By Zack Budryk
In the wake of the uptick in violence, many providers and advocacy groups are calling for and implementing more concrete solutions.
Following the murder of Brigham and Women's Hospital's Michael J. Davidson, M.D., nurses in Massachusetts lobbied heavily for proposed legislation that would require hospitals and unions to collaborate on comprehensive workplace violence plans, similar to those discussed by Christine Pontus, R.N., an occupational health nurse and associate director in the Massachusetts Nurses Association's Division of Health & Safety. The proposal featured improved procedures for securing facilities as well as comprehensive risk assessments.
Most experts agree that going forward, risk assessments are vital to future anti-violence efforts, since certain areas are at high risk for violence. For example, of 150 hospital shootings in 2011, 30 percent happened in the emergency department. EDs have features that make them particularly susceptible, such as limited security, likelihood of strong emotions or panic and easier substance access.
The time of day matters too; the risk of violence is far higher on night shifts. At University of California at Irvine, 32 percent of violence occurred between 11 p.m. and 7 a.m., despite that time only accounting for 13.3 percent of patient volume, according to the American College of Emergency Physicians. The organization recommends looking out for clues of potential violence in individual patients, such as tense posture or a threatening tone, as well as equipping hospitals with unobtrusive "panic" buttons and direct phone lines to make it easier and faster for staff to call for help.
But even beyond the realm of security protocols, hospital leaders must take action to make sure staff feel comfortable speaking up. A survey of nurses last year found respondents underreport violence directed at them. Half of respondents said they didn't report a violent incident because it caused them no physical harm, while a quarter said the reporting process was too inconvenient and, most disconcertingly, about 25 percent said the violence comes with the territory, and reporting it will make so little difference that it would be a "waste of time."
In Ohio, 340 nurses and 520 people overall fell victim to assaults over a two-year period, with 114 cases of workplace and domestic violence or disputes at the Cleveland Clinic alone. A major nurses' union in the Buckeye State argues nurse underreport violence for fear of retaliation from management, according to ABC5.
"Insubordination, or the facility saying they're being insubordinate because they are not taking care of the patient at that time when the violent act takes place against them,"Ohio Nursing Association Executive Tiffany Bukoffsky told the media outlet. "It's a fear of being disciplined."