Today Kara and Geary are discussing violence in the nursing work environment, continuing their conversation regarding this issue which is increasing at an alarming rate.
Any and all information discussed on this podcast or at the goKrazy website are the opinions of the hosts only. Hosts opinions are not meant to serve as medical advice and do not reflect the opinion of any of the hosts' current or past employers.
Good morning and welcome to go crazy at the nurses' round table.
Geary:I'm Gary.
Geary:I'm Kara.
Geary:What are we gonna go crazy with today?
Geary:Today, we're gonna continue our discussion over the work environment, and
Geary:we're gonna specifically talk more about the violence and safety in the workplace.
Geary:What does that look like?
Geary:I agree.
Geary:I that will continue.
Geary:so today we are talking about workplace violence with the
Geary:continuation of our conversation on nurses working environment.
Geary:you were doing research regarding this topic?
Geary:Yeah.
Geary:What did you come up
Kara:with?
Kara:So I was reading a little bit about it and we, we've heard several news
Kara:stories about nurses getting shot or
Kara:people are a little bit.
Kara:Tolerant of each other and a
Geary:lot more bold, a little bit.
Geary:. Uhhuh.
Kara:That's an understatement, right?
Kara:Yes.
Kara:COVID I think heightened a lot of people's, heightened everybody's stress,
Kara:but then it also made a lot of people, a lot less trusting of people at each other
Kara:in general, in the healthcare environment.
Kara:But I was re reading a little bit, and according to the Bureau of Labor
Kara:Statistics, The rate of injuries from violent attacks against medical
Kara:professionals grew by 63% from 2011 to 2018, and now that's right
Kara:before Covid, but I don't think the pandemic has made it better.
Kara:That's an incredible jump.
Kara:That's a
Geary:huge jump in crime statistics against nurses.
Geary:Is that just against nurses or against healthcare workers in general?
Geary:It's against nurses
Kara:and healthcare workers in general.
Kara:Okay.
Kara:I There was an incidence in Tulsa.
Kara:where a surgeon was shot to death or shot.
Kara:Yeah.
Kara:He was shot to death because he had, because the patient had continued
Kara:back pain after an operation.
Kara:That's horrible.
Kara:Well, We don't often think about that when we go to work.
Kara:What if this patient doesn't like how my, what my treatment plan is, or how I carry
Kara:out my treatment plan and they attack me.
Kara:, what are the consequences of.
Kara:Our daily work environment, sometimes If the outcome isn't satisfactory,
Geary:that's true there, but there are so many common hazards to healthcare workers.
Geary:But I think right now violence is probably at the top of the charts
Geary:as far as a hazard for nursing and.
Geary:Healthcare workers in general.
Geary:I was listening to an ANA webcast and they were talking about physical hazards
Geary:one of the things they pointed out were different general physical hazards
Geary:over exertions slips, trips, and falls.
Geary:And they had workplace violence as the third most common health
Geary:hazard for healthcare workers.
Geary:But I think, it's come to the forefront of what's happening.
Geary:, violence against healthcare workers and nurses That they're definitely, and it's
Geary:already noted that it's under reported.
Geary:. what we see and what we know.
Geary:There's more out there than that.
Geary:What else did you find out?
Geary:Oh,
Kara:I was looking, I was, thinking broad spectrum, right?
Kara:Like workplace environment hazards response time.
Kara:How long does it take security to get to you, or how long does it take
Kara:your response team to get to you?
Kara:Some facilities have developed response teams to deescalate situations.
Kara:Oh yes.
Kara:So you call a response team and then they come to deescalate it.
Kara:But there was an incident in Louisiana in January where a man was unsatisfied
Kara:with the outcome of his parents who were in the intensive care unit,
Kara:and he punched a nurse unconscious.
Kara:What is the repercussion for him?
Kara:Is she okay?
Kara:Who covers her medical bills now that she's been knocked out in the workplace?
Kara:And then at the same time, is she gonna be scared to come back to work?
Kara:Is she gonna even wanna come back into that unit?
Kara:How's, what's the trauma follow up after that?
Kara:Also, I wonder what and is he?
Kara:Is, does she press charges?
Kara:Does he go to jail?
Kara:Yes.
Kara:And what we don't often hear about the repercussion, like
Kara:what happens to this person?
Kara:What is the consequence of their behavior?
Kara:Even if it's just irate, even if you're in a clinic and you have an
Kara:irate family member come in screaming and yelling and bowling you into a
Kara:certain type of treatment, right?
Kara:What is the consequence of their action, right?
Kara:Do we fire them from being able to come back to that clinic?
Kara:Do we say, you're no longer welcome here.
Kara:Can we refuse?
Kara:That's the other thing, you know as a nurse, are you able to
Kara:say, I'm not taking care of you?
Kara:We hear all the time in when you're working in the building, right?
Kara:The family fired this nurse, they don't want her back.
Kara:Or they don't want that tech back, or they don't want that doctor back.
Kara:Yes.
Kara:What if I don't wanna take care of you either, right?
Kara:What if I don't wanna be subjected to your kind of abuse,
Kara:aggression, or abuse or verbal?
Kara:Verbal, derogatory statements constantly, right?
Kara:What if I don't want to come in here and risk being punched in the face
Kara:because I woke you up the wrong way,
Geary:right?
Geary:If you've already displayed violent behavior and then the nurse comes in and
Geary:says, I don't want to take that assignment because that patient was abusive with
Kara:me yesterday, or They're threatening my license, they're
Kara:a threat to my license now.
Kara:, because now they're making it seem as though my care isn't adequate, or
Kara:everything that I'm doing isn't enough.
Kara:And now when I do it, are you gonna sue me or are you gonna threaten my license?
Kara:Then I was reading more about social media and how that
Kara:people really attack each other.
Kara:We know people attack each other on social media all the time, you can
Kara:destroy a surgeon or a physician or nurses, anyone's reputation.
Kara:Oh, definitely.
Kara:Just by saying, oh, he didn't do a good job.
Kara:He didn't do a good job.
Kara:Don't ever go back here again.
Kara:And who looks
Geary:into that?
Geary:That's just the tip of the iceberg with everything that's going on out there.
Geary:The bullying that can be done or the repercussions.
Geary:If you say something on social media that doesn't agree with a narrative
Geary:of or what the general view is, there can be severe repercussions.
Geary:There can be.
Geary:You yourself end up being bullied, and so you have to be very careful.
Geary:I think social media can, it's a double edged sword, right?
Geary:, it can be used for good.
Geary:There are so many good things that have come out from being
Geary:able to connect with your friends and family that live so far away.
Geary:The good aspects.
Geary:So let's say the good aspects of Facebook are you get to see
Geary:those pictures of the baby of your new niece or nephew instantly.
Geary:Or you get to connect and talk to someone from high school or from wherever.
Geary:Those kind of connections that we're able to achieve.
Geary:Now, those are great, but then there's the other side of that is
Geary:the people that get upset with you.
Geary:A patient or anybody, they weren't satisfied with the care you provided,
Geary:and then they find you on Facebook or they go look for you on any of the
Geary:other social media platforms and they start harassing you or trolling you.
Geary:, that type of thing.
Geary:That's a certain type of violence as well.
Geary:And how do we deal?
Kara:Exactly.
Kara:I know some hospitals are installing or investing in more secure technology,
Kara:so they have cameras up everywhere.
Kara:Even some places have like nurses wearing cameras, like I guess pinned to them.
Kara:, so if someone is getting overly aggressive or they've been flagged as an aggressive
Kara:family member or an aggressive patient, they can say this is all being recorded.
Kara:Kind of like the same thing for police officers.
Kara:There has to be a level of accountability and we're not saying.
Kara:Medical professionals aren't responsible for their behavior either, or our
Kara:response, cuz none of us are perfect.
Kara:But the accountability goes both ways, right?
Kara:You're expecting a service, you expect to be treated a certain way when
Kara:you're coming in for the service that you're paying for, but then at the same
Kara:time, it doesn't give you the right to overstep and act any way you want.
Kara:To get that service and.
Kara:I waiver back and forth because I think, okay, now we've entered into
Kara:this age of where we have to flag aggressive patients or flag family
Kara:members or people who you think might are gonna go in this direction, right?
Kara:. And so there's a targeted response where your management is notified,
Kara:the charge nurse or whoever is notified, like who we're gonna have
Kara:to deal with this family a certain way or this patient a certain way.
Kara:Yes.
Kara:But then I think people who are around and watch that, like I think in ER
Kara:settings and in clinic, Did people in the waiting room watch this person
Kara:was acting out and they were screaming and yelling and they got what they
Kara:wanted, or they got to be seen, or in some way seen they got heard faster.
Kara:. So then people come in with that attitude like I can start out nice, but
Kara:if I need to get rough, I will to get
Geary:what I want.
Geary:What is the
Kara:behavior?
Kara:Because that gets a response.
Kara:And so are we training society as a whole to be more aggressive, to
Kara:get a better, to get what they want?
Kara:Learned
Geary:behavior of, if I throw a.
Geary:Is that going to help me get seen by the physician sooner?
Geary:, whether I'm in the office, at the doctor's office, or I'm at the
Geary:emergency room or in the clinic because everybody knows about hcaps.
Geary:All of your scores, everybody has to, everybody wants to get a good score.
Geary:And if you have an irate patient or family member who can influence the
Geary:scores that You're going to want to give them that attention and calm them
Geary:down and make sure everything goes well.
Geary:So that they give you a 10, a nine or a 10, right?
Geary:Cause anything less than that is a zero, right?
Geary:So I think that plays into a narrative.
Geary:I
Kara:think that we should do.
Kara:the same way that we have as we have debriefing, right?
Kara:, like someone dies, you lose a patient on any floor.
Kara:There should be a debriefing moment.
Kara:And I think a lot of places have moved towards talking
Kara:about what did we do right?
Kara:What did we do wrong?
Kara:How does everybody feel about this situation?
Kara:, did we do everything we could do?
Kara:Could we have responded better?
Kara:And so you do that in the instance of a death.
Kara:And I think when there is.
Kara:a work environment hazard that's happened, or violence issue or a safety issue.
Kara:Where something has been breached.
Kara:Somehow our level of security was breached.
Kara:We should have a debriefing on that.
Kara:And I think everybody involved, whether, some level of, Hey, how
Kara:do you feel like we handled that?
Kara:Do you think that the security response time was fast enough?
Kara:Are you okay?
Kara:Is this gonna affect you when you come back to work?
Kara:I don't know how I, I have yet to see that.
Kara:I've had a couple of experiences.
Kara:personally, it's 2:00 AM in the morning.
Kara:The halls are dark, everybody's asleep, and I'm in a pediatric unit and a
Kara:psych patient somehow ended up in my facility fully in a psychotic break.
Kara:His head was covered up with a towel.
Kara:We don't know how he got there.
Kara:He's just sitting in the middle of our, in like inside the unit waiting room.
Kara:Not speaking to anyone.
Kara:We don't know if he's aggressive and it's me and one other female employee.
Kara:There to navigate this situation, right?
Kara:Security's in the basement somewhere, dealing with the ER
Kara:because they never stop, right?
Kara:, hit our distress button, but it's still up to me to guide this man
Kara:safely out of the unit and then try to figure out how he got there.
Kara:. And so for me it meant a lot that the head of security leader called
Kara:me later couple days and said, Hey, you were the one who was there.
Kara:How do you feel about this situ?
Kara:What do you think we could have done better?
Kara:Right when, and what had happened was our behavioral unit wasn't locked down
Kara:yet, so he just walked right out of the unit that he was supposed to be.
Kara:Restricted to.
Kara:Found an in facility inpatient elevator and went straight up to the
Kara:first floor that he could get off on.
Kara:Oh, okay.
Kara:That could have been potentially hazardous for any one of our little
Kara:kids who was there unaccompanied.
Kara:Not to mention the staff if we had have approached him aggressively, . Cause
Kara:we don't know what he's there for.
Kara:But follow up is so important and I.
Kara:There's, I don't see a lot of discussion on that about
Geary:the follow up.
Geary:I agree.
Geary:I do think that those debriefings are very helpful and also nurses and
Geary:the general support staff as well have ideas, and they're on the floor
Geary:24 7, so they may see something that upper management or leadership is not
Geary:seen as far as how we can make the environment safer because what's our.
Geary:Our goal is to make the environment safer.
Geary:So if there is that type of violent attack or that type of shooting or that
Geary:type of physical violence against a nurse that happens, how can we make it better?
Geary:What can we do to prevent this type of event from happening?
Geary:And if it's, I think that recent shooting that happened, it was a
Geary:family member or friend or something.
Geary:Was able to get into the unit.
Geary:Can we look at that policy again?
Geary:Let's look at that visitation policy again, and let's see if there's something
Geary:that we could have done and then moving forward, what can we do to change that?
Geary:Because if you're going to put the staff at risk, it's better to make the
Geary:changes and that just goes towards.
Geary:Behavior in general.
Geary:If you have good behavior that's going to be rewarded with the more
Geary:availability of visitation or something more opening of our hospital policy or
Geary:our facility policy, no matter where we are to be able to allow more visitors.
Geary:But if this type of event is happening, then we need to protect our staff because
Geary:we need to think about the patient,
Geary:and how that's going to affect the entire patient population.
Geary:If nurses are afraid to come to work because they're worried
Geary:about their safety, then you know that damages the whole system.
Geary:which ultimately damages the patients as well,
Kara:think moving forward to, we do safety, we have safety checks
Kara:right in place for kids in school.
Kara:They have to go through drills and what happens if this happens?
Kara:Do we need to have safety plans?
Kara:We do have safety plans, but do we go over them as a facility?
Kara:, where's your exit?
Kara:How are you getting out?
Kara:What is your responsibility to your patients, right?
Kara:, if there's an active shooter or if there's a bomb threat, we go over them.
Kara:What?
Kara:Once every few years, but maybe we should do them more frequently.
Kara:Where are the panic buttons located?
Kara:Does everybody in the unit even we have so many travelers
Kara:and so such high turnover.
Kara:Does everybody know the steps to take, to even get to a panic button?
Kara:, or where the fire exit is, or where the stairs are, or.
Kara:Et cetera.
Kara:It goes on and on.
Kara:And then who do I go to for help if I feel like it's been linear?
Kara:If it's been my coworker, I've been subjected to a coworker who backed me into
Kara:a room and was yelling in my face and.
Kara:. , almost in a physical al altercation.
Kara:, I was so shook up, I didn't know what to do.
Kara:Do I'm in charge right now, and this has happened to me.
Kara:Do I call security to deal with my coworker?
Kara:Do I go right?
Kara:Where's my manager after hours, they're not there?
Kara:How do I handle this situation?
Kara:Who do I go to get something done or to, how do we
Geary:deescalate?
Geary:I do think that's something that, the generation arriving now, or the
Geary:nurses and staff that are working now.
Geary:I don't know that they encountered that type of confrontation as much as some
Geary:of the more experienced nurses and staff have, because when I first started in
Geary:nursing, I did encounter that as well.
Geary:I did have a senior person.
Geary:And it was actually more than one senior person just get in my face and say, turn
Geary:that alarm off, or make those alarms stop going off, or that type of thing.
Geary:Just in my face saying, go do that right now.
Geary:I think that type of behavior is not acceptable.
Geary:when I first became a nurse, that type of behavior was allowed.
Geary:However, now, That wouldn't even be tolerated.
Geary:That would not be tolerated.
Geary:A nurse would definitely, I think in nurse would go running to a leader,
Geary:a manager or director or something.
Geary:If anyone approached them and got in their face, if any manager or coworker
Geary:got in their face and yelled at them for something, I think they would be quick to.
Geary:What do you think about that?
Geary:Do you think nurses are more willing to report things like that, or you think
Geary:they're still not under reporting?
Geary:I think
Kara:it's still under report.
Kara:Okay.
Kara:I think it depends, obviously on the person that's being bullied or the
Kara:person that's being attacked, right?
Kara:, like what their personal experiences are.
Kara:, are they gonna be paralyzed with fear?
Kara:Is have they had over overcome other traumas?
Kara:Is this a familiar situation?
Kara:, do they know their rights?
Kara:, know, like a lot of it comes down to, do you know your rights?
Kara:, and I think as nurses are, we come into this position, , I'm here to serve
Kara:you and I'm here to take care of you.
Kara:And we set ourselves aside to do this job right, because this is
Kara:part of our work to care and to love and to, give these services.
Kara:. a lot of times we don't realize our rights, even when it comes to the patients
Kara:and the family members, violating them with their, demands and attitudes and.
Kara:verbal aggression.
Geary:No, I definitely agree.
Geary:I think that it's just very important for nurses to be aware of the process
Geary:and of their facilities policies, whether it's physical safety, knowing, , in
Geary:general, policies address the issue when nurses and staff are onboarded,
Geary:All right, that's all the time we have for today.
Geary:We'd love to continue to hear your thoughts and opinions.
Geary:And remember whatever life hates you today, don't go
Kara:crazy..
Kara:So email us, drop us a line at, go crazy at the nurses round table.com and