- Email: [email protected]
Creating a Safer Work Environment
EMERGENCY NURSING ADVOCACY
CREATING
A
SAFER WORK ENVIRONMENT
Author: Cindy L. Hearrell, RN, BA, CEN, Fredericksburg, VA Section Editor: Kathleen A. Ream, BA, MBA
Earn Up to 8 CE Hours. See page 272.
doi: 10.1016/j.jen.2009.01.010
perienced physical violence weekly.2 With the mindset of health care providers that these assaults are part of the job, these numbers have likely been underreported. Not only do we need to report these incidents, we also need to be more proactive in making assault on health care workers a felony like it is in many states for police officers and prehospital providers. In 2008, numerous states had bills introduced that were directed at workplace violence. Many of these measures increased penalties for assault on health care workers, whereas others focused on mandating education and safety efforts to reduce violence in health care settings. The New York State Nurses Association, for example, has been instrumental in promoting legislation aimed at violence against nurses in that state. Its bill would make it a class C felony to assault and cause physical injury to a registered nurse or licensed practical nurse while on duty.3 Although the bill did not pass in 2008, the New York State Nurses Association will be continuing its efforts in the upcoming legislative session. In addition to making assault on health care workers a felony, efforts need to be made to educate staff on how to create a safe work environment. The Occupational Safety and Health Act of 1970 mandates that in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious harm. In 1993, California was the first state to enact legislation that required acute care and psychiatric facilities to implement comprehensive workplace violence programs.4 Programs to educate nurses and health care workers on workplace violence prevention are vital to address this growing problem. The education should include overviews of the hospital policy, risk factors for possible assaults, and potential warning signs of escalating aggressive behavior. In addition, staff members need to feel comfortable with reporting any acts of workplace violence. As a health care provider, you play an important role in workplace safety. Take an active role by looking at what your facility currently does for violence prevention. Then take a look at your local and state regulations that address assault on health care workers. If there are no regulations covering assault on health care workers, begin by establishing supportive networks of your peers and possible legislative
242
JOURNAL OF EMERGENCY NURSING
R
ecently, while I was reading the local newspaper, an article describing an assault on a community police officer caught my attention. A young man was arrested for driving under the influence, and while he was being detained, he kicked out the window of the cruiser. The flying glass resulted in the officer receiving minor lacerations to his face, and the individual was charged with assault on a police officer. Now move this scene into your emergency department. The same individual is now a patient who becomes combative and strikes the bedside nurse. Security is called, and the patient may receive a chemical sedative, but no mention of assault on a health care worker is made. This scenario has been considered a part of the job, and routinely, no legal action has been taken. As health care providers, our role is to provide care and a safe environment for our patients, but we also need to provide a safe work environment for ourselves. Being assaulted at work is not “part of the job,” and as health care providers, we need to become more involved in protecting ourselves while on the job and to take action when we are threatened by workplace violence. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assault) directed toward persons at work or on duty.”1 The US Bureau of Labor Statistics reports that there were 69 homicides in health care services from 1996-2000. In 2000, 48% of all nonfatal injuries from occupational assaults and violent acts occurred in health care and social services.1 In 2007, the Emergency Nurses Association’s Violence in the Workplace Work Team conducted an online survey of the ENA membership. In responses from 3,465 nurses, approximately 23% experienced physical violence monthly and 20% exCindy L. Hearrell, Member, Virginia State ENA Council, Rappahannock Chapter, is Trauma Program Director, Mary Washington Hospital, Fredericksburg, VA. For correspondence, write: Cindy L. Hearrell, RN, BA, CEN, Mary Washington Hospital, 1001 Sam Perry Blvd, Fredericksburg, VA 22401; E-mail: [email protected]. J Emerg Nurs 2009;35:242-3. Available online 12 March 2009. 0099-1767/$36.00 © 2009 Emergency Nurses Association. Published by Elsevier. All rights reserved.
35:3 May 2009
EMERGENCY NURSING ADVOCACY/Hearrell
supporters. For more information on workplace violence and to obtain some helpful tools to further your work, go to the “Government and Advocacy” section of the ENA Web site; the toolkit on workplace violence can be found at http://www.ena.org/government/Advocacy/Violence/default.asp. To assist you in working with your employers and your legislators, this advocacy packet contains tools such as sample legislation, a “how-to” checklist, talking points, and other supporting literature on workplace violence and safety legislation. Emergency departments serve many types of people with various needs. Frequently, the visit to the emergency department places individuals and their families in a stressful situation, bringing out unusual behaviors. The bedside nurse can become the victim when violence is the outlet for their stress—from the grandmother who has dementia and is now in an unfamiliar setting to the chronic pain sufferer who becomes outraged when he or she is unable to get a medication refill. Emergency nurses need to feel safe at work. Mandatory education programs and stronger laws can help make this possible. As you undertake an advocacy role in decreasing workplace violence, you can take personal pride in the fact that you are doing something to
May 2009 35:3
make your work environment a safer place for yourself, your peers, and your patients. REFERENCES 1. US Department of Labor. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care & social service workers. 2004. Available at: www. osha.gov. Accessed December 27, 2008. 2. ENA study measures impact of workplace violence on emergency nurses. ENA Connection December 2008;32:8. 3. Medical News Today. Nurses association calls for laws to crack down on violence against RNs. 2008. Available at: www.medicalnewstoday. com. Accessed: December 28, 2008. 4. Peek-Asa C, Casteel C, Allareddy V, Nocera M, Goldmacher S, OHagen E, et al. Workplace violence prevention programs in hospital emergency departments. J Occup Environ Med 2007; 49:756-63.
Submissions to this column are encouraged and may be sent to Kathleen A. Ream, BA, MBA [email protected]
JOURNAL OF EMERGENCY NURSING
243
CREATING
A
SAFER WORK ENVIRONMENT
Author: Cindy L. Hearrell, RN, BA, CEN, Fredericksburg, VA Section Editor: Kathleen A. Ream, BA, MBA
Earn Up to 8 CE Hours. See page 272.
doi: 10.1016/j.jen.2009.01.010
perienced physical violence weekly.2 With the mindset of health care providers that these assaults are part of the job, these numbers have likely been underreported. Not only do we need to report these incidents, we also need to be more proactive in making assault on health care workers a felony like it is in many states for police officers and prehospital providers. In 2008, numerous states had bills introduced that were directed at workplace violence. Many of these measures increased penalties for assault on health care workers, whereas others focused on mandating education and safety efforts to reduce violence in health care settings. The New York State Nurses Association, for example, has been instrumental in promoting legislation aimed at violence against nurses in that state. Its bill would make it a class C felony to assault and cause physical injury to a registered nurse or licensed practical nurse while on duty.3 Although the bill did not pass in 2008, the New York State Nurses Association will be continuing its efforts in the upcoming legislative session. In addition to making assault on health care workers a felony, efforts need to be made to educate staff on how to create a safe work environment. The Occupational Safety and Health Act of 1970 mandates that in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious harm. In 1993, California was the first state to enact legislation that required acute care and psychiatric facilities to implement comprehensive workplace violence programs.4 Programs to educate nurses and health care workers on workplace violence prevention are vital to address this growing problem. The education should include overviews of the hospital policy, risk factors for possible assaults, and potential warning signs of escalating aggressive behavior. In addition, staff members need to feel comfortable with reporting any acts of workplace violence. As a health care provider, you play an important role in workplace safety. Take an active role by looking at what your facility currently does for violence prevention. Then take a look at your local and state regulations that address assault on health care workers. If there are no regulations covering assault on health care workers, begin by establishing supportive networks of your peers and possible legislative
242
JOURNAL OF EMERGENCY NURSING
R
ecently, while I was reading the local newspaper, an article describing an assault on a community police officer caught my attention. A young man was arrested for driving under the influence, and while he was being detained, he kicked out the window of the cruiser. The flying glass resulted in the officer receiving minor lacerations to his face, and the individual was charged with assault on a police officer. Now move this scene into your emergency department. The same individual is now a patient who becomes combative and strikes the bedside nurse. Security is called, and the patient may receive a chemical sedative, but no mention of assault on a health care worker is made. This scenario has been considered a part of the job, and routinely, no legal action has been taken. As health care providers, our role is to provide care and a safe environment for our patients, but we also need to provide a safe work environment for ourselves. Being assaulted at work is not “part of the job,” and as health care providers, we need to become more involved in protecting ourselves while on the job and to take action when we are threatened by workplace violence. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assault) directed toward persons at work or on duty.”1 The US Bureau of Labor Statistics reports that there were 69 homicides in health care services from 1996-2000. In 2000, 48% of all nonfatal injuries from occupational assaults and violent acts occurred in health care and social services.1 In 2007, the Emergency Nurses Association’s Violence in the Workplace Work Team conducted an online survey of the ENA membership. In responses from 3,465 nurses, approximately 23% experienced physical violence monthly and 20% exCindy L. Hearrell, Member, Virginia State ENA Council, Rappahannock Chapter, is Trauma Program Director, Mary Washington Hospital, Fredericksburg, VA. For correspondence, write: Cindy L. Hearrell, RN, BA, CEN, Mary Washington Hospital, 1001 Sam Perry Blvd, Fredericksburg, VA 22401; E-mail: [email protected]. J Emerg Nurs 2009;35:242-3. Available online 12 March 2009. 0099-1767/$36.00 © 2009 Emergency Nurses Association. Published by Elsevier. All rights reserved.
35:3 May 2009
EMERGENCY NURSING ADVOCACY/Hearrell
supporters. For more information on workplace violence and to obtain some helpful tools to further your work, go to the “Government and Advocacy” section of the ENA Web site; the toolkit on workplace violence can be found at http://www.ena.org/government/Advocacy/Violence/default.asp. To assist you in working with your employers and your legislators, this advocacy packet contains tools such as sample legislation, a “how-to” checklist, talking points, and other supporting literature on workplace violence and safety legislation. Emergency departments serve many types of people with various needs. Frequently, the visit to the emergency department places individuals and their families in a stressful situation, bringing out unusual behaviors. The bedside nurse can become the victim when violence is the outlet for their stress—from the grandmother who has dementia and is now in an unfamiliar setting to the chronic pain sufferer who becomes outraged when he or she is unable to get a medication refill. Emergency nurses need to feel safe at work. Mandatory education programs and stronger laws can help make this possible. As you undertake an advocacy role in decreasing workplace violence, you can take personal pride in the fact that you are doing something to
May 2009 35:3
make your work environment a safer place for yourself, your peers, and your patients. REFERENCES 1. US Department of Labor. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care & social service workers. 2004. Available at: www. osha.gov. Accessed December 27, 2008. 2. ENA study measures impact of workplace violence on emergency nurses. ENA Connection December 2008;32:8. 3. Medical News Today. Nurses association calls for laws to crack down on violence against RNs. 2008. Available at: www.medicalnewstoday. com. Accessed: December 28, 2008. 4. Peek-Asa C, Casteel C, Allareddy V, Nocera M, Goldmacher S, OHagen E, et al. Workplace violence prevention programs in hospital emergency departments. J Occup Environ Med 2007; 49:756-63.
Submissions to this column are encouraged and may be sent to Kathleen A. Ream, BA, MBA [email protected]
JOURNAL OF EMERGENCY NURSING
243