Issue link: https://nnumagazine.uberflip.com/i/117874
Who���s ultimately responsible if a nurse is assaulted at work? as opposed to a blanket determination of anyone assaulting a nurse be treated as a felon, there is a strong argument for holding the hospital to a high standard of corporate responsibility in preventing the assault in the first place. Hospital administration must provide a safe environment for both nurses and patients. Assault occurs when the defendant���s acts intentionally cause the victim���s reasonable apprehension of immediate harmful or offensive contact. Of the grade or quality of a felony, as for example, a felonious assault, such as an assault upon a person, would subject the party making it, upon conviction, to the punishment of a felony which is imprisonment. ���Felonious��� is a technical word of law which means ���done with intent to commit a crime, i.e., criminal intent.��� Patients may enter the hospital, and for a variety of reasons (e.g., drug interactions, allergy, fear, anger, sadness, anxiety), experience diminished capacity negating the traditional definition of intent as it relates to criminal assault. Intent and motive should not be confused. Motive is what prompts a person to act, or fail to act. Intent refers only to the state of mind with which the act is done or omitted. In contrast, hospital management should proactively safeguard the nurses��� workplace. An affirmative duty should attach to corporate responsibility ��� providing RN staffing and ancillary personnel based on the determination of the direct-care RNs accountable for the patients; appropriately trained security personnel; functioning security measures such as locked doors/units, hallway cameras as appropriate, alarms/panic buttons, and emergency response/paging systems; and ongoing education and training programs. The employer should not escape its corporate duty to provide a safe workplace because of budgetary and financial concerns. Corporate responsibility manifests as a proactive environment of nurse safety, rather than a reactive, after-the-fact patchwork of remedial measures. Rather than assign blame to individual patients, primary responsibility for a safe working environment rests with the owner/holder of the environment: the corporate hospital/workplace owner and management. It is a corporate responsibility to be in compliance with licensing and accreditation guidelines and regulations. Charging a patient with a felony with resulting jail time upon conviction doesn���t change the environment of care and mitigate the risk of workplace violence. In effect, it lets corporations off the hook, and thus becomes a de facto exoneration and cover-up of management���s failure to hold itself accountable. Direct-care RNs are the last line of defense between vulnerable patients and the employer���s bottom line. RNs have a duty to act, as circumstances require, to change conditions that are against the interests of patients. Summary and Conclusions ���Knowing is not enough, we must apply; Willing is not enough, we must do.��� ���Goethe national nurses united (nnu) has been very active in educating nurses and the community about the frequency of violence in the healthcare setting and the fact that a great deal of it is preventable and underreported. Historically, nurses may have bought into a commonly held belief that violence is just a part of the job. NNU is working to banish this belief from our profession. While increased risk is associated with the perception that administrators consider assaults to be part of the job, receiving assault preven- 22 N AT I O N A L N U R S E tion training, annual staff review and competency validation, together with the presence and availability of specially trained security and/or law enforcement personnel mitigates the risk. Increased awareness and active surveillance of the environment for hazards, and effective communication and implementation of ���zero tolerance��� policies regarding lateral and physical violence reduces the rate of assaults. News media have trumpeted urgent concerns about hospital understaffing and research has shown that a high turnover of hospital nursing staff may be linked to unrealistic nurse workloads. Forty percent of hospital nurses have burnout levels that exceed the norms for healthcare workers. When taken together with the fact that violence in healthcare settings occurs at a rate of four times the national average, it���s no wonder that job dissatisfaction among hospital nurses is four times greater than the average for all U.S. workers. According to a study conducted by nurse researcher Martha Griffin, 60 percent of new nurses leave their first places of employment within six months because of lateral violence against them! Environmental and organizational factors are associated with patient and family assaults on healthcare workers, including understaffing, (especially during times of increased activity such as admission, transfer, discharge, and meal times), poor workplace security, unrestricted movement by the public around the facility, and a high patient/nurse-staffing ratio. Although mental health and emergency departments have been the focus of attention and research on the subject, no department within a healthcare setting is immune from workplace violence. Consequently, violence prevention programs would be useful for all departments. OSHA, NIOSH, and Joint Commission guidelines provide a framework for addressing the problem of workplace violence and include the basic elements of any proactive health and safety program: management commitment and employee involvement, worksite analysis, hazard prevention and control, and training and education. Investigators who���ve studied the effectiveness of such training have generally found improvement in nurses��� knowledge, confidence, and safety after attending in-service education programs on aggression/behavior-management. However, implementation of comprehensive violence prevention programs that go beyond staff training will improve safety of the healthcare workplace for all workers. These advanced programs include the use of currently available engineering and administrative controls such as security alarm systems, adequate training, and staffing. Compassion, Caring, Community, Courage, and the Social Contract it���s been said that culturally competent advocacy is rooted in the commitment to preserve and protect fundamental human rights. A human rights framework informs ethical behavior in RNs, and compels them to act with fundamental moral authority and courage, to facilitate access to services that promote survival, decrease suffering, prevent injury and death, and promote their own security as well as that of the other members in their community. Compassion has been identified as the motivation that compels RNs to act on behalf of others. It is the desire to help that is intimately linked with an empathetic understanding of the suffering and distress of others. Belief in the collective identity and interdependence of all human beings promotes the empathy and advocacy inherent in the social contract between the public and the profession of nursing. 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