What can hospitals do to mitigate workplace violence? Q&A with 2 RWJBarnabas Health execs

Violence can occur in any workplace; however, healthcare workers are especially at risk, given the high-stress, high-risk environment in which they work. The American Hospital Association declared June 8 Hospitals Against Violence Friday in an effort to raise awareness about the violence healthcare workers, particularly frontline workers, face using digital media.

Becker's Hospital Review spoke with two executives from West Orange, N.J.-based RWJBarnabas Health about workplace violence risk factors as well as what hospitals can do to support their employees and patients. The executives are:

• Nancy E. Holecek, BSN, RN, senior vice president and chief nursing officer of the Northern Region
• Milton Anderson, executive vice president of management services administration and chief administrative officer

Both Ms. Holecek and Mr. Anderson are co-chairs of RWJBarnabas Health's Workplace Disruption and Prevention Committee.

Question: What are the most common types of violence healthcare workers, particularly nurses, face?

Nancy Holecek: Healthcare workers, and especially nurses, report that they are commonly subjected to verbal abuse and threats which include racial bias. In addition, because we value transparency with our patients, employees have their first and last names visible, which can lead to online harassment through social media platforms. Physical abuse occurs less frequently, but many healthcare workers have been assaulted, whether accidentally or purposefully [we sometimes don't know].

Q: What are the workplace violence risks that nurses may not report?

NH: Nurses and other caregivers tend to tolerate a certain amount of workplace threat or violence, attributing it to physical or behavioral illness that the patient cannot control. For example, a patient with dementia or one having a psychotic episode may injure a nurse without meaning to. It is also imperative that we establish a safe reporting culture so that we may respond appropriately, trend the incidences and construct strategies around the trends identified. In addition, threats and assaults are not limited to patients, but can involve a family member who receives bad news about their loved one, or visitors.

In general, nurses have been increasing their reporting of perceived and actual threats of violence to their supervisor, especially in the past decade. It is imperative to establish a safe reporting culture so that incidents can be tracked to ensure the safety of both patients and employees.

Q: What are some reasons for nurses' under-reporting workplace violence?

NH: Under-reporting can be attributed to any number of factors that can include its impact on career progression, potential retaliation by the patient, disbelief from supervisors and loss of hours.

Q: What are some strategies hospitals can implement to ensure safer workplaces and encourage reporting?

Milton Anderson: Establishing ongoing training of on-site and corporate threat assessment teams, [which] is essential to ensure case management and tracking that meets and exceeds the OSHA General Duty Clause of 2011, is a good start.

In short, awareness and informing supervisors of how to share concerns, and to whom, can literally save lives before a scenario escalates that puts staff or patients at risk. In this area, organizations such as RWJBarnabas Health can seek expert assistance.

Q: What can hospital leaders do to support nurses when they do report incidents?

MA: Encouraging contact with [an] employee assistance program is meaningful, but has become an instant solution that is largely ignored by a nurse who feels he or she may be in harm's way.

The best and first intervention is a private meeting, where a nurse discloses to human resources and possibly site security what happened, why they feel concerned and what was shared in any email, conversation, text message or other. It goes back to creating a safe reporting environment so our nurses feel more comfortable.

We need to be candid about the risks as much as the rewards of the career of a nurse. We must share nonalarming but real examples of situations that can occur and how the administration turns to law enforcement when necessary, the system's own threat assessor when appropriate and many other resources.

Listening, empathy, potential paid time off [for] a few days after an altercation or incident — each of these can and do make a difference to emphasize that nurses are valued as professionals.

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