Nursing Notes

April 25, 2011

Nurses fear even more ER assaults as programs cut

Here is an article that is a bit old, but still imparts useful information. The violence against nurses is escalating.   When you go to your work prepared to do whatever it takes to help people survive and improve, the last thing you expect is to be attacked or killed.  It seems that violence against nurses is becoming  the norm not the exception.  What really bothers me is that we seem to have become used to hearing about this violence and no longer react with appropriate dismay.

One of the factors that contribute to this violence may be the actual staffing ratios that hospitals use to staff.  When a very few staff are expected to do all, you set the stage for frustration and violence.  We see evidence of this everywhere today.  Simple frustration regularly erupts into full blown violence.

Please read this article and tell me your thoughts on the topic, won’t you?  This article is from the San Diego Union-Tribune.   You can visit the site to read comments and leave your own.

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By JULIE CARR SMYTH, Associated Press Writer

Tuesday, August 10, 2010 at 11 a.m.

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

// / AP//

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio. A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

U.S. map and chart show expected state mental health budget cuts;

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

In this July 29, 2010 photo, emergency room nurse Jeaux Rinehart sits in a treatment room at Virginia Mason Hospital in Seattle. Rinehart was accustomed to fielding kicks, spits, scratches and flying punches from his patients there, but one day in 2007 he didn’t move quickly enough. An erratic intravenous drug user who had entered the ER in search of a fix, grabbed a club, came up from behind and, as Rinehart turned, smashed it into his face. Bones broken, Rinehart sucked meals from a straw for weeks. (AP Photo/Elaine Thompson)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first – and I don’t think anybody has a question about that – but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts – and, at times, nurses themselves, who are often reluctant to press charges – that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong – among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

Please go to the original site to read this and others like it:

Online:

Emergency Nurses Association: http://www.ena.org

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March 5, 2010

Violence in Nursing

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Here’s just a quick follow-up on yesterdays post.  Violence is very commonplace in my line of work, but it seems it is becoming more common in all aspects of nursing.  How will we ever convince people that there is satisfaction in becoming a nurse when we cannot protect them?

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March 4, 2010

Workplace violence against hospital nurses is so common, many healthcare practitioners don’t bother to file reports. But that attitude is changing. HR leaders of healthcare facilities should increase training for nurses — to equip them to deal with potentially volatile situation — as well as enhance reporting and response mechanisms, experts say.

By Marlene A. Prost

When we think of a hazardous occupation, jobs like construction and fire fighting are at the top of the list. But when it comes to daily assaults, few professions can rival nursing.

For years, nurses have been punched and threatened by patients — from intoxicated ER patients to geriatric patients with dementia. They’ve accepted the abuse as part of the job and rationalized that, as long as they didn’t take time off, management wouldn’t care.

But that is changing. Today, nursing and hospital associations are fighting workplace violence by improving security, encouraging incident reports and fighting to strengthen state laws to prevent violence and punish offenders.

The numbers alone are staggering. Last month, a survey in Western Australia reported that slightly more than half (52 percent) of 113 registered nurses in one Australian hospital were physically assaulted in the past year by patients or patients’ families or friends. About seven in 10 (69 percent) were threatened and nearly all (92 percent) were verbally abused.

Workplace violence is a growing problem for U.S. nurses as well, says Nancy Hughes, a registered nurse and director of the Center for Occupational and Environmental Health at the American Nurses Association in Silver Spring, Md.

Healthcare workers accounted for 45 percent of all reported non-fatal assaults resulting in lost work, according to a 2005 report by the U.S. Bureau of Labor Statistics. And in 2006, the Massachusetts Nurses Association reported that half of 172 nurses surveyed had been punched at least once in the past two years, while 44 percent reported frequent verbal threats and abuse.

Not surprisingly, the biggest risks occur in emergency rooms and psychiatric units, although healthcare workers in nursing homes are often subject to abuse by geriatric residents with dementia.

“We’ve become a more violent society,” says Christine Pontus, a registered nurse and associate director for Health and Safety at the Massachusetts Nurses Association. “We’re the front line. … Nurses are operating in facilities where the doors are open 24/7. Police are bringing in a spectrum of human behavior that’s not experienced in other jobs.”

Kathleen McPhaul, a registered nurse at the University of Maryland School of Nursing in Baltimore, says “there is also evidence that the long wait for service, the frustration, hearing bad [medical] news, can set somebody off.”

With mental-health facilities cutting beds and releasing patients to the community, some patients who come to the hospital are “sicker, more violent and decompensating,” she says.

However, nurses today are less willing to tolerate abuse, says Karen Nelson, a registered nurse and senior vice president for clinical affairs at the Massachusetts Hospital Association.

Years ago, when she was a staff nurse, “nurses just had to accept … the slapping and spitting,” she says. “The culture has changed to acknowledge that staff has rights, too. … Hospitals no longer accept that assault and battery by a patient is acceptable.”

Improving the Environment

There is no federal standard requiring workplaces to protect nurses against violence, according to the American Nursing Association, but The Joint Commission — which accredits hospitals — does require that hospitals have a code of conduct to define disruptive behavior and implement a process to manage disruptive behavior.

Hospitals across the country are assessing risk areas and improving security, using guidelines from The Joint Commission, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health, experts say.

Basic measures include installing metal detectors and panic buttons, setting up monitors, adding cameras and lighting in hallways, controlling access to interior areas, enclosing nurses’ stations, designing the triage area to minimize risk of assault, improving security response time and offering security escorts.

Training Nurses to Manage Behavior

Like police negotiators, nurses are being trained to defuse volatile situations verbally. That’s important in the era of patients’ rights, when staff no longer routinely use physical or chemical restraints to control patients.

“One thing we find in this country [is that] new, untrained nurses are often the victims. They don’t know how to recognize escalation. They don’t know how to defuse it,” says Hughes.

Five years ago, administrators at Signature Healthcare Brockton Hospital, an urban hospital south of Boston, noticed an increase in patients with substance-abuse and mental-health issues, “who were out of control and required restraints,” says Kim Walsh, a registered nurse and vice president of patient services.

The hospital, which has a locked psychiatric unit, hired a nurse with prior experience with the prison system specifically to train staff to control high-risk situations. They also created response teams to manage volatile patients, she says.

Encouraging Reporting

Nurses may confide in researchers, but they are more reluctant to tell their supervisors if they’ve been attacked by patients, experts say.

Only half of the Australian nurses who had been assaulted mentioned the incidents to senior staff or co-workers. Only 16 percent filed an official report. Thirty percent said they didn’t make a report because such occurrences are not unexpected.

“A lot of nurses feel being assaulted verbally and physically is part of the job, which is unfortunate. They don’t see it as a reportable incident. It’s more paperwork. They’re there to deal with the patient,” says Elise Geig, director of health policy for the Ohio Nurses Association.

Geig says some nurses speculate that an “informal” incident report “sometimes disappears because, to be honest, it affects liability.”

At worst, nurses fear they may be blamed.

“Some hospitals hold the nurse responsible. … Through their tone, they hold them responsible for the action. ‘[What did you] do to provoke it?'” says Pontus of the Massachusetts group.

Facilities need a mechanism for reporting agitated patients before they act out, Pontus says. “That’s where the gap is. We’re not recognizing the small stuff before the real stuff happens.”

OSHA requires that every needle prick be reported, but when it comes to abuse, nurses are forced to make a judgment call.

“HR should encourage nurses to report any incidents, as long as they are going to do something about it,” MacPhaul says. “The policies have to be created to define the incident, be specific about the reported behavior, and what the facility will do.”

Hughes of the American Nurses Association says her organization encourages nurses to report all incidents. “You can always go and report, even to HR. The employer has the responsibility to provide [a safe workplace].”

“Certainly hospitals all have reporting for incidents and accidents,” says Nelson of the Massachusetts Hospital Association.

She advises HR to use orientation sessions to inform nurses of their rights and reporting avenues. “If a manager learns of an incident where a staff member was harmed, you take lessons learned and make sure policies and practices are working.”

Supporting Legislation

Nursing associations are lobbying for state laws aimed at strengthening criminal penalties and requiring hospitals to take more precautions.

For example, H.B. 450 was introduced in Ohio in February to make workplace assault against a nurse equivalent to assault on school employees, police, fire and emergency medical workers — a felony with a mandatory 12-month sentence. Eight other states have enacted such laws.

In Massachusetts, the nursing association is rallying around several bills, including S.B. 988, which would require hospitals to develop a comprehensive workplace-violence-prevention program. Such bills have been signed into law in eight states.

However, the hospital association maintains that the bill duplicates practices that already exist under OSHA and The Joint Commission.

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March 4, 2010

ED Shooting Shows Why Confronting Hospital Violence Must Be A Priority

There is no excuse for any person to come into a hospital, church, or school and start shooting.  This is an occurrence that we are becoming way to familiar with.  This article caused me quite a bit of concern because I had not read anything about this incident before.  How is that possible?

Why was this incident not played up in the national news?  Is it deemed normal for someone to shoot up an Emergency Room?  This is scary and I hope you will also feel threatened when you read this article.  I go to my job to help others and I never for a minute expect that someone will take shots at me for doing my job.  Maybe I need to rethink my position.

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John Commins, for HealthLeaders Media, March 1, 2010

The Feb. 15 early morning shooting inside the emergency department of Scotland Memorial Hospital in Laurinburg, NC, provides an unwelcomed, frightening, and extreme example of the violence that healthcare professionals too often confront. If you want to read the details of the report, here’s a local news link. Bottom line: some jerk allegedly brought a gun into a hospital and started shooting people. I really don’t care what his motive was, although I was gratified—but not surprised—to read that the healthcare professionals on duty acted heroically to secure the safety of their patients. When the attack was over, one patient at the hospital had suffered multiple critical gunshot wounds to the chest, his alleged attacker was in police custody, the hospital was in lockdown, and a number of healthcare professionals and their patients—though not physically injured-were badly shaken. The story got little play nationally and not that much play around North Carolina—a couple of news cycles and then nothing. That left me wondering if hospital violence has become so commonplace that it no longer warrants extensive news coverage. Had a similar shooting occurred in a school, for example, it likely would have generated much more media coverage. Is this a sign that we are becoming inured to the idea of violence in the ED? Let’s hope not. From everything I’ve heard and read so far, it appears that Scotland Memorial CEO/President Greg Wood and his staff did a good job responding to the shooting, and then keeping the public informed. SMH issued two press releases in the hours immediately after the shooting—doing their best to explain the convoluted chain of events and the hospital’s response, even as the police investigation was still underway. “We have never experienced anything like this in our hospital before,” Wood said in a media release. “The safety of our patients, visitors, and staff is of paramount importance to us, and we have extensive security measures in place to minimize the likelihood of such a horrific incident as this.” Wood understands the importance of keeping the public informed on this critical issue. He could have simply referred inquiries to the local police. You’d be amazed at how many hospitals do. SMH is still assessing its reaction to the shooting, what worked, what could be improved upon, etc. I hope to speak with Wood when that review is complete. When will hospital violence get the attention it deserves? This is not a new phenomenon. HealthLeaders Media and other healthcare media have reported on it, but you don’t see it talked about much anywhere else. An Emergency Nurses Association survey last year found that more than half of emergency nurses say they’ve been “spit on,” “hit,” “pushed or shoved,” “scratched,” and “kicked” while on the job. One in four of the 3,465 emergency nurses surveyed for Violence Against Nurses Working in U.S. Emergency Departments say they’ve been assaulted more than 20 times in the past three years, and one in five nurses have been verbally abused more than 200 times during the same period. A report from the National Advisory Council on Nurse Education and Practice also found “considerable evidence that workers in the healthcare sector are at greater risk of violence than workers in any other sector.” The report cites Bureau of Labor Statistics data which show that 48% of all non-fatal injuries from occupational assaults and violent acts occurred in healthcare and social services settings. BLS data also show that 9.3 in 10,000 employees in the health services sector suffer injuries that require time off from work, compared with two in every 10,000 workers overall in the private sector. There are cost big factors at work here too. How much are hospitals paying in workers’ compensation claims, or litigation for unsafe work environments, or for missed work, or for overtime or hiring temps to cover those missed shifts? How will a shooting in your emergency department affect recruiting and retention? These are grave questions that deserve immediate attention. First and foremost, however, this is a human resources issue. This is about providing dedicated healing professionals with a safe working environment. They have enough stress in their work already. They shouldn’t have to worry about getting shot, or stabbed, or kicked, or slapped, or scratched, or punched, or spit upon, or pushed, or cursed at, or intimidated. That sort of abusive conduct is not tolerated almost anywhere else. Why are hospitals the exception? Note: You can sign up to receive HealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.

John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.

Here’s the link to the original article

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