AJN, American Journal of Nursing:
Jessica Leigh Taylor is a staff ED nurse at St. David's South Austin Hospital, and a doctoral student in the School of Nursing at the University of Texas at Austin
Contact author: firstname.lastname@example.org.
It's not a part of your job description.
I was working in the ED one day when a patient looked up and threatened to kill me. Grabbing my hand, he squeezed it until I thought it would break. It took several staff members to restrain him and force him to let go. I'll never forget how he looked into my eyes and smiled as I screamed in pain.
Some of my colleagues said I should file a police report; others told me to get used to this type of behavior and toughen up. I called the police, and although they took my statement, they wouldn't arrest the patient because he hadn't inflicted "serious bodily injury."
Many nurses assume that violence is a part of the job. This isn't surprising—whereas some areas of clinical practice (the ED or psychiatric units, for example) may be more vulnerable to violence than others, no specialty or setting is immune to the threat of workplace violence. Most of us have witnessed it or been a victim of it. It may range from offensive behavior, including verbal, emotional, and physical abuse, to murder.
No matter the type, violence shouldn't be tolerated. Nursing organizations have produced position statements against workplace violence, and sporadic research has been published. Legislation calling for enhanced penalties for assaulting nurses has been enacted in several states, and others have mandated that employers create workplace violence prevention programs. Yet we've made little progress in eliminating it. Where is the national effort to enhance nurses' legal and institutional protections—protections afforded to police officers and public servants in most states?
According to the International Council of Nurses (www.icn.ch/matters_violence.htm), health care providers are at a greater risk of being attacked on the job than police officers and prison guards; nurses, particularly female RNs, are the most vulnerable. Yet we have little protection from this frequently occurring violence, and even less expectation that it shouldn't occur. We need to stop making excuses for and justifying violent behavior. It shouldn't matter if the perpetrator is intoxicated, angry, grieving, in pain, or mentally ill.
Every state must pass legislation that makes assaulting a health care provider as serious a crime as assaulting a police officer or public servant. The workplace would also be safer if the Occupational Safety and Health Administration guidelines for workplace violence were enforceable. Although employers can be cited for failing to prevent or stop violence, this has only occurred in the rare cases of serious negligence. Every national nursing organization should make combating workplace violence a top priority and devote significant time and energy to addressing it.
Examine what can be done at your facility to enact zero-tolerance policies. For example, join or form a committee and work with colleagues and the administration to find the best way to address the occurrence of violence in each department. Encourage victims to report abuse to both the institution and the police, and be supportive by ensuring that they receive medical attention and know that any type of violence is unacceptable. Speak up whenever possible to highlight the prevalence and consequences of workplace violence.
Since being attacked two years ago, I've worked within my institution and the Texas legislature to advocate greater protections for nurses. I also help to educate fellow RNs on basic safety strategies to reduce the chances of an attack; for example, by not undressing a psychiatric patient alone and knowing where the exits are located.
I'm not a victim anymore. I've declared that it's not acceptable to abuse or harm me at work, and every nurse should make the same pledge.
© 2010 Lippincott Williams & Wilkins. All rights reserved.