National Nurses United

In the face of escalating workplace violence, possibly even more widespread than the reported numbers, nurses have been mobilizing to call for greater protections. The California Nurses Association, for example, shepherded passage of the 2014 Healthcare Workplace Violence Prevention Act. This landmark bill requires California hospitals to adopt comprehensive workplace violence prevention plans and also forces hospitals to document and report incidents of violence to the California Occupational Safety and Health Association (Cal/OSHA). At a National Nurses Organizing Committee conference in Janu- ary, around 100 RNs from Florida, Texas, Missouri, Kansas, and Nevada, echoed California's call for stepped-up action to reduce hos- pital violence. They gathered in Tampa for a rally piggybacking on proposed Florida legislation geared, much like California's, to stan- dardizing and formalizing workplace violence prevention. "Such a large percentage of us are assaulted at work," said rally attendee Kim Scott, an intensive care unit RN at Oakhill Hospital in Brooksville, Fla. Her own violent experiences range from verbal assaults, to watching a coworker get kicked "hard in the chest." She joined RNs holding signs that read "Assaulted" and "Physically Assaulted," while Bonnie Castillo, RN and director of National Nurses United's Registered Nurse Response Network, read statistics from the Journal of Emergency Nursing citing that 76 percent of nurses with at least 10 years of experience had experienced some form of workplace assault in 2013. There are a multitude of reasons why vio- lence against healthcare workers is on the rise. But in discussion with registered nurses across the country, several key factors attributable to the hospitals and healthcare industry's prioritization of profits over its staff and patients are most prominent. One main way hospitals can prevent workplace violence, agreed nurses, is to simply increase staffing. More staff means more sets of eyes on the patients, more hands and bodies to step in if a patient or family member acts out. Better care also means patients and fam- ilies are less likely to become agi- tated. This applies across all levels to not just registered nurses, but techs, aids, and sitters to watch potentially volatile patients. Cali- fornia's recent legislation, for example, involves safe staffing protocols written into its stan- dards for healthcare facilities. Holder points out that not being left alone may have pre- vented the patient from slugging her. "The hospital is always trying to save money, downsizing, mak- ing staff cuts," she said. "We used to have a person on every shift who would help nurses with transporting, drawing blood, get- ting people undressed or helping us with agitated patients. They cut those positions, so we didn't have help at all. It really made a difference." A second is that patients today tend to be sicker and more likely to present with emotional and psychological volatility—if not out- right untreated mental illnesses. Millions of people lost their jobs and, subsequently, their health insurance during the Great Reces- sion and have had to go long periods without primary healthcare, therapy, or needed prescription medication. Private and public serv- ices for patients suffering from mental health issues have been cut, cut, cut. According to a 2014 report by the National Association on Men- tal Illness (NAMI), the lack of acute inpatient or crisis stabilization services for patients who are experiencing psychiatric emergencies has "contributed to the problems with 'psychiatric boarding' in emergency rooms." "There's a serious problem throughout the country with ERs hous- ing psych patients because there aren't enough psych beds," said Judy Lerma, an RN of the Center for Healthcare Services (CHS) Crisis Care Center in San Antonio, Texas and an active member of NNOC-Texas. Lerma's facility assesses adult patients having a psychiatric emergency, and accomplishes a 48-hour crisis observation in order to keep these patients "out of jail—or the hospital." "The idea is that [our facility] will stabilize them, and they won't need to end up sitting in the ER, waiting in a bed there." But many psychiatric patients across the country still wind up in the emer- gency room, nonetheless. Last, nurses point to changes in hospital visitor policies intended to maximize hospital profits that result in many more people besides just patients and hospital personnel to be present on a unit. When Scott became an ICU nurse 27 years ago, RNs had to buzz visitors in. Today, she said, there is minimal security and few rules about who and when someone can be on the unit. Hospitals will never admit it, but they actually need and want patients' families and friends to stay and do the work—helping patients to the toilet, feeding them, refilling their water—that was once performed by paid staff they've now eliminated. J A N U A R Y | F E B R U A R Y 2 0 1 5 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 In January, nurses in Tampa, Fla. rallied for legislation to require better workplace violence preven- tion planning by hospitals.

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