Q Recently, there have been several high-profile incidents in which nurses were severely injured by patients. I'm concerned about keeping my staff safe at work. What should I be doing differently?
Sadly, violence against nurses is on the rise. According to the Advisory Board, 25% of nurses experienced workplace violence in 2016. In addition, there's been a staggering 110% increase in the rate of healthcare workplace violence between 2005 and 2014, with nearly 75% of all workplace assaults happening in healthcare.1 When we're at work, we need to feel safe and supported, and we should know that everything that can possibly be done to prevent violent incidents is being done. Leadership plays a key role in creating a safety environment through advocacy, education, implementation, and mitigation.
Advocacy begins with ensuring that your team, unit, or organization has the resources it needs for a safe environment. Although the recent news has centered on violence against nurses, there are many other workplace safety issues that require our attention, such as patient handling, sharps injury prevention, and adequate rest and breaks for employees. As a leader, you have input into prioritizing your budget around these issues, as well as making sure that those above you in the chain of command understand the unique needs of your staff, patients, and physical environment as they work on your behalf.
In addition to advocating within our organizations, we must engage in advocacy at the state and national level to lobby lawmakers who are in the position to discourage violence against nurses through legislation. Many states have recent laws on the books making violence against nurses a felony. However, many of these laws fall short because they tend to focus on higher risk areas, such as the ED or prehospital setting. These are important steps in the legislative process, but more must be done to safeguard all healthcare workers in all practice settings.
Education, like advocacy, must occur at various levels—both inside and outside of your organization. Staff members must be knowledgeable about your safety program policies and procedures, and should practice their responses to these situations throughout the year. It's also critically important to help staff learn and understand the notion that safety is everyone's responsibility. In addition to daily rounds, invite senior leaders to visit your work area to participate in safety rounds and use these experiences as a platform for educating decision makers about the unique safety challenges in your work environment.
Once decisions are made, resources allocated, and policies and procedures established, it's your responsibility as the leader to ensure that all of these pieces are fully implemented. The best safety plans include shared accountability for each caregiver and confirmation that team members not based on the work unit, such as physicians and support staff, have the information they need to foster a culture of safety. Implementing preventive measures isn't always easy—there are so many other competing priorities in the healthcare setting. However, proactively preventing safety issues is always much better than reacting to a situation once it's occurred.
Finally, mitigation is a critical piece of any solid safety and violence prevention strategy. The mantra “if you see something, say something” should be part of your everyday assessment during routine rounds on your unit or with your team. Safety should always be a topic of discussion when talking with staff. I always ask the question, “What do you think is the next big safety issue that will happen here and what can we do to prevent it from happening?” This open-ended question provides important information on what's top of mind for caregivers in terms of staff, patient, and organizational safety issues, and what should be done to mitigate these concerns. One of the most important things you must do when asking questions like this is to follow up on staff concerns and close the loop to let people know they've been heard. This is also a great opportunity for you to engage staff in problem solving.
Safety and violence prevention are truly everyone's focus; however, as the nurse leader, you're uniquely positioned to create a culture of safety that encompasses all aspects of your clinical operation.
1. The Advisory Board Company. The alarming stats on violence against nurses. https://www.advisory.com/daily-briefing/2016/12/07/violence-against-nurses