Michon Dohlman, MSN, RN Erin Larson, MSN, RN Maria Levy, BSN, RN Julie Stene , BSN, RN

1. Michon Dohlman, MSN, RN Erin Larson, MSN, RN Maria Levy, BSN, RN Julie Stene, BSN, RN Workplace Violence: Giving Staff the Tools and Support to Report

2. Workplace Violence Objectives • Define workplace violence (WPV) • Discuss short- and long-term effects of WPV on staff • Discuss the WPV quality project presented for Saint Marys Emergency Department • Identify the essential elements of the WPV reporting tool and the keys to a successful WPV reporting structure

3. Definition OSHA: Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. ENA: An act of aggression, physical assault, emotional or verbal abuse, coercive or threatening behavior that occurs in the work setting and causes physical or emotional harm. Examples Verbal threats, spit on/at, yelled at, biting, hair pulling, scratched, being sworn at, being hit, pushed or shoved, etc. Workplace Violence Emergency Nurses Association, 2013; US Department of Labor: OSHA, 2013

4. Workplace Violence 2013 Minnesota Statutes: 609.2231 Assault in the Fourth Degree: Subd. 2. Firefighters and emergency medical personnel. Whoever assaults any of the following persons and inflicts demonstrable bodily harm is guilty of a felony and may be sentenced to imprisonment for not more than two years or to payment of a fine of not more than $4,000, or both: (1) a member of a municipal or volunteer fire department or emergency medical services personnel unit in the performance of the member's duties; or (2) a physician, nurse, or other person providing health care services in a hospital emergency department

6. Workplace Violence Statistics • Average annual rate of non-fatal violent crime by occupation: - Private sector 12.6 per 1,000 workers - Nurses 21.9 per 1,000 workers • Study of 6,300 MN nurses: - Rate of both physical and non-physical attacks on nurses • was 52 per 100 nurses per year • - Consequences for victims following non-physical violence was • more severe (anxiety, stress, quitting as a result) • Routinely underreported: - Due to perception that assaults are “part of the job” Gerberich et al., 2004 U.S. Department of Labor: Occupational Safety & Health Administration, 2004

7. Workplace Violence Effect on Staff Difficult to measure: - Most studies done through surveys - Using a convenience sample - Based on remembered events (rely on memory)

8. Workplace Violence Effect on Staff Studies Show: • 94% of nurses that experienced WPV met at least one symptom criteria for PTSD • 17% (of the 94%) scored high enough to be diagnosed with PTSD • 15% had scores associated with suppressed immune system function Gates, et al, 2011

9. Workplace Violence Effect on Staff ↓ Productivity • Negative impact on managing the workload and cognitive demands • Absenteeism and job changes ↓ Morale • Belief among nurses that violence against nurses is a result of incompetence ↓ Quality • Patient care Gates, et al, 2011; Gillespie, 2008; Kowalenko, et al, 2013

10. Workplace Violence Effect on Staff Deena Brecher (ENA President): “If nothing else, the fact that nurses consider leaving and in some cases do leave a job because of violence should be impetus enough for hospital leadership to take the problem seriously.” “It costs about $65,000 to replace a nurse.” Pecci, 2014

11. Workplace Violence Effect on Staff We can only manage what we have measured Reality ? Perception ?

12. Workplace Violence • The WPV committee - Formed in Spring 2012 • Purpose: - Assess the incidence of WPV in the ER - Assess staff knowledge of what defines WPV - Learn why staff felt unsafe yet had 0 WPV report (perception vs. reality) - Change the perception that WPV is “part of the job”

13. Nursing  Surveyed in March, 2012 Survey modeled after the ENA Emergency Department Violence Surveillance Study Interventions: staff education, development of the reporting tool Post-intervention  Staff surveyed one year later Workplace Violence WPV Assessment Survey

14. Workplace Violence Initial Survey Results

15. Workplace Violence Initial Survey Results

16. Workplace Violence Initial Survey Results

17. Workplace Violence Initial Survey Results Only 33%of assaulted staff Reported it!! WHY?

18. Workplace Violence Initial Survey Results Survey question: Do you feel that workplace violence from patients and/or visitors is simply “part of the job”? 53% - Yes

19. Workplace Violence Initial Survey Results Survey question: Have you been instructed to report physical or verbal abuse regardless of severity? 47% - NO

20. Workplace Violence Initial Survey Results Survey Quotes: • “ this has been an accepted way for so long” • “I shouldn’t feel that way, but it has been going on enough that I am desensitized to it” • “it is part of the job, up to a point” • “there is more that can be done in order to keep ourselves and our patients safe”

21. Workplace Violence • Developed a simplified reporting tool (handout) • Staff educated • Fliers in KEY places - even the bathroom • Included in weekly management report to all staff • Power Point presentation given at the department level nursing practice committee meeting • Included in yearly competency program • “real-time” encouragement to report all incidents Following the initial survey:

22. Workplace Violence Following the initial survey: 100% OF REPORTS SUBMITTED WERE FOLLOWED UP ON BY MANAGEMENT WITH STAFF CONTACT

25. Picture of the reporting tool

26. Workplace Violence Intervention Report received by management Flag to chart Management Chart Review Monitor “Flag” • Internal to the emergency department • Consists of a red folder with a brief description of the issue • Used for staff and patient safety • Prints out with every visit to the emergency department

27. Workplace Violence Post Intervention Results

28. Workplace Violence Post Intervention Results

30. Workplace Violence Post Intervention Survey Results

31. Workplace Violence Post Intervention Survey Results ~55% Decrease

32. Workplace Violence Post Intervention Survey Results Staff comments on follow-up survey: “it should not be considered part of the job by anyone” “I feel now that it is NOT a part of my job and I will not tolerate it” “I think it is because it does happen, but I don’t think it should be tolerated like it is”

33. Workplace Violence Summary Keys to Successful Reporting of WPV: • Staff education • Simplified reporting tool • Change the culture that WPV is “part of the job” • SUPPORT FROM MANAGEMENT IS ESSENTIAL

34. Workplace Violence: Giving Staff the Tools and Support to Report Questions…? Discussion…?

35. References Emergency Nurses Association. (2010) Position statement:Violence in the emergency care setting. Retrieved from http://www.ena.org/SiteCollectionDocuments/Position%20Statements/Violence_in_the_Emergency_Care_Setting_-_ENA_PS.pdf Gates, D.M., Gillespie, G., Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29(2), 59-66. Gerberich, S.G., Church, T.R., McGovern, P.M., Hansen, H.E., Nachreiner, N.M., Geisser, M.S., Ryan, A.D., Mongin, S.J., Watt, G.D. (2004). An epidemiological study of the magnitude and consequences of work related violence: The Minnesota nurses’ study. Occupational Environmental Medicine, 61, 495-503. Gillespie, G. (2008). Consequences of violence exposures by emergency nurses. Journal of Aggression and Maltreatment, 16(4), 409-418.

36. Koalenko, T., Gates, D., Gillespie, G., Succop, P., Mentzel, T. (2012). Prospective study of violence against ED workers. American Journal of Emergency Medicine, 31, 197-205. Pecci, A. (2014). ED violence racks up huge costs. Health Leaders Media. Retrieved from http://www.healthleadersmedia.com/page-1/NRS-300840/ED-Violence-Racks-Up-Huge-Costs The Office of The Revisor of Statutes (2013) Minnesota Statues: Assault in the fourth degree (609.2231). Retrieved from https://www.revisor.mn.gov/statutes/?id=609.2231 U.S. Department of Labor: Occupational Safety & Health Administration. (2004). Guidelines for preventing workplace violence for health care & social service workers (OSHA 3148-01R 2004). Retrieved from https://www.osha.gov/Publications/OSHA3148/osha3148.html U.S. Department of Labor: Occupational Safety & Health Administration. Workplace violence. Retrieved from https://www.osha.gov/SLTC/workplaceviolence/

37. Thank You