National Nurses United

and The Joint Commission guidelines to enforce a responsible workplace violence prevention policy. Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior. Document all attempts to address intimidating and disruptive behaviors. The Joint Commission in july 2008 jcaho issued a Sentinel Event Alert that increases the accountability of accredited facilities for disruptive conduct by their staff, titled: ���Behaviors that undermine a culture of safety��� Issue 40. Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction, allow preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments. To assure quality and to promote a culture of safety, healthcare organizations must address the problem of behaviors that threaten the performance of the healthcare team. Organizations that fail to address unprofessional behavior through formal systems indirectly promote an unsafe work environment. Intimidating and disruptive behavior stems from both individual and systemic factors. In the Joint Commission���s view, verbal outbursts, physical threats, and condescending language can undermine health team effectiveness and ultimately compromise safety. The Joint Commission release notes a history of ���tolerance and indifference��� to intimidating and disruptive behavior that exists in the healthcare community. Individual factors such as self-centeredness, immaturity, and defensiveness as well as institutional demands, including productivity demands, cost containment requirements, embedded hierarchies, and litigation fears all contribute to the problem. A survey by the Institute for Safe Medication Practices revealed that ���40% of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator.��� Beyond the official accreditation standards, the Joint Commission also suggests certain actions, including educating all team members; holding team members accountable for modeling desirable behaviors; developing and implementing ���zero tolerance��� policies; protecting those who report or cooperate in the investigation of intimidating, disruptive, and other unprofessional behavior; provide skills-based training and coaching for all managers; and developing and implementing a reporting/surveillance system for detecting unprofessional behavior. OSHA the occupational safety and Health Administration encourages organizations to have written workplace violence prevention programs. OSHA says these programs should, at a minimum: Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats, and related actions. Ensure that managers, supervisors, coworkers, clients, patients, and visitors know about this policy. Ensure that no employee who reports or experiences workplace violence faces reprisals. Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress. Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with law enforcement representatives and others who can help identify ways to prevent and mitigate workplace violence. Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that the team or responsible individuals develop expertise on workplace violence prevention in healthcare and social services. Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the patient or client. Set up a company brie���ng as part of the initial effort to address issues such as preserving safety, supporting affected employees, and facilitating recovery. Joint Commission suggested actions for developing and implementing processes appropriate to the organization: ���Zero tolerance��� for intimidating and/or disruptive behaviors by any professional designation. Reducing fear of intimidation or retribution and protecting those who report or cooperate in the investigation of intimidating, disruptive, and other unprofessional behavior. Responding to patients and/or their families who are involved in or witness intimidating and/or disruptive behaviors. How and when to begin disciplinary actions (such as suspension, termination, loss of clinical privileges, reports to professional licensure bodies). Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution. Develop and implement a system for assessing staff perceptions of the seriousness and extent of instances of unprofessional behaviors and the risk of harm to patients. Usually, a supervisor is the first contact to report violence, followed closely by the workplace security service. However, depending on the severity and duration of the incident, nurses might choose to call 911 first or shortly after asking coworkers to put in a call to the supervisor. If help from supervisors or facility security does not arrive promptly, an employee definitely should call local police. Recommended practice points include: Report any impending and actual acts of violence at work to your supervisor immediately, regardless of who is the victim and whether injuries have occurred. Reports must be written as well as verbal. Call the police immediately. If necessary, file a police report as soon as possible. Take someone with you when you file the police report, preferably coworkers who are familiar with the event. If the assault is from a patient, document the patient���s behavior in the medical record. This is the most essential legal documentation. Seek medical attention even if there are no ���obvious injuries.��� Be sure to document any physical injuries and your emotional state. 16 N AT I O N A L N U R S E RNs should note: Given that these are ���guidelines and recommendations,��� not ���mandates,��� they don���t have the force of law so employers can choose to ignore them. And the vast majority do! More than 70 percent of United States workplaces do not have a formal program or policy that addresses workplace violence. W W W. N A T I O N A L N U R S E S U N I T E D . O R G MARCH 2012

• Cover