Workplace Violence

[Nicole Hopper]

Hello,
I just became a certified CNL and I’m still working in a staff nurse position but am actively working with my manager to step into a more CNL-like role. An issue on my unit currently is workplace violence. I work on a neuroscience/ trauma unit so we often work with TBI patients, those with psychiatric disorders, or those who are violent. We have many incidences of staff getting verbally or physically assaulted and though we are getting better about reporting these events, we often don’t because staff feels that the patient wasn’t in their right mind. As a CNL, I am wondering how to go about addressing this problem beyond improving reporting of the events. Our team has a good relationship with our security department and we do end up using physical and chemical restraints on these patients but those are often just as traumatizing for nurses because they continue to agitate patient and cause increased verbal abuse. It feels like a problem with no good solution but I want to help my staff moral and keep patients safe and happy at the same time. If anyone has suggestions I’d appreciate it!
Thank you, Nicole

[conni...@gmail.com]

I would start with asking the chief of your device to collaborate at their level with chief of staff and hold a small forum for your concerns of mental and physical injuries to be addressed just as they have done across the nation with Covid. You still need to write incident reports which go to QM and are tracked. That will serve 2purposes; you reporters it and it is tracked; secondly, if you ever suffer a permanent or short term disability at work; there will be previous documentation on record.
I have seen so many times, nurses that don’t report and who end up without a job from unreported incidents. It is to protect you and the organization. Keep records.

[Kate Schultz]

I work on a similar unit and I know this population can be quite difficult. 

My question with the reporting is has anything happened with it? What did the data show? Staff will probably not be too excited to spend time reporting if they perceive it is not worth it. 

We had issues with reporting at times but then we proved we needed more security guards or more frequent rounding, etc. 

Does your organization use CPI or another time of workplace violence education? 

If you have received this message in error, please notify Middlesex Health by sending a reply email to the sender or calling the Middlesex Health Privacy Office Hotline at 860-358-4630 and then delete this email and all attachments.

The information contained in this email and any attached files from Middlesex Health are confidential under federal and state law and are intended only for the person to whom they are addressed.  If you are not the intended recipient, you are hereby notified that any inappropriate use or reproduction of the information is strictly prohibited and may subject you to civil or criminal penalties.  

[ccj...@hotmail.com]

Nicole,

 Is there a neuropsychiatrist on staff or medical director that you and your team could partner with to create a practice bundle that would include the assessment and treatment of escalating agitation of these patients? Perhaps using the RASS score as a guide and orders for antipsychotic meds to start early, before having to restrain. I would also look and see if the AANN has any resources for managing brain injury that you could tap into and or other centers (rehabs, etc) that have had success with this issue. If you have a unit council, see if they want to use this as a project for process improvement for staff and patient safety. Good luck with this!

Regards,

Jane

[Nicole Hopper]

Hi everyone, thank you for your responses! I could try and ask for data about my units work place violence demographics but it feels incomplete because of the lack of reporting. I could do a survey monkey for all staff to complete as to if they have encountered physical or verbal violence. I would like more staff to go to CPI training because it is offered but it’s not a requirement. I wish our security would be better about de-escalation because I feel like they often instigate the problem. Our organization has a psychiatrist, but not a neuropsychiatrist, working with inpatients. Trying to make a nursing-driven protocol would be helpful, but I feel like there is still a divide between MDs and RNs so it would be difficult getting medication orders for them.

[Kimberly K]

Hi there,

I used to work as a surgical device representative and called on the ICU and neurosurgeons, neurologists, etc 24/7. The reps have TONS of educational material about TBIs etc but more importantly, in regards to your issue, you should contact your device rep and schedule an in-service. I used to host in-services for the ICU nurses all the time (upon RN mgr's requests..) and if you cant dig up anything on the topic im sure the rep will have information. He/she can be a great avenue and if anything, it'll help with increasing fluidity of the discussion among many multi-disciplinary HCPs. I used to work for Integra Neurosciences and would be happy to contact the rep for you in your area, if needed. :)

- Kim