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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 — > http://chng.it/WWvXZxwfcX

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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