergency Nurses Association, which is currently working with the new Occupational Safety and Health Administration (OSHA) director to get nurse self-defense training federally mandated. The Centers for Disease Control and Prevention (CDC) is also working on an online module similar to what is happening in Oregon.

“I’m so excited that NFN is working with us and others to make this happen,” Susan says.

Susan and her staff now train more than 700 bedside providers on workplace safety because they recognize that this is not just an issue in Emergency Rooms, but in all parts of a hospital. Her team has also developed strategies that alert hospital staff to people with a history of aggression by incorporating a simple icon that tells staff what they need to know.

In the meantime, Susan says, nurses can make some easy, simple changes today. “One thing that nurses can do right now is to stop wearing their stethoscopes around their necks. Being safe means staying ahead of the curve and fine tuning peoples appreciation of being watchful and aware.”