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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

Ready or Not!

We are in a nursing crisis.  Working in nursing pretty much all of my life, I have seen a lot of issues from patients spitting, punching, biting, kicking and slamming nurses against walls.  Is this behavior acceptable?  Absolutely not!  It has been my mission to advocate for others and help them to advocate for themselves, so helping nurses is one of my highest passions.

Nearing the end of my DNP (Doctor of Nursing Practice) project and program, I am honored to have had the privilege of working with some of the best healthcare professionals that have helped me navigate through the doctoral process.  They have helped me grow my focus instead of patient on nurse abuse but the overall picture.  It took me a very long time to get others around me to see the problem and proud that they would look at me like I was insane!  Needless to say, it is important to educate everyone about the issues that we face and give support to all nurses and healthcare workers.

 

Circle of Violence

Lateral and patient/family on nurse abuse has gotten so out of control that in the news we are reading more and more nurses are committing suicide.  We need to really help ourselves as nurses, through education and helping one another or the violence is only going to get worse.  Some may agree with what I am about to say, others may really get offended, but as nurses, we need to hold ourselves accountable and fix what we can with this mess we are in.  Legislation is what we also need for increased security and mandate hospitals to provide protections, but also education to keep us safe.  My goal is to help nurses through education and to hopefully prevent another injury.

So let’s be objective, shall we?

Here is a scenario:

Nurses suffer an enormous amount of abuse —>  Nurse has her 5th admission for the day—> Nurse cannot eat or go to the bathroom as they are slammed! —> Nurse files a report about the verbal or physical abuse —> Nurse Manager starts writing the reporter up for things they did wrong —> Reporting Nurse tries to recoup and stops reporting —> Nurse still has not had a break since she started the shift, even yesterday for that matter! —> Nurse sneaks to the bathroom —> Nurse is being paged, bed 8 is screaming —> Patient is punching the nurses’ aid —> Nurse tries to stop the battery, blocks the CNA and gets hit.

…How would you feel?  Pleasant?  Hardly!  Definitely defeated, upset, feeling like you could do more, what did you do, and in pain but afraid to report it because you know that you are under a magnifying glass.  Face it, we are human too and have a tough job without a moment or a day to recover, we are forced to get back up and keep going.  If the nurse is needing help and asks for help, will she get it?  Probably not because all the other nurses are busting tail just as much as the nurse that needs help!

Will the nurse manager step in?  Maybe or maybe not, depends on how their boss views teamwork and patient care.  If the nurse manager calls into her meeting, will the DON or administration be forgiving?  Wait…she just wrote the nurse up, no way is that nurse going to her!  The patient is #1 but also, what about the nurse?  Staffing is bad, patients are mean, the staff is grouchy, bed 8 just clocked her in the head…and this has the other 6 patients to care for.  Smile and keep going is the current culture of nursing and we are losing nurses just as fast as gaining them to an already struggling profession.

As a side note, I decided to look into how much education there is on acute mental illness, addiction in nursing school.  Barely any.  The Florida professional and practical nurse frameworks have minimal requirements for mental illness and substance abuse.  Is there a de-escalation program offered to nurses on med/surg?  Probably not!  Injuries are not being reported due to retaliation and accepted as “a part of the job” and “nobody will do anything anyway”.  So being that nurses are in fact human beings, the nurse may indirectly start behaving like an abuser.  Yes…I know I am about to get blacklisted from the unapproving reader but really think about it.   How much abuse can 1 person take?

Is this nurse going to be happy or mean?  I would have to say appearing to be quite kind and happy but the underlying personal family history and built up pressures or abuse, maybe not.  This nurse may be having increased anxiety progressing toward burn-out and post-traumatic stress disorder (PTSD).  Some may call it compassion fatigue, to me, that sounds like another fancy name to cover up a huge problem in nursing.  Police and first responders get more recovery time than a nurse!  The nurse calls off, the floor is short, no fill-in for their spot….so nurses have increased their patient load by 1 patient.  Will they be happy?  Probably not.  Will there be increase patient errors?  Unfortunately yes, it puts the patient and nurse at risk.

Education is power and the elimination of violence in the workplace.

Workplace Retaliation

The theme of my research is patient violence against nurses…but there are more sources.  Nurses have messaged and thanked me for taking the stand against violence in the workplace.  When I took on this sensitive topic, it was apparent that this would be a very unpopular topic among employers.  I too have been retaliated against throughout my career, but that has not stopped me.  I feel that it is important to bring our profession up to speed with the rapidly changing patient population through education and tactics to decrease our nurses from being injured.

Retaliation is when someone returns a perceived attack.  The nurse reporting is not attacking the organization but truly trying to bring to light an issue that is occurring on their unit.  When looking at the nursing indicators laid out by the American Nurses Association, it was not surprising to see that psychiatric physical assault and nursing turnover were both on the list.  I personally have seen and talked with nurses that have been injured, that have stated they have reported a physical attack and have been told that they perpetrated and caused the person to attack them.  All the while the nurse stands in their own blood, suspended until an investigation is completed…with no pay.  So about underreporting…this is one of the reasons.

Understanding the bottom line and the costs involved in advertising, interviewing, hiring, and training new nurses and nursing staff, is it truly necessary to look for new help when you already have great nurses?  Not at all.  Playing the advocate role for the nurses that leave their positions, a majority are leaving because they are not being heard, tired of being hurt by patients, while being told that they could have done a better job.  When a patient hurts them, the nurse composes themselves trying to brush it off, while smiling and caring for the other 4-6 patients that they are assigned…without a bathroom break…or lunch…or a moment to sit down to rest.  If the nurses and nursing staff report a problem, please listen, we are on the front line of patient care.

I love being a nurse, we are a tough bunch that love our patients.

Shouldn’t we be loved too?

 

WPV: Reporting Barriers

The one thing that I have found while educating the staff over the years, is a mix of psychology where most nurses are taught between 2-4 weeks of psych in their rotation and want more understanding about how to treat this population.  The next area is negative reinforcement by rewarding the bad behavior, such as ordering more pain medication, giving PRN’s on a timed basis just so they “will have a good shift and not get beat up”.  When a nurse understands the importance of why reporting is necessary, I have found they are more receptive.  The holes of the computerized system not relaying the “misc” data, which is where WPV is reported, does not label or track the data.  The computerized reporting system does not have WPV as an option and if it is charted as miscellaneous, it is not capturable for statistical reasoning.  The average time for reporting in the computerized system is 10-15 minutes juggled between the other 4-6 patients that also may not be staffed according to acuity.  The nurse simply does not have time.

Another barrier, which is pretty huge, is the fact that when a nurse is hurt and reports the incident, there is no provided light duty so the nurse is forced to out on worker’s compensation and to use their banked time (PTO) to make up the difference.  Let me stress…the nurse is not only injured, but they are victimized again by being forced off the floor due to not having provided light duty and a third victimization by losing their hard earned and rewarded PTO time.  In some facilities, sick time is PTO.  As a result, the injured nurse forces themselves to manage, report it to the next nurse, and keep on moving with a smile as patient satisfaction is #1.  The end result, the nurse developing burn-out and possibly Post-Traumatic Stress Disorder.

Environmental Exposures of Mental Illness

Mental health can be affected by various environmental agents.  Several contributors that enhance and bring about mild to acute mental illness include nutritional deficiencies, injuries, alcoholism, illicit drug use, or victimization (National Institute of Mental Health [NIMH], 2017).  Situational stress, such as natural disasters or seasonal affective disorder, can also be a causative agent of an individual’s mental well-being (Heekin & Polivka, 2015).  Mental health can also be a genetic factor.  In 2016, adults suffering from mental illness reached approximately “44.7 million, where women were the largest population affected at 21.1 percent versus the males at 14.5 percent” of the total amount presented (National Institute of Mental Health, 2017, figure 1).  Due to the nature of women having a hormone imbalance, such as serotonin, where levels can be low and be a contributor to developing depression and anxiety (Young, 2018).  A combination of “lower socioeconomic status or stressors” that are related to “job loss, financial hardships, and changing schools” are a few additions to increasing mental illness among both females and males (Heekin & Polivka, 2015, p. 5).

Environmental health risk

As we all know and have heard that when you lead a stressful life, you can become ill.  There are many outcomes from the environmental exposure to stressors.  There is a decrease in life expectancy by “10-25 years”, which could be a result from the development of chronic diseases, such as “heart disease, infectious disease, hypertension, diabetes, and suicide” (World Health Organization [WHO], n.d., para. 1).  Nearly “one in five adults in the United States lives with a mental illness”, which equates to “44.7 million individuals in 2016”, with individuals between “18-25 years with two or more races” (NIMH, 2017, para. 4).  With a large number of those with mental illness comes with a cost of “$89 million in 2013, and with serious mental illness, $193 million reported in 2008” (Kamal, 2017, figure 27).

Health disparities

While working with acute mental health patients for years in various healthcare environments, the background of those I worked with were from a lower socioeconomic situation, including those that are homeless.  However, mental illness can affect anyone.  For the purposes of this discussion, when you have someone that is suffering from mental illness, they often do not keep up with their appointments or check-ups with the psychiatrist or with the primary.  Not to seem controversial in our discussion, but from my experience, patients that are hard to talk with, such as those with schizophrenia, borderline personality, or bipolar, nurses really have a hard time separating the subjective from the objective data.  When a patient says they are fine and ramble off into a tangent, the nurse will get nervous and either end the physical assessment stating that were non-compliant or they take for granted that since the appearance looks normal that they are of sound mind.  To fix this issue, effective communication would be the key to help the nurse to complete their thorough assessment and not the issues the patient may be having.  More times than not, I have found abscesses and septic patients from my time on the floor which infection can also contribute to behavior issues.

References

Heekin, K., & Polivka, L. (2015, November). Environmental and economic factors associated with mental illness. The Claude Pepper Center, 1-16. Retrieved from https://coss.fsu.edu/subdomains/claudepeppercenter.fsu.edu_wp/wp-content/uploads/2016/02/Environmental-and-Economic-Factors-Associated-with-Mental-Illness-Manuscript.pdf

Kamal, R. (2017). What are the current costs and outcomes related to mental health and substance abuse disorders [Report]. Retrieved from https://www.healthsystemtracker.org/chart-collection/current-costs-outcomes-related-mental-health-substance-abuse-disorders/#item-eighteen-percent-adults-united-states-mental-behavioral-emotional-disorder

National Institute of Mental Health. (2017). Mental illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Schmidt, C. W. (2007, August). Environmental connections: A deeper look into mental illness. Environmental Health Perspectives, 115, A404-A410. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1940091/

World Health Organization. (n.d.). Premature death among people with severe mental disorders [Report]. Retrieved from http://www.who.int/mental_health/management/info_sheet.pdf

Young, J. L. (2015). Women and mental illness. Retrieved from https://www.psychologytoday.com/us/blog/when-your-adult-child-breaks-your-heart/201504/women-and-mental-illness

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Reporting: Patient on Nurse Violence

          There is an influx of verbal and physical abuse that is affecting nurses throughout that United States and the world.  According to the American Nurses Association in the latest survey and response to the Joint Commission sentinel event, is that “62 percent of nurses had experienced verbal or physical abuse” (American Nurses Association [ANA], 2018, para. 4).  Working on the floor myself for 26 years, until last year taking a teaching position, verbal and physical abuse is a common occurrence no matter what unit that you worked on.  Experiencing first hand the morale of the staff when it came to the effectiveness of reporting incidents to the unit managers or administration, and nothing changes.  The rationale given by nurses is that they believe that their patients are not in their right mind when they lash out at the nurse and leaves them unsure of what constitutes as a violent act (The Joint Commission, 2018).  The nurses that do report the incident usually give a verbal report of the issue to the supervisor, and since it is not in writing, the incident may not be available to pass along for policy changes (Arnetz et al., 2015).

Strategies for stakeholder participation

            Awareness of the problem and formulation of a plan is the first step in the process of creating a policy (Laureate Education, Inc. (Executive Producer), 2011).  One of the strategies for stakeholder participation is through implementing an education plan for nursing professionals and practitioners focusing on the barrier to reporting incidents.  When analyzing the structure of an organizational policy that is in place, the facility should have reported data in their system, if not then this would be the best place to start.  The goal should be finding out why there is no data that reflects patient on nurse injuries.  When nurses state that they obtained lasting injuries, then ask them if they reported it, many times they will tell you no due to “nothing being done to fix the problem.”  One reason for underreporting can include a “lack of reporting policy, lack of faith in the reporting system, and the fear of retaliation” from the organization (Occupational Safety and Health Administration [OSHA], n.d., p. 2).  Many places have a no tolerance policy when it comes to workplace violence.  However, the verbiage is mainly geared towards lateral violence and not upheld when the incidents happen.  When it comes down to be a patient safety issue, patient on nurse violence is huge.  The rationale is, if a nurse is injured, staffing is often reduced, leading to job dissatisfaction, and eventual nursing turnover.

References

American Nurses Association. (2018, April 18). ANA responds to the Joint Commission sentinel event alert on physical and verbal violence against healthcare workers. Nursing World.

Arnetz, J. E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M. J., Russell, J., & Essenmacher, L. (2015, May). Underreporting of Workplace Violence. Workplace Health & Safety, 200-210. https://doi.org/10.1177/2165079915574684

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and the policy process [Video file]. Retrieved from https://class.waldenu.edu/bbcswebdav/institution/USW1/201870_27/DR_NURS/NURS_8100_WC/USW1_NURS_8100_week03.html

Occupational Safety and Health Administration. (n.d.). Workplace violence in healthcare; Understanding the challenge. Retrieved from https://www.osha.gov/Publications/OSHA3826.pdf

The Joint Commission. (2018). Physical and verbal violence against health care workers. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_59_Workplace_violence_4_13_18_FINAL.pdf

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