Nursing Assignment Danger.

The medical-surgical nurse gets the report on a 49 y.o. man, that fell into a thorn-bush and a foreign body is embedded into his arm. Nurse Allen, who is a seasoned nurse has 4 patients and is receiving a report on Mr. Smith. Allen’s current assignment is an ORIF (hip surgery) completed 2 days prior, MI rule-out, a pain management client that has been requesting PRN pain meds on a scheduled basis since last shift, and a patient that was unresponsive under a bridge yesterday that tested positive for opioids, THC, and alcohol, with a BAL 378, that in the ED was rebounding with IV fluids. Mr. Smith was admitted yesterday and being held in the overflow ED area until some unit beds were discharged. Allen is having a very eventful day as usual and extremely busy, so are the other nurses.

The patient finally comes to the floor, IV is halfway out of the patient’s arm, the site was now edematous and told that it must have just happened enroute. Nurse Allen asks for assistance for the vitals and he would be right in to say hi to the patient and start their head to toe assessment. Allen stops the fluid, assesses the area and starts another IV site then starts working on the skin assessment. Nurse Allen immediately sees multiple dots/lines in a row that are healed over but the area on his forearm is red, angry, swollen and painful to touch. Mr. Smith was diagnosed with cellulitis and is ordered to start IV antibiotics with an OR consult. Nurse Allen starts the antibiotic therapy, antipyretics, and the patient had a visitor. This was a particularly normal person, a female that holds some resemblance to Mr. Smith and introduced her as his sister visiting out of concern for his well-being. Nurse Allen attempts to take a break, notifies his colleagues and is so excited that he can get to the coffee shop for a little pick-me-up. The charge nurse Maggie walks in to adjust Mr. Smith’s IV pump, it is beeping and annoying the patient in the same room. When Maggie walked in, she saw Mr. Smith actively using a needle to inject a brown liquid into his IV line, this is why the pump was beeping. A code blue was activated as the patient was slumped over and leaning against the bathroom wall, a needle hanging out of his IV tubing.

This patient was sent to the ICU, nurse Allen was written up for not adequately performing a skin assessment, as the needle casing imprint was on the patient’s leg, where the TED hose was pushed down. A blood test was performed, the patient tested positive for opioids and meth that was injected into his arm. Should Allen be liable if the needle was not there during the skin assessment and was possibly brought in from the visitor? Some say absolutely and others may not see it that way. Security is minimal in all healthcare facilities, so much that nurses and CNA’s are unable to keep up with their own assignments and tasks than to be in the room observing contact between a patient and their loved one. Syringes, along with many other objects are being “pocketed” in rectums or flesh folds, not to mention the female genitalia or even brought in by friends and family. This article is not to condemn those who are addicted but to bring awareness about addiction and how it is straining healthcare workers, who are not adequately trained with nursing education or from their facility. Furthermore, a set up for failure. It is not fair or right that nurses should feel that standing up for what is going wrong in healthcare that it is pointless to report. Many lives that we work with depend on healthy nursing staff, we cannot remain healthy if not protected from harm or have resources to become a stronger and a happier workforce.

If you or someone you know that needs a voice, please join us on Facebook at: Nurses Against Violence Unite (click the business name) and join our community today, feel the difference and supported.

What is Nurses Against Violence Unite?

Freshly graduated from my Master’s program, with a project focused on de-escalation techniques, I decided to bring to light a sensitive subject among nurses.  Before deciding which way that I was going to go with Nurses Against Violence Unite, Inc, NAVUnite for short, the one thing that came up was staffing shortages.  But WHY were the floors always short?!  Growing up in the nursing field since a kid, 16 years old, I have seen many issues with violence against nursing staff.  It wasn’t until I became a nursing instructor is when the dots were connecting.  Between lateral and patient on nurse violence, who would want to come to work and deal with that every day?  Unless you enjoy the constant negativity, I would have to say this was a direct correlation of why the turnover and injuries are high and job satisfaction scores are so low.  My fellow advocate groups shooting for more staffing are marvelous and respect their cause as it indirectly relates to mine.  Partnered with a couple of my closest friends that are connected but respect my vision, have supported me through this venture and grateful to them for believing in me.  To be honest, I am sure they thought by now I would have given up on this cause but there is no way.

My vision for Nurses Against Violence Unite, Inc, a non-profit 501 (c) (3) is to create an education plan, as it is coming along nicely, to fill the gap of acute mental health and addiction that is a missing piece in the nursing curriculum.  There is also roughly 25 hours of mental health training in the nursing frameworks that equates to minimal chronic mental health training and awareness.  With the opioid epidemic combined with other substances, nurses are learning from an ancient curriculum.  It needs to be modern and reflects the current trends in healthcare.  October 2, 2017 was our first free event and plan to continue to them as education is number one along with therapeutic interventions for nursing staff that are on the front line in healthcare.

The events will continue to be free and donations will start to be accepted.  With donated funds, we will continue the events, build scholarships for nursing students, build a community online and in-person to help nurses be heard without retaliation or bullying, and resources for nurses to receive free to discounted private therapeutic services that are separate from their employer.  Nursing is about caring about others and have been in the field for over 27 years, yes dating myself, we are a family that argues and can still love each other equally, as this is what we do.  A team of professionals that have your back and laugh with often because we are a silly and resilient profession that need to stick together to make the change we need in nursing.

If you hate what is happening in nursing, help us change it!

Dr. Sandra Risoldi

Nurses Against Violence Unite: Stop the Bleeding of Frontline Nursing Staff

Nurses and healthcare staff feel unsupported and leaving the field altogether due to unsafe work environments and lack of organizational support.

Join Our Facebook Support Group for Healthcare workers: #NursesAgainstViolenceUnite

Nurses and all those that help us with our jobs are at risk for our safety, have less than adequate training which should focus on prevention, not solely on the de-escalation of verbally aggressive patients and their families. We are losing nurses and healthcare staff every day and feel as if we do not have a voice, as our employers discourage us to report, make every effort to silence us while making vicious retaliation attacks, by also using micromanagement and attempts to ruin careers. When we do report an incident or injured on the job, we are frowned upon, made an example of and many have lost their jobs because of the injuries they received. There are many issues that still need to be addressed with the Workplace Violence Bill 1309, that was recently passed.

Workplace Violence Bill 1309

Other areas that need to be added for clarity:

1) Clear reporting on the computerized program for reporting incidents, to not be under the tabs labeled “miscellaneous” or “provision of care”. By having the titles unclear, the reports are not accessible to count.

2) Implement anonymous reporting for workers who are afraid to report, encrypted by a government system so the employer cannot detect the person to retaliate against.

3) Offer therapeutic services as a 3rd party vendor and no way connected to the partnered agency. This will enable the healthcare provider to feel safe and move onto recovery.

4) Overhaul OSHA’s system to have a healthcare sector that does not make recommendations but instead, OSHA will enforce investigation of retaliation within the organization.

5) Behavior Prevention programs designed with systemwide training that is not monopolized by a single company and have frameworks applied that target the problem. It should be mandatory for all healthcare agencies to build from the provided extensive frameworks without the healthcare worker being penalized by losing their job for making an error by hyperextending an inch farther due to fear of being injured or trying to shield and protect themselves.

6) Lateral violence of demeaning, hateful, targeted behavior to another staff member including turning pumps off without a rationale, not assisting with potentially violent or upset patients or family members, and not blending the acuity fairly with the patient assignments, should not be tolerated.

7) Implement acuity to patient ratios with algorithms to assist and color coding to mild to severity patient care, including mental health incorporated with medical.

8) Mental health/addiction in nursing education is subpar and schools are not preparing nurses for the reality of societal trends, resulting in the newly graduated nurse not being prepared. This includes behavior from other nurses or healthcare staff that have endured high levels of stress, burn-out, and PTSD. According to the recent ANA study, 1 in 4 nurses are suffering from workplace violence, and these represent those individuals that have reported.

9) Organizations to offer light-duty positions for all healthcare workers. Many nurses and healthcare staff would rather continue to work while injured and should have this option.

10) Organizations should not use personal time off that is accrued for injuries that occurred on the clock, and the employer’s obligation to keep the healthcare worker safe. Instead, organizations have been taking the earned time off to supplement the employee’s time off from work. This is a form of retaliation, as the recipient is a victim of violence.

11) Workers Compensation should cover mental health, including PTSD for employees that witness severe self-injurious behavior (suicide) of the patient or the person being attacked by a patient.

12) Penalties to employers with high turn-over and investigated for the root of the issue, such as employees being afraid to come forward, and offer a retraining program to assist in the retention of healthcare staff.

13) Increased security measures, cameras in all garages, hallways including patient rooms, drug and weapon dogs, police officers with tasers — more than 1–2 security personnel in the facility. Trained behavior techs, CNA’s and nurses should be on every unit in every facility, to have an enhanced violent code team that immediately intervenes without a delay of a code team to arrive.

14) Streamline police reports through the reporting system and the police to take the report on-site and not on the employee’s own time. The incident happened during working hours and should not be penalized to report it on their own time.

15) Have therapists round the clock who are in-house to assist with patients suffering from acute mental illness, or escalating to be called for assistance.

16) All patients that consciously threaten to cause bodily harm, stalk, harass, physically attack or cause the worker to fear for their own safety should be held accountable and punished to the fullest extent of the law. If the patient was incompetent, the employer should be held accountable.

Our Polls:

Do you feel safe at work?

9,510 participants reached, 547 votes 71% No 29% Yes

Have you suffered Lateral/Horizontal Violence from co-workers or administration?

5,971 participants reached, 279 votes 81% Yes 19% No

Please sign and share this petition as we are on the verge of making a huge impact in our profession. More things will be added along the way, but this is the data from doctoral project research, and from all valued members who participate in Nurses Against Violence Unite, Inc. Without your voice, we cannot get the protection we need to feel safe in our roles. This is the change that We have been asking years for…Our Time is NOW!!

Click Here — >

Peacefully marching to fruition

Let’s face it…this march is happening and solidifying an end to one of the most difficult transitions into the most prestigious category both in education and career.  Why a march to #EndHealthCareViolence ?  Well, my question is, why not?!  Isn’t it about time? Aren’t the lives of my co-workers, those that work in the thick of things…aren’t their lives worth anything?

When determining the path of my DNP project, I could have easily picked something simple, easy-breezy, and complicated it with something unmeaningful with enough passion to graduate -or- focus on something that has affected myself and others personally, to create social change.  The culture of nursing, in particular, is one that I am very familiar with.  Not so much about patient on nurse violence personally, as I would ask to have the most volatile patients on the floor, but how nurses not only treat each other but how they are treated by administration and co-workers.

At the time, I was working as a nursing professor, working on the curriculum from the Department of Education, finding the connection with all the hard data that I could gather, interviews, past experiences, latest issues, and societal trends in nursing, there was something terribly wrong.  I had been on the floor for approximately 27 years until achieving my MSN Ed, I saw this but did not even realize how big the problem really was.  I was not imagining what was in front of me!  One day my former co-worker asked me about what my project was going to be.  I sat back in my chair, gave her a look in disbelief shaking my head, turning into a smile and said, “You know how you know something and no matter how kind and nice that you make it, it is going to be ugly? I’m going to get kicked out of my clinical setting, I just know it and feel it in my bones”.  She said “what?!”  I just nodded and at that moment, I made a decision that no matter how much backlash that I would get, that my nursing family needed to feel safe and protected, that the violence had to stop.

All these years I saw the abuse, heard the complaints of nothing being done, seen open wounds and bruises from patients on my co-workers over the years, something had to be done.  Some of you reading this might say “yeah no duh” but the fact of the matter was, nothing was truly being done and confirmed while working on my DNP.  I was blacklisted by my former employer, nobody would hire me and it proved even more challenging as the school said DNP or Ph.D. educators were not allowed to mentor me for my clinical rotations.  The clinical rotation was to be in a clinical setting, despite what the AACN Essentials state that it would be acceptable.  So I sold my house, moved 2 hours to the Orlando area to ensure that I had access to a DNP as the psychologist that I was with was approved, but not an assistant Dean of Nursing with their DNP that was 5 miles from where I was living prior to moving.  Sincerely Thankful for those that reached out to help, more than they will ever know.

Why am I saying this?  Did I stop because of a barrier, actually many?  No.  Healthcare violence has to be stopped.  If I picked pressure ulcers or something benign, would there be another nurse injured?  Yes.  Is there legislation being introduced?  Yes.  How many nurses will still be injured until legislation is enacted?  Many!  We need solutions and protection now and funding to make this happen.  The fact of the matter is, we do need legislation but by the time something is done, organizations will turn their head to Joint Commission sentinel events, OSHA recommendations, and the ANA will continue to be ignored.

The time is now to show the world that Nurses & Healthcare workers in the United States are Done with Healthcare Violence.  Our time is now to take back our professions!

Join Us: Peaceful Rally/March 8/2/19 starting at 10am Freedom Plaza, Washington DC then walk down Pennsylvania Avenue to the front of the Capitol.  Friends & Family are Welcome!

Nurses are suffering.

How much more can nurses take when it comes to mental and physical injuries?

Growing up in the nursing field, starting as a nurse’s aid assistant, I fell in love with taking care of patients. It did not matter their background or why they needed help; I was there to help them to not only feel better but to live as close to normal life as possible. As the years progressed, it was apparent that not only I was getting tired, but so were the nurses around me. Achieving every level in nursing, there has only been a progression of increased stress, fewer resources, and more of the same every year. The organizations offer employee assistance programs for nursing staff to discuss their troubles and issues they are facing if they do not feel supported. The EAP is linked to the organization, and employee records have a higher incidence of exposure to reveal issues about the organization. Is this fair? No, of course not. Does it happen? Absolutely.

There have been more incidences than not that are not being reported, due to the fear of the organization penalizing the nurse reporter. Happens all the time and has pushed nurses into feeling helpless, that nothing else will get done about the problem, so why even report it. Then we have nurses that are pushing for legislation and acuity. These are gallant acts of heroism, but the real problem is sinister and reveals itself as overwhelming violence in not only the emergency rooms but trickling to the floors such as medical/surgical units, telemetry, orthopedics, and anywhere there is an observation or emergency holding bed in the hospital. Patients are transferred to these units where nurses are not trained to work with behavior issues that could present.

Is there a hole in the education system? Yes. Being a nursing professor in recent years, I have seen firsthand and created curriculum from the board of nursing approved frameworks.  The information that is given is vague and does not offer much to nursing schools that are equally understaffed to create frameworks in a subject that the professor is not familiar with. For example, you may have a nursing professor that was a chemo nurse for about one year and have a total of two years then become a nursing chair for the department and overlooks curriculum. How about a maternity nurse teaching mental health? What do they know about mental health or addiction? 

One of the largest failures in nursing is the education system and the lack of administration to be proactive and adhere to the trends in healthcare. Right now, we are in a full-blown opioid epidemic, and nothing is addressed in schools for curriculum modifications or withdraw protocols to assist nurses in determining and preventing patient on nurse attacks. This is what Nurses Against Violence Unite, Inc. which is a 501 c (3) nonprofit geared towards educating, empowering and eliminating violence in the workplace. Other initiatives will be to offer low fee to free third-party therapeutic services to help nurses, and healthcare workers receive care in a safe space without feeling of retaliation.

Join us on FaceBook: #NursesAgainstViolenceUnite Community