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Nurses should not be afraid to go to work
Leaders have a role in thwarting workplace violence
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An outpatient being assessed for mental health issues becomes verbally abusive and combative. Before the staff can initiate the appropriate safety measures, he kicks one of the nurses in the abdomen.

A bereaved husband whose wife expired in the ED returns to the ED the next day with a gun and shoots and injures a doctor and two nurses before he can be subdued.
An upset mother visiting her child asks that he be medicated for pain. Before the nurse has a chance to assess the child, the mother’s request escalates to a demand, a threat and then an altercation in which she pushes the nurse into a wall, causing injury. These fictional scenarios are within the realm of possibility in healthcare. Nurses go to work each day to provide excellent patient care, achieve quality outcomes and make a positive difference. They don’t expect to be victims of violence from patients, family members or visitors — and certainly not from their co-workers. But they sometimes are.
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Violence perpetrated by patients, their family members or visitors often escalates from stressful events that can quickly spiral out of control. Nurses are familiar with situations like these, and current research tells us they’re increasing. TV and print media report stories of gun violence and domestic disputes finding their way into workplaces, and troubled patients making hospitals more dangerous.

According to an article published last year in
The Atlantic
, “hospital patients are attacking staff at an alarming rate, and there are no federal regulations requiring employers to provide any protection.” Lateral violence also is an issue — we’ve heard the term, we know it exists. As wonderful and positive as nursing collegiality and camaraderie are, we know nurses frequently report being victims of this type of employee-on-employee violence. Bullying, one form of lateral violence, is defined by the ANA as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient.” Incivility is defined as “rude, discourteous, disrespectful actions that may or may not have negative intent behind them.”
By Eileen Williamson
Violence can manifest from any direction
What leaders can do
Studies show violence is more likely to fester in unhealthy, negative work environments, so it’s up to leaders to make environments as healthy and positive as possible. They need to know what initiatives to put in place; what their obligations and rights are in doing so; and the legal ramifications of taking action in response to violence. Administrators and human resources professionals need to understand that as staff comes to work each day, there’s a chance they’ll be victims of some type of violence. The thought of working in a caring, giving profession, of ministering to others, yet facing violence on the job is difficult to comprehend. When it occurs, we find it upsetting at the very least and horrific at worst. We’ve heard the stories, read the statistics and know altercations and violent events must be dealt with swiftly and appropriately. Facilities from coast to coast are working on initiatives to create more positive work environments to ameliorate violent or potentially violent situations. It must be clear that patients and visitors will abide by certain rules. There must be codes of conduct for employees that include zero tolerance for disruptive behaviors such as harassment, verbal abuse, intimidation, bullying or incivility. Staff must be educated and never be afraid of reporting patient, visitor or family violence, or any type of lateral incivility, bullying or harassment.
Professional organizations are there for us
The ANA is a strong advocate in protecting nurses from workplace violence through advocacy and policies, and they want RNs and employers to join with them in building healthy, safe, positive workplaces. Other professional and regulatory organizations also are calling on employers to recognize that policies and standards on safer workplaces are needed to ensure that bullying or incivility and certainly any overtly violent acts can’t be tolerated.
The thought of working in a caring, giving profession, of ministering to others, yet facing violence on the job is difficult to comprehend. When it occurs, we find it upsetting at the very least and horrific at worst.”
— Eileen Wiliamson, RN

10 quick tips leaders can use
Be aware of the risks for violence nurses face each day.
Attend facility training programs on workplace violence.

Update yourself on new rules and regulations on violence.

Keep abreast of current legislation on workplace violence.

Inform management of unit safety problems you identify.

Know the patient behaviors that can escalate to violence.

Let your voice be heard when it comes to lateral violence.

Report any concerns you have about a troubled coworker.

Advocate for the anti-violence measures your unit needs.

Remember that it’s your workplace and yours to keep safe.
Eileen Williamson, MSN, RN, is the former senior vice president and chief nurse executive at OnCourse Learning. Williamson continues to write for by OnCourse Learning and serves in a consultant role.