National Nurses United

historical record for tracking of trends, eliminates administrative deniability, and may be used as evidence in court, or by local, state, and federal agencies. The Nursing Process: Assessment, Planning, Implementation, Evaluation, and Advocacy Assessment of factors that may contribute to tragic incident of workplace violence Insufficient nursing and security staff to observe potential violence? Insufficient staff to de-escalate or physically prevent an attack? Insufficient education and training in causes of violence, prevention through communication techniques, violence avoidance techniques, and how to restrain a violent person? Was there a root cause analysis of the system? Does the physical environment need to be changed to prevent violence? Is there a need for improved policies and procedures on violence? Is hospital administration supportive of RNs��� concerns about violence? Are front line staff encouraged/supported to report and document all incidents of violence? Is there fear of retaliation for reporting? Planning to mitigate and limit the risks of harm Educate all staff in recognizing a potentially violent situation. Advocate for management to be active in supporting violence prevention. Use existing state law, OSHA, JCAHO, and NIOSH guidelines to enforce a responsible workplace violence prevention policy. This includes policies that make it clear that intimidation is never OK. Not from managers, physicians, staff, security, visitors, or patients. Have direct-care staff, especially ER and mental health personnel, recommendations included in the updated policies and procedures. These must include the need for sufficient staff. 10 Actions a Nurse Should Take if Assaulted at Work GET HELP. Get to a safe area. CALL 911 for police assistance. GET RELIEVED of your assignment. GET MEDICAL ATTENTION. REPORT THE ASSAULT to your supervisor and union representative. GET COUNSELING or assistance for critical incident stress debriefing (CISD) to address concerns related to post-traumatic stress disorder (PTSD). EXERCISE YOUR CIVIL RIGHTS as circumstances require. File charges with the police. GET COPIES OF ALL REPORTS and keep a diary of events. Take photographs of your injuries. RETURN TO WORK ONLY when you feel safe and supported and have been cleared by your healthcare provider. ���Code Grey��� is not a substitute for sufficient staff to prevent a violent incident. Implementation of the Action Plan Enforce contract provisions Employer response to PPC plan of correction monitored by staff nurses Monitor employer compliance with JCAHO, OSHA, and NIOSH Standards Advocate for the adoption of ���Workplace Violence Prevention��� legislation Evaluation of the Results Were the policies implemented? Are verbal, intimidation, and actual attacks being reported? Is the plan adequate? An Advocacy Success story Lorraine Sandoval, RN led a yearlong effort to achieve prevention of violence in the ER at Ventura County Medical Center, California. As in other healthcare settings, violence had been increasing over the years. RNs and others had filled out the hospitals incident reports but management failed to respond and take action on the RNs��� documented concerns. The RNs then began keeping their own records using both assignment despite objection forms (ADOs)and other written reports. The violence continued to escalate. There were so many violent incidents the police were called at least twice a day and often more often than that. One of the many examples: a patient suffering from psychosis pulled out his intravenous line and threatened nurses with scissors, police were called and drew guns in the emergency department. Patients and others had brandished firearms and knives in the waiting room and patient care areas. Patients were found to have a weapon on their person. The RNs requested a meeting with management. They wrote a petition asking for: Training in de-escalation and how to restrain a violent person. Metal detectors A police officer assigned to the emergency department. Hundreds of hospital staff signed the petition in solidarity with nearly 100 percent of the RNs and physicians. The RNs took their documentation to the Board of Supervisors, the governing body of this hospital. The supervisors were told, ���Someone is going to die if nothing is done. You are aware.��� Thanks to the collective actions of the nurses, RNs at the facility are now offered a six-hour class in de-escalation and restraint techniques. They were supplied with a metal detector wand and a ���walkthrough��� metal detector was installed at the entrance to the ER. The RNs were successful in achieving their goals because they: Consistently documented their concerns Organized their fellow workers to sign their petitions Lobbied and educated the governing body of the hospital and explicitly identified what was needed and required to maintain a more secure work environment for the provision of safe, therapeutic, and effective patient care. In addition, a Ventura County Police Officer is now assigned to the ER 24 hours a day. RNs report that just having the officer present has been a huge factor in preventing assaultive behavior. Compare and Contrast: Vulnerable Patient vs. Corporate Goliath MARCH 2012 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 21

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