Nurses and allied health professionals are at increased risk of workplace violence, and yet there remain challenging barriers to preventing violence in the hospital setting, researchers report.1
“We all know it’s a problem, but the next step is: what are people doing about it, what is effective, and what isn’t effective?” says James Blando, PhD, lead author of the study and an assistant professor at Old Dominion University College of Health Sciences in Norfolk, VA.
Barriers to preventing workplace violence include:
Lack of action following reporting incidents and different perceptions of what constitutes violence: Nurses and other health care professionals will fail to report violent acts when the prevailing attitude is “this is just part of the job.”1 Hospitals that fail to provide adequate communication and follow-up with employees who take time to report violence are reinforcing the idea that it’s not worth the effort to report every incident, Blando notes. Also, nurses will excuse the behavior of patients, particularly when the patient has a mental illness, he adds.
“We found that behavioral psychology nurses in mental health wards tend to interpret everything in terms of the person’s disease,” he explains.
They don’t call security when they should and fail to report aggressive and violent incidents because they don’t see these as violence, he adds.
For example, Blando interviewed a nurse who was stabbed in the back with a fork by a patient with dementia. The nurse didn’t report the incident because she thought the patient didn’t intend to hurt her. Her failure to report it resulted in a lost opportunity, as managers realized months later that giving dementia patients metal forks was a mistake.
“Maybe if it had been reported earlier, an intervention could have been instituted,” Blando says. “Reporting violent acts is crucial, and some hospitals have done it effectively. It’s important to hospitals in terms of decision making, so they can see which areas are at high risk.”
Lack of management accountability and profit-driven management models: Hospitals should have committees addressing workplace violence, with at least half of the panel members comprised of people with patient care responsibilities, Blando suggests. This can be challenging since employees find it difficult to take time away from their patients to attend meetings, he notes.
“But if management isn’t held accountable to do something about this, then you’ll have decisions being made that do not include the best security decisions in a hospital,” he adds.
This customer is wrong
Another barrier is the idea that patients and their families are customers, and the customer is always right.
“Lots of nurses reported to us that if you have a patient acting very aggressively complaints fell on deaf ears because this was a paying customer,” he says. “The customer would be right even if off base. Also, in the U.S., we’ve had lots of reports of visitors being very problematic.”
Dysfunctional families will complain to hospital management, or — worse — assault a nurse, and when the nurse reports this to police, the hospital might ask her to drop the charges so the patient/family member won’t sue the hospital, Blando says.
“The nurse says, ‘I was assaulted and want to press charges,’ and the hospital says, ‘Was there something you could have done differently?’” he adds.
Employees also told the researchers that their hospitals’ focus on profits resulted in staff being cut at a time when more staff and security personnel were needed. This resulted in making the threat of violence even greater.
Weak social service and law enforcement approaches to mentally ill patients: Hospital employees often are at risk of violence from mentally ill patients. In some hospitals, local police bringing inebriated, high, and mentally ill patients to the emergency room, Blando says.
“Some places have great security programs, but if the police department is dumping people into their emergency department then the security program will be stretched,” he explains. “They say, ‘The government is closing state hospitals, and we’re losing beds left and right, so what do we do with chronically mentally ill patients?’”
Also, every hospital should at least boost security in their behavioral health settings because these are at very high risk for violence, Blando says.
“This risk is compounded severely by the weakness of the social health care system,” he explains. “We’ve had hospitals that take on average 48-72 hours to get someone screened, so you could have a behavioral health patient who is suicidal or homicidal, and there are not enough screeners.”
The mentally ill patient would be forced to wait in the emergency department or in a hallway for several days — a worst-case scenario that could escalate the patient’s frustration and lead to violence, he adds.
- Blando J, Ridenour M, Hartley D, et al. Barriers to effective implementation of programs for the prevention of workplace violence in hospitals. OJIN 2015;20(1): http://bit.ly/1Ea03z4