Nurses may work on the frontline, but it shouldn’t feel like they’re engaging with an enemy.
They have a significant amount of contact with patients and may perform procedures which can cause discomfort or pain. These factors, and others such as inadequate staffing and nurse bullying, can place nurses at an increased risk for physical or verbal abuse from patients or their family members. This can contribute to an undesirable, or even unsafe, work environment, which may result in a higher turnover rate and decreased job satisfaction.
While it may not be possible to change the procedures that nurses perform or the location in which they perform them, you’re far from powerless when it comes to making them feel safe and supported. Adopting a zero-tolerance culture and providing education and support can go a long way when trying to promote a safe work environment.
Identify Risks of Workplace Violence
The Occupational Safety and Health Administration (OSHA) reports that from 2002 to 2013 the rate of serious workplace violence resulting in lost days worked was four times greater in healthcare than in private industries. This number may be higher due to under-reporting caused by fear or the belief that verbal or physical violence is part of the nursing job.
Patient violence is often unintentional due to fear or confusion, and it can leave the nurse seriously injured, needing time off work, or experiencing job dissatisfaction. The highest rates of patient violence often occur in the emergency department and psychiatric units, but patients can react with violence in any department due to many reasons such as:
- Cognitive impairment
- Substance abuse
- Post-anesthesia effects
- Confusion during treatment or other care
- Fear and frustration
- Mental health conditions or crisis
Reduce the Risk
Education and awareness can prevent or reduce physical or verbal violence. Facility administrators and managers must be aware of high-risk situations and prepare by addressing these issues. Actions you can take to reduce the risk of violence include:
- Encourage nurses to report verbal or physical abuse. Gathering this data can assist in identifying areas and situations that carry an increased risk of violence.
- Set standards to implement a zero-tolerance policy that reinforces that violence is not a part of nursing. Develop policies and procedures regarding the appropriate code of conduct for patients and staff.
- Educate and train nurses to recognize dangerous situations. Help staff identify the warning signs of increasing patient anxiety such as pacing or tense body language.
- Identify and address how to safely provide care in situations when staff are at an increased risk for injury. Examples of these situations include when physically close to a patient or while performing uncomfortable procedures.
- Assess the environment and strive to promote safety. Provide comfortable areas for the patient and family. Remove items that could be used as weapons, maintain adequate lighting, and assist staff in identifying all available exits to use during a crisis.
- Provide clear communication to patients about what to expect regarding their care or treatment and work to reduce extended wait times.
- Alert staff of patients with a history of violence.
- Maintain adequate staffing. Remember that a hectic pace, fatigue and long hours can result in decreased awareness even in the most seasoned nurses. Strive for proper staffing of high-risk areas and potentially volatile situations.
Address Workplace Bullying and Incivility
Unfortunately, bullies aren’t restricted to elementary school. According to a survey by RNnetwork, 45% of nurses have been harassed or bullied by their peers. Bullying can infect the healthcare environment with fear and humiliation, leading to workplace negativity, decreased productivity, and an increased turnover.
The American Nurses Association (ANA) defines bullying as repeated, unwanted harmful actions intended to humiliate or offend the recipient. These behaviors can be motivated by envy, competition, stress or conflicting personality traits, but regardless of the reasoning behind them, they are sure to be damaging to the overall morale of your practice.
Confront Workplace Bullying
Nurse leaders can nourish a healthy and positive work environment by promoting a culture that rejects negative behaviors. No matter what provokes the bullying, reinforce that the action is unacceptable and can be detrimental to the work environment. The lack of a collaborative working relationship between nurses can impede the flow of communication and affect the provision of patient care.
Here are a few ways you can confront workplace bullying head-on in your facility:
- Model the desired behavior by making yourself approachable. When addressing staff be sure to practice clear, calm communication. Be mindful of the volume of your voice and body language.
- Educate your nurses about what constitutes unacceptable behavior.
- Set the tone by holding people accountable for destructive or threatening behavior.
- Adhere to policies and follow through on disciplinary procedures.
Make Staff Safety a Priority
Nurse leaders face many challenges in maintaining adequate and quality nursing staff. Addressing workplace violence can help prevent an unsavory or unsafe work environment from contributing to job dissatisfaction and poor retention. By offering a supportive and safe workplace environment, you can empower nurses to provide the highest level of nursing care.