The National Institute for Occupational Safety and Health defines workplace violence as violent acts which are comprised of physical assaults or threat of attack which are directed towards healthcare workers who are on duty. Research indicates that employees who are affiliated with nursing homes, hospitals and other healthcare settings are highly susceptible to instances of workplace violence (Kowalenko et al., 2012). These assaults take different forms and emanate from various sources such as gang violence in emergency departments; physical or verbal attacks by patients; instances of domestic violence which spills over into the workplace; bullying from co-workers or a distressed family member who may become abusive and in extreme cases may even turn into an active shooter. Equally important is the fact that the healthcare industry faces extraordinary challenges insofar as workplace violence is concerned in the sense that clinicians often work directly with individuals who may be delirious, under the influence of drugs or have a history with violence (Speroni et al., 2014). Moreover, there exists the widespread misconception that workplace violence is tolerated as part of the job description which only serves to compound on the prevalence of the problem.
According to the Bureau of Labor Statistics, between the year 2011 to 2013, healthcare workers suffered 15,000 to 20,000 workplace related grievances each year with some injuries being severe to the extent requiring time away from work. Moreover, healthcare and social assistance workers experienced 7.8 cases of serious workplace violence injuries per 100,000 full-time equivalents (FTEs) (Phillips, 2016). Equally important is the fact that the Seven Hills Behavioural Health Hospital has experiences changes in the landscape which creates new challenges regarding workplace violence. Initially, the health facility had more patients than it currently does and the staff had stricken a rapport with their patients since majority had been committed for life. Currently, Seven Hills experiences changing dynamics where patients experience more severe threats and pose greater danger than in the past especially with a surge in involuntary commitments and referrals from emergency departments while patients stay for shorter durations as residents. Additionally, the medical community has been quite vocal concerning the use of restraints and seclusion as treatment techniques concerns raised by the staff prompted the need for developing a response strategy to workplace violence with much emphasis created on preventive measures. Some of the professionals to be involved in the implementation of the action program include partnering with a private security firm whose mandate would provide insights on potential loopholes in security breaches (Pompeii et al., 2013). A training officer from the Occupational Safety and Health Administration (OSHA) will be in-charge of training the staff on adopting preventive strategies regarding workplace violence. Lastly, the facilitys administration will have the responsibility of teaching a culture of a violence-free work environment.
One of the primary objectives of the intervention that is to be adopted is identifying the workplace challenges such as lack of available security services and low staffing levels which can have a negative impact on hospital safety. Moreover, the security agency would be tasked with the duty of installing panic buttons, CCTV and other alarm systems including modification of the lighting conditions in and around the health facility with the aim of deterring workplace violence. Officers from OSHA will assist in developing policies that will act as road maps in making sound decisions in regards to workplace safety in healthcare settings. This objective may be realized through a strong commitment from the hospital management where administrators assert their position that violent and aggressive behavior is unacceptable and will ultimately result in dire consequences. Moreover, there is the need to objectively analyze the communities that surround frequent the health facility with the aim of comprehending their role in workplace violence such as recognizing covert gang members and reporting them to the appropriate authorities.
Nursing managers began with a series of focus groups to solicit directly for input from staff who work both during the day and night shifts. To encourage employees to speak freely, the training meetings with the OSHA officer were conducted without the presence of supervisors, and the employees were separated by their various disciplines (mental health workers, physicians, and nurses). This strategy helped the managers comprehend that majority of the health workers perceives violence as part of their job description. Moreover, the health facility intends to address the workplace issue over one year with the main agenda being management settings; creating a comprehensive Staying Safe Program; encouraging collaboration and dialogue between the campus police and clinical staff; implementing daily safety briefings and formulating a steadfast training program (Littlejohn, 2012). In the long-term, the Seven Hills intends to develop a model program that may be utilized by other health facilities that want to implement violence prevention efforts through disseminating information through mainstream media, sharing information and strategies with other facilities and conducting conferences on a regular basis. Moreover, the institution intends to adopt an electronic incident reporting program including the implementation including offering training on how to prevent the aggressive behavior from escalating into violent reaction (Morken, Johansen & Alsaker, 2015). In addition to putting security apparatus such as proper lighting, cameras, and panic buttons, the institution will from a trained Response Team that will be available at all times to assist nurses in situations involving violence.
The health institution intends to implement the Action Plan within one year where the first month will involve installation of CCTV, panic buttons and launching and incident report department which would work closely with the selected security agency. The second month will be concerned with recruitment and placement of additional security personnel especially in sensitive areas of the institution such as emergency departments (Lanctot & Guay, 2014). The next six months will comprise of training sessions in conjunction with officers from OSHA with the primary objective being the implementation the principles of the Stay Safe Program (Lipscomb & El Ghaziri, 2013). The final four months would be concerned with follow-ups and evaluation of the overall workplace violence prevention program including the incorporation of this information in the employee handbook. The stakeholders who are directly involved in the processes of the Action Plan will be contacted through email at the scheduled timelines as described above.
The expected budget for the program will be 300,000 dollars where $100,000 was spent on hiring OSHA trainers during the entire training session. Another $100,000 would be used in upgrading security features such as recruiting security personnel; installing cameras and other security gadgets and hiring consultants to implement the incident report program. The other $100,000 will be used to expand the prospects of the intervention such as publishing information concerning the follow-ups on the project.
Kowalenko, T., Cunningham, R., Sachs, C. J., Gore, R., Barata, I. A., Gates, D., ... & McClain, A. (2012). Workplace violence in emergency medicine: current knowledge and future directions. The Journal of emergency medicine, 43(3), 523-531.
Lanctot, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and violent behavior, 19(5), 492-501.
Littlejohn, P. (2012). The missing link: using emotional intelligence to reduce workplace stress and workplace violence in our nursing and other health care professions. Journal of Professional Nursing, 28(6), 360-368.
Lipscomb, J. A., & El Ghaziri, M. (2013). Workplace violence prevention: improving front-line health-care worker and patient safety. New solutions: a journal of environmental and occupational health policy, 23(2), 297-313.
Morken, T., Johansen, I. H., & Alsaker, K. (2015). Dealing with workplace violence in emergency primary health care: a focus group study. BMC family practice, 16(1), 51.
Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), 1661-1669.
Pompeii, L., Dement, J., Schoenfisch, A., Lavery, A., Souder, M., Smith, C., & Lipscomb, H. (2013). Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: a review of the literature and existing occupational injury data. Journal of Safety Research, 44, 57-64.
Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of emergency nursing, 40(3), 218-228.Appendix A and B
Interview transcript with a Nursing Practitioner
Interviewer: DNP Graduate
Interviewee: Alice Echeta (Doctorate in Psychiatric Mental Health Nurse Practitioner)
Interviewer: Hello. Thank you for creating time for this interviewing session with the impeding implementation of a workplace violence prevention program. In your opinion, what are some of the consequences of workplace violence to nurses?
Interviewee: Negative outcomes that may be associated with workplace violence include low morale, decreased productivity, increased job stress, and development of a negative perception of the work environment.
Interviewer: What are some of the risk factors that are associated with workplace violence that is perpetrated by patients?
Interviewee: According to the OSHA, client-on-worker violence may be categorized as being environmental, organizational, and clinical. From a clinical perspective, a client is likely to act out violently if they have a history of violence or being under the influences of drugs. The environmental aspect may be as a result of design, layout, and contents of the workplace environment and its vulnerability to violence. The organizational risk factors refer to the policies and the prevailing culture of the healthcare facility regarding security and safety of workers.
Interviewer: What are the indicators of workplace violence from co-workers?
Interviewee: The Joint Commission on Accreditation of Healthcare Organisations has reiterated that disruptive and intimidating behaviors may adversely jeopardize the safety and quality of care delivery. These practices may be epitomised by physical threats, verbals outbursts as well as passive activities such as expressing uncooperative attitudes in executing daily routines.
Interviewer: Finally, what is the role of nurses in developing prevention strategies for workplace violence?
Interviewee: The fundamental role of nurses is proactive in preventing workplace violence where they form multidisciplinary teams that brainstorm and inculcate a culture of safety. This may be achieved through maintaining awareness of the verbal and non-verbal cues exhibited by patients and their families to prevent the aggressive behavior from escalating into violence.
Name: Dr. Felix Aguilar, MD, MPH, MHCM
Current Occupation: Associate Vice President/Medical Director at Blue Shield of California-Care 1st and part-time at Garrison...
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