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As a nurse working in an emergency department, you soon learn to feel the beat of the rhythm.
Your co-workers are like fine-tuned instruments, working in sync. No one has to say a word. Nurses use all the other senses to act and react when the need arises. During a difficult case, the voice we may hear is a physician and a fellow nurse repeating back an order, but when we look at each other, the eyes are telling the message. The rest of the nurses usually are looking at each other and giving hand movements for instructions while the tasks are being preformed.
As a nurse you need to be able to rely on your team of co-workers and knowing the beat to the rhythm is the answer. Nurses are able to function in all sorts of disruptions, like having a gun shot victim, a dead child, a stabbing victim, a heart attack patient, a violent patient, the person who forgot to take their medication and had a seizure or the person who forgot to eat after taking their insulin.
Some of these patients get angry and belligerent. Nurses are well-trained to notice this behavior and respond in a professional, educated manner to assist the patient through this crisis.
However, when the ED nurse and team get assaulted, the rhythm and beat change. In the commonwealth of Massachusetts it is a misdemeanor to hit a nurse.
Reported Incidents
In recent weeks, we have had several nurses assaulted. A medical assistant was kicked in the chest while two police officers were standing there. A security guard was knocked out, and two other security guards were injured.
Violence is happening in every healthcare facility. It is stated in the booklet "Protecting Our Caregivers from Workplace Violence," prepared by William R. Keating, JD, MBA, Norfolk district attorney, Canton, MA, only 40 percent of nurses had reported violent incidents to management. Furthermore, the booklet states 48 percent of all non-fatal assaults in the U.S. workplace are committed by healthcare patients, and healthcare workers experience violent assaults at a rate four times higher than other industries. For nurses and other personal care workers, this rate jumps to 12 times higher.
Pending Legislation
There are two issues that need to be dealt with to get back into the rhythm and beat of our ED.
One issue would be to pass the legislation that has been in the state House of Representatives for more than 10 years. It is the assault bill, initiated by Massachusetts Nurses Association (MNA). The bill will be filed again this month. Nurses in Massachusetts should ask their representatives in Congress to pass this bill. The bill will make it a felony to hit a nurse, no different than a police officer, a firefighter or EMS/ambulance driver.
The second bill is to have the employer maintain a safe environment, which the MNA also initiated and which also will be filed again in the state House this month.
Asking your Congressmen and Congresswomen to pass these two bills will help all of us. A person who assaults a healthcare worker wouldn't think twice about assaulting a patient, especially if the patient got in the way.
Violence Prevention Plans
According to Keating, the following steps can be taken in any workplace to prevent violence.
• Educate employees about workplace violence prevention policies and plans.
• Communicate a clear definition of workplace violence.
• Solicit input from front-line employees to identify risk factors, report problems, and suggest improvements and interventions.
• Require employees to report all incidents of workplace violence.
• Develop communication systems that alert staff to a patient's history of violent behavior.
• Track all reports of violence to identify trends that can be addressed.
• Identify steps for employees and managers to take when violence occurs.
• Focus on ways to make the physical environment safer (this can be as simple as replacing all broken light bulbs).
• Provide prompt and comprehensive assistance for victims and witnesses of violence.
If the healthcare team and administration work together, we can accomplish zero tolerance for workplace violence. The healthcare team can continue in the rhythm and beat that is so necessary for the ED to function.
Sheila Wilson is a staff nurse in the ED at Caritas Carney Hospital, Dorchester, MA.
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