Workplace Violence Among Nurses: The Minnesota Nurse’s Study

Workplace Violence Among Nurses: The Minnesota Nurse’s Study Epidemiology Nursing 702 Maria-Idalia O. Lens, RN, PHN, MSN, FNP-C

Work Setting • Inpt Setting • 534 physicians, 341 beds, 14-bed preoperative, 60 critical care beds • Medical/telemetry floor (32 beds) • Every week there are encounters between patients, staff, family members. • Mostly are verbal, however, few become physical.

Current Policy • Call security • Call police if necessary • Use restraints • Use medications • Use sitter (1:1) care • Press charges if severe assault • Member loses coverage

One bad episode: Pt had physical contact with another pt, 3 staff, and ANM. • This has led to closure of the room, PTSD for staff and other pt involved. • Staff/staff confrontation. • Currently defense classes being taught to staff as well as how to deescalate possible violent situations. Care classes based on Jean Watson’s Theory. http://currentnursing.com/nursing_theory/Watson.html

Minnesota Nurses’ Study • To identify magnitude and potential risk factors for violence among an occupational population (nurses). • Collection of data done through surveys among RNs, and LVNs. • Collect data on physical and non physical violence in a 12 month period. • Results: Most violence is instigated by patients or clients; certain factors found to contribute to violence.

Work Violence • Violent acts including physical assault, threats of assault directed to persons who are on duty. • In 2001, 639 work related homicides (3rd leading work related cause of death in workers, 2nd among women). • Most research is based from public policy.

In California, 82.5/100,000 (0.08%) related occupational injuries. • Occupational homicide 1.3/100,000 (0.0013%). • In California, (hospital workers) non-fatal assault 465/100,000 (.46%). • Work violence among nurse known, but risk factors unknown.

Methods • RNs: n=57,388, LVNs: n= 21,740 • Gathered from state database • Random sample of 6300 chosen to participate with 78% return rate. • Violence included: physical assault, non-physical threats,

Data Collection • Done in 2 phases: • Phase 1: Estimate frequency and consequences of work related violence and identify risk factors. • Phase 2: Use case-control approach to identify specific risk factors for the assault outcomes.

Surveys sent to nurses (up to four times). • Survey designed specifically related to work violence.

Data Analysis • Analysis based on reported events and consequences from events. • All variables were considered based on directed acyclic graph (DAG).

Results

Characteristics of Perpetrators

Clinical Significance • From this study, we know that physical work related violence in nurses is from inpt settings, med/surg areas, in the adult population, while providing direct care. • In addition, related to neuro impairment/or disease, in adults older then 66.

Implications for Practice • Develop a policy among patients with certain diagnosis and illness to help prevent physical violence among nurses. • Prevent PTSD among nurses. • Increase pt/nurse safety. • Have psych or Geriatric/Neuro CNS/NP to evaluate pt’s within 24 hours to appropriately diagnose and treat.

Implications for Practice • Give appropriate medications to pt’s/ everyone responds differently to certain medications. • http://www.premieroutlook.comsummer_2004/medications_and_behavior.html

Education and Research • Educate staff on self defense, but also on statistics and other medications that can be used. • Do research specific to geographic location and population. • Be able to recognize possible physical altercations before it happens.

Develop policy and protocol related on what nurses can do before it happens. • Gather data on facilities own statistics and develop policy and protocol based on data. • Work collaboratively with physicians, specialists, and etc…

Questions • ????

References *

Workplace Violence Among Nurses: The Minnesota Nurse’s Study