A nurse's 'gut feeling' could stop hospital violence before it happens

Hospitals across the country are responding to the recent surge in violence against healthcare workers by launching violence prevention campaigns to spread the message to all who enter: acts of aggression will not be tolerated here

In theory, being proactive against violence seems like a good tool to pull out of the toolbox. On the other hand, common sense might dictate that a person who is tempted to lash out — physically or verbally against a nurse, physician or other hospital employee — might not be swayed by signage. 

So how can clinicians stay aware and get ahead of potential challenges — avoiding becoming the victim of a verbal assault, being punched or grabbed or having things thrown at them?

Students at Biddeford, Maine-based University of New England's nursing program are now required, since March, to take a violence awareness certification course before graduation. The four-hour course is the "Deescalation" module of MOAB Training International's comprehensive program that teaches professionals to recognize, reduce and manage aggressive behavior in and outside of the workplace. Once completed, the certification is good for two years. 

The course is also available to, but not mandatory for, all students at UNE's Westbrook College of Health Professions.

The training also reduces some of the onboarding responsibilities a hospital provides when hiring a new nurse.

Chad Stevens, UNE's associate director of safety and security, told Becker's the course teaches nursing students about situational awareness and how to look for nonverbal clues that something might be about to happen. This includes reading body language and eye communication. These skills can be used when a potentially aggressive individual is not being obvious but instead exhibiting emotion through nonverbal communication.

"It provides mental conditioning and teaches our students to recognize that something is wrong — to listen to that gut feeling, like when the hairs on the back of your neck stand up," he said. "You don't know what's going to happen, but you have to prepare yourself and have a plan for whatever is coming down the road. 

"I've seen it at work. I know that it teaches skills that can be immediately put into practice to keep themselves safe."

Donna Hyde, MSN, RN, associate director of nursing and associate clinical professor at the School of Nursing and Population Health at UNE, said many acts of aggression in hospitals are reactionary as there is no shortage of things to get frustrated about in healthcare these days. A long wait, pain, an upsetting diagnosis — these could, and often do, spur violence.

Aggressive behavior management, she said, is not usually taught during nursing school. But it should be, she said, and recalled a situation in her early days as a nurse that underscores the need. 

"A patient was very upset because the provider wouldn't give them pain medication. I knew they were upset. They were pacing the room," Ms. Hyde said. "All of a sudden, they just stopped and stared away with clenched fists. I thought to myself, 'What are they doing?' Then they took the IV pole and threw it at me across the room."

In hindsight, after hearing the information Mr. Stevens teaches in the de-escalation certification course, she said, "I realize that I should have seen the behavior as a preemptive move to a potential attack or assault. I didn't recognize it when I should have."

Mr. Stevens said Ms. Hyde's example underscores the reason why nursing students need to be taught in school about how to spot and manage an aggressive situation before it gets out of hand. 

"Once they get into a nursing role and they're faced with these challenges on a regular basis, it can be too late," he said. "We're preparing new nurses prior to them getting into those roles. Now they are ready to start with a mindset focused on protecting themselves and keeping themselves safe."

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