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Workplace Violence Outside the Hospital Setting

Schmidt, Joanne MS, RN, FNP-BC, NP-C

Author Information
AJN, American Journal of Nursing: February 2020 - Volume 120 - Issue 2 - p 11
doi: 10.1097/01.NAJ.0000654240.51610.b1
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Abstract

Figure
Figure:
Joanne Schmidt

My shift as a home visiting nurse began at 7:30 AM. I got out of my car, grabbed my equipment, and headed for the door of the building where I was to make my first visit. When I stepped into the entryway, I was met by a group of men, crouched on the floor over a game of craps and shouting excitedly. One of them stood up when he saw me come through the door. I noticed that he was clutching a fistful of cash in one hand and dice in the other. He dropped the dice, pulled a gun from his waist, and pointed it at my face. I froze, and all I could hear was a high-pitched ringing sound ...

Throughout my nursing education and career, no one warned me about this type of situation. Why should they? I am a nurse, not a cop. But in my 17 years of nursing, I have experienced many scary situations outside of a hospital setting. I am not alone. There are many nurses practicing in nonhospital settings, vulnerable to risks that are often overlooked or underestimated. Workplace violence risks aren't the same across environments, and conversations about protecting nurses should be more inclusive.

With the gun pointed at me, I was overcome by fear and numbness. Tears welled in my eyes. I felt helpless, isolated from coworkers or peers . . .

Minimal literature has been published on workplace violence prevention for nurses working in areas such as home care, schools, correctional facilities, medical mobile vans, or forensics. Most workplace violence prevention efforts in health care are based on hospital settings. But there are many stories that do not fit this model. I worked with a nurse who had been savagely mauled by a dog during a home visit. She survived the incident by placing her head and neck between an infant scale and a wall. Another nurse described locking herself and several students in a school clinic during an active shooter incident. More recently, I've had conversations with nurses about their experiences working in medical mobile vans without security guards or call buttons and with limited physical barriers, including no locking doors.

“Please God, help me, please,” I pleaded in my head. “I'll never see my son again.” My last memories would be of this group of men shooting dice and shouting profanities . . .

Violence toward nurses has often been misrepresented or accepted by administrators and even other nurses as “just a part of the job.” Such incidents are not part of our job description. Our job is caring for and protecting others. But who cares for the caregiver? Who is responsible for protecting us? Careful consideration must be taken in protecting nurses, including recognition that a “workplace” does not equal four walls or a secure building.

The Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1309) is a bill that requires employers to create comprehensive workplace violence prevention programs that are specific to one's work environment, including fieldwork. The bill recently passed in the House, and now must pass in the Senate. Employers must be accountable for assessing risks, implementing safety strategies, and tailoring interventions to the environment in which one works. One module once a year as a workplace violence competency checkbox is not going to cut it.

After what seemed like a lifetime passed with the man glaring at me, he lowered his gun and his gaze.

“My bad, nurse,” he said casually, and went back to rolling dice.

I believe I received mercy that day because I was wearing a jacket with the word “nurse” embroidered on the front along with my stethoscope around my neck. But countless others are harmed in spite of, or because of, being a nurse. It is time we change this, and without leaving anyone behind.

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