Point-of-Care Violence: A Call to Action from Members

    Members who have attended national meetings have come to expect presentations that include not only a robust set of best practices, but also in the moment dialogue between members sharing mutual challenges and solutions. Over the years, these conversations have complemented our formal research agenda, providing session attendees with valuable, additional learnings to consider.

    During the Nursing Executive Center’s 2017 national meeting series, which focused on millennial turnover, members received a five-part framework for building loyalty among millennial nurses and best practices for implementation. During those sessions, members frequently expressed concerns about the impact of workplace safety on overall retention; in particular, safety issues generated by escalating patient and family violence. And with good reason—the statistics are alarming. According to a recent US Bureau of Labor of Statistics report, more than 25% of all nurses have experienced workplace violence at the point of care.

    Experts note that the primary root cause of increasing point-of-care violence is an uptick in the number of patients with behavioral health or substance abuse disorders. Several factors are contributing to this trend, including an aging population and an increased number of patients struggling with drug addiction. These patients often present with acute clinical challenges while also cognitively impaired or confused. This creates a practice environment that’s prone to escalating patient or family behaviors. Unfortunately, staff are typically not equipped to support these patients’ unique needs, and the end result is frequently verbal or physical violence directed at the nurse.

    Some members participating in the discussion about point-of-care violence at national meetings shared their own organization’s practices to address this challenge. The following are two examples.

    Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN; Chief Nursing Officer at Texas Health Presbyterian Hospital, Dallas, highlighted his organization’s commitment to advancing a safe workplace for all practitioners. He led a re-assessment of the safety and security risks of the physical facility in partnership with safety and security leadership. He also shared THR’s commitment to advancing a safe workplace by providing behavioral de-escalation training for all employees, making it a requirement for all RNs. From Dr. Edmonson’s perspective, this type of skill building is foundational; no matter what the employees’ role is in the organization.

    Louise White, RN, Chief Nursing Officer at Sharp Grossmont Hospital in San Diego, CA., and Deene Mollon, RN, Director of Progressive Care, led an effort to ensure all patients and family members at risk of behavioral escalation are routinely identified and managed. With increased reports of patient and family violence occurring in various areas throughout Sharp Grossmont, a team worked to develop a process that RNs use on a daily basis to assess a patient and/or family member’s propensity for behavioral escalation. Called the Disruptive Behavior Algorithm, all patients are assessed on a three-point scale for disruptive behavior potential as part of the daily nursing assessment process. Should the patient’s disruption “potential” increase in severity, a behavioral plan is generated and travels with the patient as he or she is transferred to different units. A copy of each behavioral plan is also kept on file by the Administrative Liaison for future reference, should the patient be readmitted. At daily leadership huddles, the entire nursing leadership team is alerted to any patients that have a behavioral plan to coordinate the management of potentially destructive behavior throughout the entire organization and ensure safety for all RNs.

    In these and other examples, members note the historical reluctance of nurses to even call for help until it’s too late. Further, in a time of resource constraints, CNOs are carefully monitoring investment costs. However, the need for all staff to be skilled in managing behavioral escalations is critical, as is access to 24/7 help at the bedside, should the RN deem additional help to be necessary.

    These discussions from last year’s meeting series prompted new research for 2018. The new study, Rebuild the Foundation for a Resilient Workforce, examines four “cracks in the foundation” of an increasingly complex care environment:

    • Point-of-care safety threats are now commonplace
    • Nurses feel they must make compromises in care delivery
    • No time to recover from emotionally traumatic events
    • Nurses feel “isolated in a crowd”
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