Nurses at Seattle Children's request management's help in quelling violence

Forty-four nurses on the psychiatry and behavioral medicine unit at Seattle Children's Hospital signed a letter requesting management's support in curbing violent incidents they say have increased over the past few weeks. 

Police have been called twice to respond to incidents of violence on the unit in the past two weeks, the Washington State Nurses Association, which represents more than 2,000 nurses at the hospital, said in a Nov. 27 news release. 

According to local news reports, police responded Nov. 7 after a teenager in the psychiatry unit armed himself with a metal pole, destroyed property and attacked staff. Police said the patient held an employee in a headlock. In their request for management's help, nurses cited this incident and more than a dozen other "assignments despite objections," or ADOs, nurses have filed with the Department of Labor and Industries since mid-September. 

"Staff work in a persistent state of fear as they come into each shift expecting violence and debilitating abuse," nurses wrote in the letter. "Patient care has been compromised to an extent that our milieu is no longer therapeutic, but rather dangerous and detrimental for all who enter the PBMU, staff and patients alike. The unfortunate reality of the unit is an exponentially increasing risk of a sentinel event if the PBMU is left to continue operating under its current conditions." 

Nurses said they want to see more "communication and transparency from hospital management" around escalating violence. Specifically, they requested three safety officers be present during the day, and one overnight. They also asked for a break nurse, resource nurse and safety coach nurse to be added to support nurses working directly with patients. Additionally, they requested nurse-to-patient ratios not exceed 1:8, and for double pay to encourage nurses to stay on staff amid escalating violence. 

In June, the Department of Labor and Industries inspected the unit after nurses filed a workplace violence complaint. After that visit, inspectors offered recommendations but did not issue any citations or penalties. Nurses on the unit say the volume and severity of safety incidents have increased since then. 

Becker's reached out to the hospital for comment and asked about the nurses' requests. A spokesperson with Seattle Children's shared the following statement: 

"The demand for youth mental and behavioral health services remains alarmingly high, and the impact of this crisis is felt not only at Seattle Children's but across the state and the entire country. The safety, security, and well-being of our patients and workforce is our top priority. We have been actively working on improvements to address this crisis over many months; in the past several weeks we have intensified efforts to address the demand and increasing behavioral acuity. Earlier in November, Seattle Children's opened an Emergency Operations Center in response to the mental health crisis, which enables us to streamline communication and decision-making to immediately address concerns. Through these coordinated efforts, Seattle Children's has brought in additional staffing resources and increased both leader and security presence on the Psychiatry and Behavioral Medicine Unit (PBMU). The team is also actively seeking travel nurses to provide supplemental staffing and patient care.

"While these are critical steps to support the immediate safety of our PBMU team members and patients, this work is ongoing, and we will continue listening to and supporting our workforce, patients, and families. We are collaborating with external partners including government officials at the local, state and federal levels to mitigate current barriers and pursue both short-term and long-term solutions to address the extremely high number of patients seeking mental and behavioral health care at Seattle Children's and across the state. Greater investment in youth mental health is critical to building a pediatric mental health system that encompasses upstream prevention to the highest acuity and complexity in order to meet the needs of Washington's youth."

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