When It Comes to Healthcare Violence, Silence Isn’t an Option

Editor’s note: As the topic of violence in healthcare has become a hot topic, The Hospital Leader is offering perspectives from two of our expert bloggers. This piece is the second of two; to view the first blog post from Tracy Cardin, click here

Our health system recently started reporting the number of workplace violence occurrences on our daily safety call. Before now, most of us had no idea how incredibly common these events were within our walls! It reminded me of an event I experienced a few years ago, while rounding on a young male patient who had significant issues with chronic pain and opioid abuse. While discussing his pain regimen in his room one day on rounds, he became extremely agitated with physically aggressive mannerisms. I quickly realized that not only was I alone in the room, but he was between me and the door. Thankfully, a nurse in the hallway overheard his escalating voice and called security. The team was able to de-escalate the situation, and I was safely escorted from the room. I certainly learned some personal lessons from that experience but did not think to report the event or warn others about what I had learned.

When we started discussing these events inside and outside our safety calls and in other forums such as safety rounds, we found that many of our care team members not only fail to report these events when they occur but also consider physical and emotional violence a normal part of their job. Unfortunately, workplace violence is extremely common in the U.S. and is also remarkably underreported, especially in healthcare. For example, the Government Accountability Office estimates the volume of workplace violence incidents ranges from between approximately 22,000-80,000 a year and that fewer than 20% of such incidents are actually reported. Half of all incidents in the U.S. occur within healthcare, and direct care providers are at the highest risk of experiencing such events. For example, a survey from the American Nurses Association found that 1 in 2 nurses reported being verbally abused, and 1 in 5 reported being physically assaulted.

Given that hospitalists are at extremely high risk of being a victim of such acts, what can we do to keep ourselves and our care team members safe?

One useful resource is from the Occupational Safety and Health Administration (OSHA), which publishes guidelines on why and how to establish a workplace prevention program for healthcare. Given the frequency of the problem, OSHA and some states are actually pursuing laws to mandate the implementation of these safety programs.

All healthcare systems should at least start with a “zero tolerance” commitment to workplace violence and a basic awareness program; this should encourage timely and accurate reporting of all events and basic training in early identification and de-escalation of problematic behaviors. These basic steps should be easy to implement for most any healthcare system, and often can be completed online by care team members. Depending on the severity and frequency of events, more advanced training, including simulations and drills, may be required by some high-risk disciplines / areas. I certainly would have been grateful for such basic training earlier in my career to avoid the potentially dangerous situation I (unknowingly) put myself in. No one should learn the importance of this from first-hand experience.

To avoid regrettable and preventable violent acts, all of us should know our local policies, procedures, and trainings available for prevention of workplace violence, and we should be willing to get involved in developing future programs to further our teams’ and our personal risks.

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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