National Nurses United

As the industry has continued to commodify healthcare as a "product" and pushed the concept of patients and their families as "customers," hospitals have further relaxed visitor policies for family members who, understandably, would like unrestricted access to be with their loved ones. Some nurses reported that they felt visitor policies were geared more toward encouraging higher scores on patient satisfaction surveys, rather than facilitating care. Sadly, pay- ments to hospitals today are tied to patient satisfaction scores and reward the patient's perception of care instead of the reality of care they receive. "The hospital cares more about patient and family sat- isfaction because it impacts their bottom line," said Scott. The two drivers are, in fact, interrelated. Instead of spending money on increased hospital staffing and services, which would nat- urally improve actual patient care, outcomes, and satisfaction, the hospitals have a calculated strategy to shift the burden, cost, and responsibility for care onto unpaid family members. If relatives and friends were not available to step in to fill that void, that would sure- ly lead to greater suffering and upset by patients. Hence the current situation where many more people are on the unit, introducing potentially violent variables into the work equation. Scott understands the calming effect friends and family can have on patients and always encourages them to ask questions and advo- cate for the best care for their loved ones. But she noted that RNs sometimes have to perform job duties or procedures where, even under the most ideal circumstances, it would be best if visitors were not present. For example, when an RN asks a post-operative patient to turn and cough, the patient will likely feel pain—something that worried relatives don't understand and could further upset them. "Families will be angry at us, yelling at us," said Gwynn Pepin, an RN at St. John's Hospital in Maplewood, Minn., where a brutal Nov. 2, 2014 attack by a patient stunned the country. "There are times we don't even think about it as verbal harassment, and we just try to deal with it, to do our best." Even living on the edge of violence, via verbal threats, can take its toll. A recent study by the Manitoba Nurses Union, on the prevalence of PTSD among nurses, revealed that nurses who did not sustain any injuries, but just "anticipated some sort of violence at work, reported higher levels of stress than nurses with minor injuries." And when an RN's best isn't enough to deescalate visitors, with hospital policies barring nurses from controlling which "customers" are on their unit, the threat of violence looms. This attack had no prelude. Through security camera footage, you can see nurses calmly working and chart- ing at their nurses' station; one RN even had her hands relaxed and folded behind her head. Seconds later, around 2 a.m., RNs at St. John's Hospital in Maplewood, Minn. were blindsided when 68-year-old patient Charles Logan rushed into the med-surg station, wielding a metal bar he had stripped from his bed, and began striking nurses. Surveillance video of the assault exploded across both main- stream and social media. Reports focused on the shocking footage and subsequent injuries to four nurses (including a collapsed lung and a fractured wrist), and also on Logan's apprehension by police, several blocks from the hospital, where he collapsed while resisting arrest and ultimately died. What's not obvious in the video, according to Pepin, is that even in the midst of panic, there was also strategy. The pattern of movement, on the part of RNs, purposely led Logan away from other patients. RNs also pressed a panic button that notified a trained team of respondents, including hospital security. In the aftermath, RNs were provided with workers' comp and ongoing counseling, all as part of the facility's workplace violence plan, dubbed "Code Green." Every hospital must have a plan, say NNU nurses, not only for how to prevent workplace violence but how to handle any incidents that arise on any unit and the subsequent trauma. Any workplace violence prevention training RNs have received has traditionally focused on ER nurses in emergency and psychiatric departments, since they were often dealing with patients in crisis. However, Higgins points out that these units cannot be the only areas of the hospital prepared for violence. All units, she said, in all communities, also need access to a plan. 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 A N U A R Y | F E B R U A R Y 2 0 1 5 "You don't know where violence is going to show up. It has spread through all areas of the hospital... We should always make sure we have training in place —everywhere."

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