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Understanding the Issue of Workplace Violence. Workplace Violence Defined 1-6 Behaviors in the work setting that cause physical or emotional harm – Physical.

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Presentation on theme: "Understanding the Issue of Workplace Violence. Workplace Violence Defined 1-6 Behaviors in the work setting that cause physical or emotional harm – Physical."— Presentation transcript:

1 Understanding the Issue of Workplace Violence

2 Workplace Violence Defined 1-6 Behaviors in the work setting that cause physical or emotional harm – Physical Assault – Emotional or verbal abuse – Threatening, harassing, or coercive behavior

3 Possible Reasons for Increased Risk in the Hospital Environment 5,7-11 Lack of violence prevention programs Low staffing levels Lack of effective staff training in recognizing and coping with potentially dangerous situations Inadequate security in some hospitals The tendency for some to view hospitals as sources of money or drugs The presence of guns and other weapons among hospital patients and visitors

4 Which Nurses are at Increased Risk? 1,12-13 More likely to be experienced by – Male nurses – Nurses under the age of 55 Violence occurs most frequently to in – Emergency departments – Geriatric units – Psychiatric wards – Waiting rooms – Large urban areas

5 Factors That May Increase Emotional Tension 4-5,11,14 Patients in pain Patients and visitors dealing with fear of the unknown, especially related to the patient’s condition Anger directed at the hospital or healthcare system – Cramped physical space – Long waiting times

6 Violence Reporting is Inconsistent 5-7,9,14-18 The employee doesn’t know HOW to report an incident Some employees have the perception that it is part of the job Some employees don’t believe that reporting will benefit them or correct the situation Employee concerns that assaults by patients or visitors may be viewed as poor performance or negligence caused by the employee

7 Analyzing the Issue and Recommending Solutions 7,19-20 Emergency Nurses Association Occupational Safety and Health Administration (OSHA) The Joint Commission

8 ENA 2007 Violence Study 21 Conducted to investigate emergency nurses’ experiences and perceptions of workplace violence Collect information on the types and frequencies of assaults Understand contributing factors to workplace violence

9 ENA 2007 Violence Study: Key Findings 21 More than half of emergency nurses report experiencing physical violence on the job, including as being “spit on,” “hit,” “pushed or shoved,” “scratched,” and “kicked.” One in four has experienced such violence more than 20 times in the past three years. Just as alarming, one in five nurses have experienced verbal abuse more than 200 times during the same period.

10 Emergency Department Violence Surveillance (EDVS) Study 13 Purpose of EDVS study is to examine: Types of workplace violence Extent of under-reporting Reporting mechanisms Facility’s response to violence Trends in violence over time

11 EDVS Study: Key Findings % of emergency nurses believed that the level of workplace violence in their emergency department had remained the same or increased over the past year. 38.5% of workplace violence incidents occurred while the nurse was triaging a patient. 76.9% of workplace violence incidents occurred in a patient’s room. 26.6% of emergency nurses had considered leaving their department for another unit or leaving the hospital altogether due to the level of violence

12 ENA Position Statement 19 Acknowledges responsibility to provide safe environment – Environmental controls – Relationship with law enforcement Highlights the importance of a violence prevention program Advocates for legislation and research Stresses importance of supporting employee victims through the reporting and recovery process

13 Three-Step Initiative Prevent (pre-event) Respond (event) Report (post-event)

14 Predictive Phases of Violence CALM PHASE Normal behavior prior to disturbance PRE-ASSAULT PHASE Individual displays threatening verbal and nonverbal behaviors ASSAULT PHASE Individual displays out of control verbal and physical behavior

15 Cascade of Violence Incivility The intent to harm is ambiguous and subject to varying interpretation Non-physical Violence Intentional behavior Examples: harassment, intimidation, name calling, obscene phone calls, stalking, use of profanity, verbal threats Physical Violence Intentional behavior Examples: spitting on person, pushing, grabbing, beating, stabbing, shooting, homicide

16 Prevent Acknowledge intolerance of all workplace violence and necessity of prevention measures Raise awareness of the culture of acceptance Promote the importance of recognizing escalating situations Intervene early to diffuse the cascade of violence Understand the barriers to an effective prevention program

17 Respond Identify the barriers to swift, effective and safe response to an occurrence Educate the following groups on appropriate response policies, procedures and skills to minimize the likelihood of harm to a patient or staff member – Emergency department staff – Patients/families – Hospital administration

18 Respond Your zero tolerance policy includes responding 100% of the time Administrative support – Fair and consistent procedures – Culture of support, not punishment, for victims of violent occurrences

19 Report Acknowledge that occurrence reports hold valuable information for future improvements Filing a report should never generate a punitive response for the employee Staff culture and attitudes have an impact on whether a report is filed Lack of reporting can impede an initiative to improve the safety of the emergency dept

20 Our Project Plan Slides 20-24: Suggested topics; modify and insert slides specific to your institution/project plan or staff education program

21 Project Team Slides 20-24: Suggested topics; modify and insert slides specific to your institution/project plan or staff education program

22 Goals for Our Emergency Department Slides 20-24: Suggested topics; modify and insert slides specific to your institution/project plan or staff education program

23 Staff Involvement Slides 20-24: Suggested topics; modify and insert slides specific to your institution/project plan or staff education program

24 Resources Slides 20-24: Suggested topics; modify and insert slides specific to your institution/project plan or staff education program

25 References 1.Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. (2002). Violence: occupational hazards in hospitals. Retrieved from 2.Anderson, C. (2002). Workplace violence: are some nurses more vulnerable? Issues in Mental Health Nursing 23(4), DelBel, J.C. (2003). Deescalating workplace aggression. Nursing Management 34(9), US Department of Justice, Federal Bureau of Investigation. (2004). Workplace violence: issues in response. Retrieved from 5.McPhaul, K.M., & Lipscomb, J.A. (2004). Workplace violence in health care: recognized but not regulated. The Online Journal of Issues in Nursing 9. Retrieved from 6.Lipscomb, J., Silverstein, B., Slavin, T., Cocy, E., & Jenkins, L. (2003). Perspectives on legal strategies to prevent workplace violence. The Journal of Law, Medicine, and Ethics 30(3), US Department of Labor, Occupational Safety and Health Administration. (2004). Guidelines for preventing workplace violence for health care & social service workers. Retrieved from 8. Gilmore-Hall, A. (2001). Violence in the workplace: are you prepared? The American Journal of Nursing 101(7), Kowalenko, T., Walters, B.L., Khare, R.K., & Compton, S. (2005). Workplace violence: a survey of emergency physicians in the state of Michigan. Annals of Emergency Medicine 46(2),

26 References 10. Gerberich, S.G., Church, T.R., McGovern, P.M., Hansen, H., Nachreiner, N.M., Geisser, M.S., et al. (2005). Risk factors for work-related assaults on nurses. Epidemiology 16(5), Presley, D., & Robinson, G. (2002). Violence in the emergency department: nurses contend with prevention in the healthcare arena. Nursing Clinics of North America 37(1), US Department of Justice, Bureau of Justice Statistics. (2001). National crime victimization survey: violence in the workplace. Retrieved from 13. Emergency Nurses Association. (2010). Emergency Department Violence Surveillance Study. Des Plaines, IL: Author. Retrieved from 14.May, D.D., & Grubbs, L.M. (2002). The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center. The Journal of Emergency Nursing 28(1), Love, C.C., & Morrison, E. (2003). American Academy of Nursing expert panel on violence policy recommendations on workplace violence. Issues in Mental Health Nursing 24, Sofield, L., & Salmond, S.W. (2003). A focus on verbal abuse and intent to leave the organization. Orthopaedic Nursing 22(4), Bradley, D.B., & Moore, H.L. (2004). Preventing workplace violence from negligent hiring in healthcare. The Journal of Nursing Administration 34(3),

27 References 18.Clements, P.T., DeRanieri, J.T., Clark, K., Manno, M.S., & Kuhn, W.D. (2005). Workplace violence and corporate policy for health care settings. Nursing Economics 23(3), Emergency Nurses Association. (2010). Position Statement: Violence in the emergency care setting. Des Plaines, IL: Author. Retrieved from 20.The Joint Commission. (2010). Sentinel event alert, issue 45: Preventing violence in the health care setting. Retrieved from 21.Gacki-Smith, J., Juarez, A.M., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009). Violence against nurses working in US emergency departments. The Journal of Nursing Administration, 39, Distasio, C. (2002). Protecting yourself from workplace violence. Nursing, 32(6), Gallant-Roman, M.A. (2008). Strategies and tools to reduce workplace violence. The American Association of Occupational Health Nurses Journal, 56(11), Andersson, L.M., & Pearson, C.M. (1999). Tit for tat? The spiraling effect of incivility in the workplace. Academy of Management Review, 24(3), Hutton, S. A. (2006). Workplace incivility: State of the science. The Journal of Nursing Administration, 36(1),


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