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“Not Part of the Job”

Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

doi: 10.1097/01.NUMA.0000538919.45536.67
Department: Editorial

Editor-in-Chief, Vice President and CNO, NewYork-Presbyterian/Weill Cornell, New York, N.Y.

Violence can't be accepted as “part of the job.” We're obligated as leaders to do better than that.

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That's the brilliant title of the American Nurses Association's (ANA) 2015 book by Dr. Jane Lipscomb, about the growth of workplace violence and our reluctance for many years to address, or even acknowledge, its existence. It's about time we admit that our staff in all care settings, including the home, are at risk for injury, whether physical or verbal, and it isn't okay. The risk may be “part of the job”; however, it's our role as leaders to know the risks, minimize them, and provide staff members with the support they deserve.

The Joint Commission just released its Sentinel Event Alert #59, and no surprise, it's entitled “Physical and Verbal Violence Against Healthcare Workers.” What do they suggest as actions? Enable reporting, trend data, provide support to victims, review each case, develop improvement initiatives, train staff on de-escalation techniques, and, of course, evaluate. Are you and your organizations heeding any of this advice?

There are resources available to us. The American Organization of Nurse Executives maintains a Workplace Violence Toolkit on its website (www.aone.org/resources/final_toolkit.pdf). The ANA has adopted a zero-tolerance policy, with an appropriate hashtag #endnurseabuse, and published a 23-page position statement. Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, the president of the ANA, is quoted in a press release as saying “...‘time's up’ for employers who don't take swift and meaningful action...”

Workplace violence takes many forms. There's the terrifying active shooter, which is everyone's nightmare. Those of you who've experienced it have the nation's condolences, as well as our admiration for your courage and resilience. This is, of course, the most catastrophic and least frequent type of violence, requiring emergency preparedness protocols and drills. More frequently, we have the behaviorally disruptive patient who throws trays, urinals (possibly full), and any other free object. Or who grasps you in a chokehold, pulls your hair, bites, kicks, punches, or even stabs you. One of my ED nurses' mother, also an ED nurse, is still recovering from being viciously stabbed in her hospital's parking lot last year. This aggression shouldn't be acceptable in our work environments as part of the job.

Then there's emotional harm from verbal abuse, racial epithets, threatening remarks, and a whole host of other aggressive taunts. This isn't to be tolerated either. And remember that physical harm has a psychological component for our staff and all other witnesses, including other patients.

The patient and family may not always be right—there are boundaries grounded in basic respect. Zero tolerance doesn't mean zero care, or zero justice; after all, we're a reasonable and caring profession. Published standards for patient/visitor behavior, limit setting, patient or family behavioral contracts, and other interventions are important.

The data are elusive. Workplace violence is so underreported that we have no idea of its actual prevalence. We do know that it's either on the rise or finally being reported, most probably both. The American Hospital Association has been actively addressing this problem with its Hospitals Against Violence initiative (www.aha.org/hav), establishing June 8th as a national day of awareness to end violence (#HAVhope).

We'll need more than hope to address this issue. We need all of our organizational colleagues in administration, security, human resources, psychiatry, facilities, data analytics, education, environment of care, and more—plus external agencies, professional organizations, and local law enforcement. The first step is acknowledgment. Violence can't be accepted as “part of the job.” We're obligated as leaders to do better than that, acting and advocating for our staff and ourselves.

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