Safety — not violence — should be the expectation in healthcare, 4 leaders say

Violence, to a certain degree, has for years been expected among those working in healthcare, multiple experts recounted to Becker's. But increases in the number and severity of such incidents since the pandemic have prompted hospital leaders to rethink how they address the issue.

An estimated 42% of healthcare professionals reported feeling unsafe at work in 2023, according to a new report from healthcare staffing agency Vivian Health.

The increase in violent incidents also is leading some clinicians to reconsider their roles and consider leaving healthcare altogether. 

Around 60% of nurses say workplace violence has led them to change jobs, leave jobs or at least consider leaving their job or even the profession entirely, according to a recent report from National Nurses United. On top of that, 26.3% said they feel violence has increased significantly in the last year alone.

Many hospital and health system leaders say their employees have a reasonable expectation of safety at their place of work, which has prompted several systems to implement patient codes of conduct. Others have started investing in weapons detection equipment.

"Many healthcare employees mistakenly feel that workplace violence is just part and parcel of their jobs and that they were unlucky enough to be in the wrong location at the wrong time," researcher wrote in a 2022 report published in the Annals of Medicine and Surgery. "Many employees believe no action will be taken against the perpetrators, or they refuse to endure the stigmatization and the inconvenience of filing reports and following through on legal proceedings. They are typically concerned that if they speak up about what has occurred to them, they will be shamed or labeled incompetent with a lack of supervisory support."

Where to start 

There are a number of proposed solutions, but at the core of many are two keys: planning, and enhanced communication and education about safety protocols. 

Some clinicians have criticized health systems and hospitals over their slow pace in implementing safety solutions. 

"Violence is a problem that doesn't have direct reimbursement attached to it," Robert Bramante, MD, chairman of emergency medicine at Mercy Hospital in Rockville Centre, N.Y., told Becker's. "Facilities are already strained, oftentimes, to add new services and other things. So it is a challenge to try to incentivize staff to add on additional trainings or something like that. … The issue is another item that is competing for hospital leaders' attention." 

Tackling an issue as complex as violence prevention and safety enhancement requires planning. Dr. Bramante advises hospital leaders begin with an environmental plan that assesses hospital exit points and visitor pass systems, ramping up security personnel as needed in areas such as entryways and emergency departments, and encouraging routine crisis response training for staff. Forming strong partnerships with community partners and law enforcement is also key. 

Partnering with community organizations and law enforcement, he said, helps to "build that coalition of people recognizing that these things should not be happening, and when they do happen, that those responsible need to be prosecuted. Just like if you were on a plane or in a bank or anywhere else, we need more who recognize that violence is never appropriate, especially in the workplace."

Jennifer Kreiser, BSN, RN, chief nursing officer at Sentara Norfolk (Va.) General Hospital, and Michael Genco, MD, the hospital's chief medical officer, say beginning with an evaluation of resources can help identify what else is needed.

"[E]nsuring your hospital has the right resource mix to provide the appropriate level of care is an important first step," Dr. Genco said. "Another important step is having a good security strategy and including the right number and mix of security resources on the ground. Creating a culture of awareness and teamwork among front-line staff can alert them to patients predisposed to violence and help support and protect them."

"It is important for leaders to ensure staff know workplace violence will not be tolerated," Ms. Kreiser added. "… We do not want young people to be afraid to work in healthcare, and letting everyone know that workplace violence will not be tolerated will help."

Pamela Guillory, BSN, RN, chief nursing officer at San Antonio-based Methodist Hospital Specialty and Transplant, pointed out that while training staff in de-escalation techniques and encouraging reporting of violent acts is beneficial, listening also matters.

"We need to revisit our staffing levels, and we actively involve employees in our safety protocols," she said. "We must listen to the staff and then implement the measures that make them feel safe. It doesn't really do any good to have programs that encourage speaking out if we're not going to follow through with what we hear."

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