Health care organizations must establish a zero tolerance policy for violence against nurses to protect employees and the quality of patient care, according to Jean Henry, an assistant professor of health science at the University of Arkansas.
Henry and colleague Gregory O. Ginn of the University of Nevada outlined the issues and actions administrators can take to provide a safe and functioning health care facility in “Prevention of Workplace Violence,” a chapter in Leadership and Nursing Care Management.
“There has to be an organizational culture established that has a zero tolerance policy for violence,” Henry said. “When it comes to protecting health care workers, administrators must make it clear that they won’t tolerate any violence – verbal or physical – against workers.”
Such a commitment sets the tone for developing policies and procedures to ensure a safe workplace. Henry and Ginn emphasize the importance of implementing a risk-management system throughout health care facilities to protect people and property from violence and prevent problems.
The Front Line
“A lot of what you see now in patient violence comes from frustration with the health care system in general. The system is not doing a good job in providing adequate care,” Henry said. “Nurses are on the front line, so patients vent at the nurse.”
General frustration with the system is compounded by problems with maintaining sufficient staffing levels. In the chapter, Henry uses an example of an inexperienced emergency room nurse who misreads a situation with an angry individual in the waiting room.
“Even with maturity and experience, emergency room nurses are often swamped and stressed and can miss what is going on in the waiting room,” Henry said.
She suggested ways to handle emergency rooms to lessen the potential for patient violence. Staffing an emergency room with a patient advocate, who may be a trained volunteer, can help ensure that patients don’t feel “invisible and forgotten.” Procedures requiring that regular and frequent contact with patients be noted on a chart can facilitate follow-up and reduce patient frustration.
Henry noted that nurses themselves are the most common perpetrators of some forms of violence, such as “horizontal violence” directed against other nurses. This usually takes the form of psychological harassment, such as bullying. These actions “often seem to be precipitated by staffing shortages and increasing workloads.”
Once again, institutions must establish a culture that does not tolerate violence, including bullying and harassment, which in some workplaces “may be so endemic that it is taken for granted and dismissed as inconsequential.” Permitting bullying and harassment to go on has significant negative consequences, including demoralization and loss of confidence as well as negative attitudes and impaired work performance.
The goal, Henry said, is an organizational culture that can be characterized as “caring, trusting and collaborative.”
In addition to assessing the risks and making changes in policies, procedures and physical environment to protect against violence, health care administrators need to develop procedures for responding to incidents of violence that both support the victim and lead to improvements in the workplace.
“Nurses have to know that the organization will protect them and that if something happens, they will not be treated as though they did something wrong,” Henry said. “When people are victims of violence, we don’t want to further victimize them during the investigation.”
Finally, the researchers noted that workplace violence has a broader impact than what was done to any one victim.
“It damages trust, community and the sense of security that every employee has a right to feel while at work,” they wrote.
Health care administrators and the educational institutions that prepare nurses both have a responsibility in the face of increasing violence, Henry and Ginn wrote. Employers need to show a commitment to providing a safe workplace in all clinical areas and other high-risk settings. Educators and employers both need to prepare nurses to deal with potentially violent situations.