With Covid-19 cases now on a slow, but steady decline, hospitals and health care systems are continuing efforts to rebuild the health care workforce, in particular, stemming the alarming exodus of RNs. Ensuring safe staffing, avoiding bed closures, and maintaining full capacity is at risk across the country, and organizations are implementing myriad efforts to combat root cause of increased turnover, including factors permanently driving RNs from inpatient employment altogether.
An unanticipated challenge facing hospital leaders as they try to confront the shortage is an increase in verbal and physical violence directed at health care workers by patients, families, and community members, largely triggered by the political discourse surrounding Covid-19. As provider organizations continue to take local stands on mandatory employee vaccinations to ensure safety, organizations must take an even stronger stand on employee safety as well. Health care employees deserve nothing less. Employees are in the middle of a crossfire, not of their making. If left unaddressed, unacceptable acts of harassment will further compound the already untenable exodus of clinicians from inpatient employment.
Many organizations have been working for years to effectively respond to point-of-care threats—for example, by educating clinicians on de-escalation techniques, increasing security personnel, or equipping staff with panic buttons. While these efforts remain important, they are insufficient to protect staff from the abuse levelled at them today, for three reasons.
In addition to doubling down on security protocols, executive teams need to publicly take a stand on the violence impacting their staff and the misinformation fueling that violence. Doing so may feel counter to the personal beliefs of some leaders. But allowing for differences of personal leader opinion does not have to mean tolerating physical and verbal abuse of employees who remain committed to the system's mission of providing high quality care to all, regardless of ideology. It is the job of executives to make that clear to our communities.
While not a comprehensive solution, leaders should do what they can to bolster security within the walls of the system, in all sites of care. This includes recommitting to a zero-tolerance policy of abusive behavior from patients, families, and employees, and publicly communicating that commitment. This review must include point-of-care violence detection and mitigation strategies for all sites of care; in particular, ambulatory clinics, urgent care centers, and care sites located in outlying areas. Use our workplace violence resource library as a starting point.
If you haven't already, update the system's Consumer Code of Conduct with specific language around verbal abuse, assault, and other unacceptable behaviors—and be transparent about the consequences if those standards are not met. Arm your frontline leaders with talking points about the steps staff should take to report violence, and consistently reinforce those messages in key forums.
Executives and health system board members aren't just leaders of their organizations—they're community leaders. Work with local and regional media outlets to highlight the gravity of the situation and the steps your system is prepared to take. Deploy internal marketing expertise to implement an external communication strategy, including executives and Board members as community spokespeople to local organizations with influence in the community.
Covid-19-related conversations concerning treatment alternatives and patient preferences may be especially challenging and emotionally charged—they can rapidly escalate if not handled effectively. Frontline staff need to be coached on how to engage in these difficult conversations while being equipped with options for immediate assistance if escalation occurs.
In 2020, health care workers were applauded as heroes. In 2021, these same workers are now being attacked in record numbers by the very consumers that they are committed to caring for. As organizations work to stabilize the clinical workforce, mitigating the harassment of health care workers is a non-negotiable action—a moral leadership imperative. While arming staff with panic buttons and increasing the number of security guards near care settings is helpful, this moment in time calls for an all-hands-on-deck approach from executive teams and boards. It is time to publicly advocate for the safety of health care employees.
Lauren Rewers and Andrew Mohama contributed to this article
Workplace violence is common in health care settings around the world. In many regions, incidents of violence are on the rise. Yet despite the increase in point‑of‑care violence, many health care leaders are unsure of the best way to address this complex issue. While disruptive behaviour and violence cannot be prevented outright, these four steps detail how to make frontline staff feel safe—and actually stay safe—at work.
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