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As RNs, we are, or should be, constantly aware of our environment with the ongoing possibility of violence. Unfortunately, in our society…and with no surprise, it isn’t just our patients we need to be vigilant with.  Today’s RN, must be cautious with patients, family members, vagrants, and even co-workers.

Personally, when I was an ICU nurse: I found most patients were not only the least likely to become violent, but appreciative of the care and assistance we provided for them. Usually, it was dealing with the family members of our critical patients that became opportunities for “heated discussions and potential violence.” Often there was unresolved family dynamics, which turned into hostile behavior during the most delicate and critical of times…when we needed to decide on serious medical care decisions, which would have long term effects.

Of course, that was nine years ago and times have changed, unfortunately not necessarily for the better. Per National Nurses United:

Violence against nurses and other healthcare workers in hospitals and other healthcare facilities is a problem reaching epidemic proportions across the United States. Nurses report being threatened, punched, kicked, bitten, beaten, choked, and assaulted on the job – and some have faced stabbings and shootings. The Health Care Workplace Violence Prevention Act would mandate that OSHA promulgate a standard requiring all employers to prevent workplace violence in hospitals and other healthcare facilities.

In 2016, the nonfatal injury rate due to violence for registered nurses (RNs) was over 3 times higher than for all industry.

  • Healthcare workers in inpatient facilities are 5 to 12 times more likely to experience nonfatal workplace violence than the average for workers overall.2Per the American Nurses Association: “Examples of workplace violence include direct physical assaults (with or without weapons), written or verbal threats, physical or verbal harassment, and homicide (Occupational Safety and Health Administration OSHA, 2015).
  • NIOSH classifies workplace violence into four basic types. Types II and III are the most common in the health care industry. (Types I and IV are not addressed in this position statement.)
  • Workplace violence is under reported by hospital employees. In a 2015 study, 88 percent of respondents had not documented in their employer’s electronic system an incident of violence they had experienced in the previous year.””
  • Type I: Involves “criminal intent.” In this type of workplace violence, “individuals with criminal intent have no relationship to the business or its employees.”
  • Type II: Involves a customer, client, or patient. In this type, an “individual has a relationship with the business and becomes violent while receiving services.”
  • Type III: Violence involves a “worker-on-worker” relationship and includes “employees who attack or threaten another employee.”
  • Type IV: Violence involves personal relationships. It includes “individuals who have interpersonal relationships with the intended target but no relationship to the business” (Iowa Prevention Research Center, 2001; NIOSH, 2006, 2013).

Keeping this in mind, we need to be aware of our surroundings at all times, and have measures we can implement to help prevent personal tragedy as we care for our patients. The Crisis Prevention Institute provides the following Top De-Escalation Tips:

  • Be Empathetic and NON-Judgmental
  • Respect Personal Space
  • Use Non-Threatening “Non-Verbals”…watch that body language
  • Avoid over-reacting…how you respond can either escalate or diffuse situations
  • Ignore challenging questions…redirect to the situational topic at hand
  • Set Limits…speak simply, be clear, offer precise choices and consequences
  • Choose wisely what you insist upon
  • Allow silence for reflection and time for decisions.

Here is a URL, which can provide additional information for our nurses, to assist identifying and averting violence:

https://www.cdc.gov/niosh/topics/violence/training_nurses.html Jul 9, 2018 This free, interactive course is designed to help healthcare workers better understand the scope and nature of violence in the workplace.

What other measures have you, as a nurse been able to successfully employ to identify and offset violence at work?

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