National Nurses United

"You don't know where violence is going to show up," she empha- sizes. "It has spread through all areas of the hospital. You can never assume just because RNs are in a certain area of the hospital or in a sleepy community, that they're safe. We should always make sure we have training in place—everywhere." Public health nurse Laarni San Juan, RN, of California's San Mateo County takes the call for training a step further, advocating for plans extending beyond the hospital walls, into the community. "Public health nurses go out and visit the most vulnerable and marginalized patients, the most unlikely to have health insurance," said San Juan. "We are aware of the inherent risk, but that's why we chose this work: to help those who are vulnerable." In her 17 years with the county, San Juan has been in homes with evidence of abuse, had a drug dealer jump in her car, and navigated a number of situations where her facility's basic guidelines, such as "lock your car door" or "trust your gut," did not feel sufficient. "I cannot even recall the last training we've had," San Juan said. "It's one thing to have a general guideline, but what's missing is: If I were to get into a situation where law enforcement was involved and I needed medical attention, I don't know what the protocols are. There's nothing in place. It's scary to think an [institution] that employs nurses who are at most risk, going in their cars into the community, does not have that in place." Jon Tollefson, who handles governmental affairs for the Min- nesota Nurses Association, explained that an upcoming Minnesota bill seeks to guarantee hospital staff is fully trained for violent sce- narios. "Not just training for RNs in ER or psych," Tollefson said, "but for all healthcare workers employed or contracted. We have some hospi- tals where they have a contractor, and who knows what kind of training they get? They have to get the same as in-house staff." RNs want change. Last year, before moving to Florida, Holder lobbied for passage of California's Healthcare Workplace Violence Prevention Act. She was encouraged to do so by her friend Nicole van Stijgeren, an ER nurse at San Mateo Medical Center, in San Mateo, Calif., who also participated. "I asked her to go because I thought it would be cathartic. She was a powerful speaker; she had such a powerful personal story," said van Stijgeren, who was "devastated" to witness the impact of workplace violence on Holder. In fact, while van Stijgeren had encountered violence in her own career, it was seeing her friend in so much physical and emotional pain that motivated van Stijgeren to take collective action through her union. "This turned me into an activist for the violence that I was seeing and experiencing myself. It really made me want to speak out," said van Stijgeren. And she is not alone in her activism; nurses across the country are increasingly rallying, lobbying, and saying they have had enough of hospital workplace violence. The unions of National Nurses United are providing nurses an avenue by which to fight to protect workers and communities. "Maureen's experience gave me a voice and [so did] meeting my CNA rep, who is an activist," said van Stijgeren. "It inspired me to fight to better protect nurses." In a system where violence is both normalized and on the rise, Hold- er's story and others like it are fueling a movement to ensure that no more RNs will feel that their lives and careers are considered expend- able before the hospital industry is held accountable for change. Kari Jones is a communications specialist for National Nurses United. 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 19 The Game Plan As violence against healthcare workers continues to rise, what's being done across the nation to hold healthcare employers account- able for workplace violence prevention planning? Here's what vari- ous states have in the works: California The landmark Healthcare Workplace Violence Prevention Act, passed in 2014, requires California hospitals to adopt comprehensive workplace violence prevention plans by 2016. Documentation and reporting to Cal/OSHA will be enforced by 2017. Nurses have also been bargaining to include workplace violence prevention provisions in their contracts, such as the one recently won by 18,000 Kaiser Permanente RNs and NPs. Florida and Texas National Nurses Organizing Committee (NNOC) is working with law- makers in both states to pass legislation mandating the "adoption of a workplace violence prevention plan as a part of [a hospital's] injury and illness prevention plan to protect healthcare workers and other facility personnel from aggressive and violent behavior." Stipulations of the tentative bills include education and training for staff on how to recognize and respond to violence, systems to assess and address factors leading to violence, prevention of punitive actions against employees for reporting violence to law enforcement, and require- ments of a hospital to document and report violent incidents to the appropriate state agency (in Florida, the Agency of Healthcare Administration, and in Texas, the Department of Health). Massachusetts On Jan. 20, Dr. Michael Davidson, director of endovascular cardiac surgery at Brigham and Women's Hospital, was shot to death by the son of a former patient. Davidson's tragic shooting illuminated the importance of recent legislation supported by the Massachusetts Nurses Association, SB 1187. The bill would require healthcare employ- ers to develop and implement programs to prevent workplace vio- lence. MNA has attempted to file similar legislation for more than a decade. While the shooting did not specifically spur the bill, it per- haps brought to widespread attention the importance of passing it. Minnesota Unlike Massachusetts, legislation in Minnesota was spurred by one par- ticular violent incident: the recent attack at St. John's Hospital. Backed by Rep. Joe Atkins, in conjunction with the Minnesota Nurses Associa- tion and a task force that MNA had already been participating in with the Department of Health, the bill would require the Department of Health to collect violence in the workplace plans from every hospital. According to MNA's Tollefson, the penalty for failing to have a plan in place, as currently written (although the bill has not yet dropped) would call for hospitals to lose their license. While the video of the St. John's incident, according to Pepin, was traumatic for the nurses to relive again and again, it was so shocking that it pushed everyone to address the problem immediately. "That incident has helped legisla- tors understand that this is something nurses address every day to one extent or another," Tollefson said. "It needs to change."

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