National Nurses United

nurses faced a fierce fight for personal protective equip- ment. Earlier this year, Imwalle began working at Kaiser South Sacramento and took on the role of quality coordi- nator, interfacing with all the quality liaisons in Kaiser's Northern California facilities. But work on the TMRT at Kaiser Roseville continues under Thuy Ho, the hospital's current quality liaison, and Renee Stalker, RN and the safety liaison at Kaiser Roseville. "Nurses know work- place violence is a huge concern," said Ho, who was PPC chair when Imwalle proposed the project. "We need to make sure that the response team is effective and to hold management accountable when it comes to follow up." The duo took the project to the next stage: develop- ing two surveys, one for the management team to assess their understanding of their role in responding to a TMRT code and another to all inpatient nursing staff to assess their understanding of workplace vio- lence and the TMRT. The management data is already in. The second survey is complete and will go out to staff soon. The survey data will help inform what the education component should cover. "Once we have a plan devel- oped for education, it will involve all of the safety people in each department," said Stalker, a labor and delivery RN who was on the PPC when Imwalle first presented her plan. The education will be incorporated into a "KP Learn" module as part of Kaiser Permanente's learning management system, finally ensuring that staff can easily and routinely learn about the TMRT, a significant achievement. If it's successful at Kaiser Roseville, then it will be rolled out across all of Kaiser's Northern Califor- nia facilities. Reporting violent incidents after the fights in kaiser South Sacramento's emergency department in the fall, Cole, an ED nurse at the time, spearheaded a petition demanding changes to keep patients and staff safe, which nurses delivered to management in December 2019. They organized for three months, including holding an informational picket, until metal detectors were installed, but more needed to be done. Cole knew that firsthand reporting was essential to mitigating workplace violence. The existing online violent incident report (VIR) system was not enough. In the spring of 2020, at a PPC meeting, Cole, Rick- ford, and other nurses discussed the lack of follow-up after workplace violence incidents. At the crux of the issue was the fact that nurses would report incidents to managers, who wrote the report, but RNs would not receive any follow-up. Consequently, no one knew if anything was being done to prevent things from hap- pening again. Plus, the reports were not in the nurse's own words, the nurse did not get a copy of the report, and the PPC did not learn about incidents in a timely way. "Some employees were concerned that what they had reported to supervisors was not being transcribed to the permanent VIR," said Rickford. "We wanted to know what was the recommended follow- up and for the employee to get a copy of the report. We also wanted the PPC to be able to track these incidents." At a June 2020 nursing quality forum, a monthly meeting of all PPC members and Rickford, Cole requested and got authorization to work on a tool that would be part of the existing online violent incident report (VIR) system. And that sparked the beginning of Cole and Rickford's collaboration. Together they developed a new VIR form that would be a record in the nurse's own words of what happened, with copies going to the nurse, manager, the PPC, and security. This meant the PPC could find out each month what was happening in the facility, rather than waiting until the quarterly report from the safety operations manager. The form also includes a list of contact information and resources, including employee assis- tance program for confidential, no-cost help, and phone numbers for critical incident debriefing, security, and employee health. 18 N A T I O N A L N U R S E 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 J U LY | A U G U S T | S E P T E M B E R 2 0 2 1 Renee Stalker, RN

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