National Nurses United

still not being reported because some nurses were not aware of or did not know how to use TMRT. Less than an hour's drive away at Kaiser Permanente South Sac- ramento Medical Center, a facility with 1,400 nurses, two former ER nurses, Robin Cole, a gastroenterology RN and safety liaison, teamed up with Debra Rickford, a PACU RN and nursing quality liaison, to tackle a better way to report and track workplace vio- lence and thus mitigate future incidents. Violent incidents and assaults had been occurring for years in the emergency department, culminating in a melee in the fall of 2019 when simultaneous fights erupted, patients and visitors were evacuated from the waiting area, and the security staff needed medical care. Clearly, something had to change. They knew they needed a better tool to provide a record of incidents that would be shared with all relevant parties in a timely way. These nurses were thoroughly versed in California's landmark Workplace Violence Prevention in Healthcare Standard, which includes several key provisions, such as requiring health care employers to log violent incidents, regardless of whether an injury occurs, and to report certain violent incidents directly to the state's Division of Occupational Safety and Health, otherwise known as Cal/OSHA. The standard, made possible by S.B. 1299, the law fought for by California Nurses Association (CNA), also required employers to have plans and procedures in place to address work- place violence. The RNs were deeply committed to reducing workplace violence incidents. The law was on their side and they knew that education was essential to improving timely reporting and to mitigating work- place violence. So they embarked on projects to do just that. Mitigating threats imwalle, an rn for 37 years, including 14 years as an emergency department nurse, was instrumental in developing the TMRT back in 2015 when she began asking questions: Why do we wait until workplace violence happens? Why do we wait to report it? What support did nurses have? What can we do to mitigate it? Is this a potential psych issue? Is it a family member? How do we take care of this before we get to a Code Gray? "Most of us know when patients are a potential threat to us," said Imwalle. "I knew we needed more threat mitigation." The idea behind the TMRT is that once the nurse or other staff member triggers the TMRT code, a team of people—the house supervisor, unit leader, and security—would respond and deescalate the situation in real time. However, not all nurses and staff knew how to implement the TMRT code. There were no instructions and the TMRT was not part of Kaiser's orientation or training for nurses, noted Imwalle. "We were constantly educating people on it." So in 2019, she set out to apply for funds that Kaiser had set aside specifically for paid release time for nurses leading or partici- pating on safety projects. These funds were part of the nurses' collective bargaining agreement. In the application, she stated that the project was to educate staff and evaluate the TMRT at Kaiser Roseville to prevent and protect employees from workplace vio- lence. The education developed would be provided to all employees through scheduled training, safety meetings, ongoing drills, and training. The plan included the involvement of the quality liaison, the safety liaison, and every member of the PPC. It was approved by Kaiser in January 2020 but then the pandemic hit and it was put on hold as J U LY | A U G U S T | S E P T E M B E R 2 0 2 1 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 N A T I O N A L N U R S E 17 Left to right: RNs Thuy Ho, Joanne Imwalle, and Debra Rickford. Below from left: Robin Cole, RN and Debra Rickford, RN

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