Vital Views

Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Like many professions, nursing is not immune to workplace violence. Whether acts of aggression are verbal, physical, or emotional, the impacts remain the same, putting staff and patients at risk. Often it can be argued trouble can be neutralized early on if proper training and education are provided. So, how can nurses and other healthcare professionals gauge the level of potential danger? Joining us today is Dr. Kayla Sullivan, UNLV assistant professor and registered nurse here in Las Vegas. As a doctor of nursing practice student, Dr. Sullivan's research focused primarily on identifying and minimizing workplace violence, specifically for practicing nurses. Dr. Sullivan, thanks for coming in.

Kayla Sullivan 0:44
Thank you for having me.

Joe Gaccione 0:46
When we say workplace violence, how do we define that?

Kayla Sullivan 0:48
So, the National Institute of Occupational Safety defines it as any act of aggression towards someone that is on their job. Now, there's a few different kinds of violence, right? We have verbal violence, this is saying derogatory things to someone, yelling at someone, for example. Then you also have your physical violence, so that's actually, you know, hitting, kicking, biting, punching, attacking, physically on someone.

Joe Gaccione 1:17
Are we talking patients against nurses, nurses against patients, or nurses against nurses? Is it all encompassing?

Kayla Sullivan 1:24
I would say there is some of all of that goes into workplace violence, but primarily we're looking at patient towards healthcare workers and or family members towards healthcare workers as well.

Joe Gaccione 1:38
How do we spot workplace violence in in the workplace? I mean, obviously, if someone's attacking someone else physically, that's easy, but I guess what about more, the more subtle ways when we talk about verbal or or emotional abuse?

Kayla Sullivan 1:51
So, we think about more of like our psychology 101, I guess, and looking at different triggers that, that we see. And with patients or with family members, it can be really simple things like pacing around the room, starting to speak more loudly and more like aggressively towards who they're talking to, staring, you know, aggressively staring at someone as well, doing like hand motion motions. Flicking tapping things, you know, when you start tapping a leg, something like that. So there's little cues that we can look at to determine, “Okay, this person is potentially on the path to becoming aggressive, whether it be verbally or physically towards someone.”

Joe Gaccione 2:33
How prevalent are we talking about when it comes to workplace violence in the nursing field?

Kayla Sullivan 2:37
So the Emergency Nurses Association actually says that healthcare workers are at a 3.8 times higher risk for experiencing workplace violence than any other private sector in America. So this is pretty, pretty common. The Bureau of Labor Statistics also states that nurses account for 46% of all non-fatal workplace violence events and when you're thinking about every single kind of job, job market out there, 46% of it is on nurses, which is pretty significant.

Joe Gaccione 3:15
I mean, it's almost half. What are some of the root causes?

Kayla Sullivan 3:18
So, I would say that there's a variety of things. The research says that primarily we think about communication factors and environmental factors. So communication factors are those, you know, patients, family members, think of when you go into the ER. To you, that's your emergency, right? Whatever your situation that's happening, it's emergent to you, but it may not be emergent to an emergency nurse or an emergency physician, right? Because we are looking at, “Can you breathe,” you know, “Do you have a gunshot wound, something? Are you dying? Are you bleeding out on us? Are you having a heart attack?” Those, you know, or a stroke, to us, those are our emergent things. Those are the things that we have to prioritize versus, you know, some other diagnosis. So communication where patients feel that they don't get communicated to properly, right? “Why have I been sitting in the ER lobby for three hours? I, I'm having an emergency.” Well, we understand that it's an emergency to you, but we have other people coming in ambulance, whatever, whatever the situation is behind the scene, that maybe people don't see that those people are either dying or close to dying, that we have to manage them first. So patients and family members do really report that they feel like they aren't communicated with enough, so I think that that's something us as nurses, healthcare providers, you know, anyone on the other side of it can work towards really educating our patients on what's going on in their care and usually that can calm a lot of nerves. Now sometimes you get people, unfortunately, that they can't be reasoned with, and that happens. The other thing would be environmental factors, so that's kind of like your long wait times in the, in the. ER lobby, maybe there's not enough beds, so you're literally sitting in a chair in a hallway in an emergency room, which I'm sure does not feel very good, like, we don't like taking care of people in hallways either. It's not fun for us to, you're exposed to everyone, so it's understandable that you would get frustrated or irritated in this situation. So just, those are some of the things that we deal with.

Joe Gaccione 5:23
It has to be challenging as a nurse, as a physician, as any healthcare provider, because you are, you do legitimately care about the patient and you want to give everyone the best treatment possible, but you have an order, like a process to go through, not just like your, your own medical health checklist, but also severity of patients too, because like you said, it's important to me if I'm going in with what's potentially a broken arm, for example, but if someone's been shot, I mean, it's like you're trying to weigh, you're trying to, you can't make everyone happy, but it's not because you don't care, it's just because you're trying to manage resources, but you also have a different process. You can't be elevated as much as a patient or a family member because if you're at this high level of stress to match theirs, then that patient's not gonna get the care because now you're already, you're as emotional as them and you can't perform as well. What are the short and long-term impacts of WPV, workplace violence?

Kayla Sullivan 6:20
So there's quite a bit actually. It, it shows that nurses can suffer from their own mental health risks, depression, anxiety, stress. They can have unpleasant emotions. They can also have physical health risks too, right? If they're getting punched, kicked, wherever that is. Stress related, chronic conditions can happen. You really get some threats to like your professional integrity as well. Loss of interest in work, loss of compassion and loss of, you know, understanding for patients. I guess a word to use would be kind of jaded in the sense where they're just burnt out on it and it really is a disruption and to patient care too. So, having to deal with all these things over and over again, right, we're human as well. It takes a toll on us as well. So being able to manage that appropriately is something we probably need to work at with educating nurses and healthcare providers as well on top of hopefully decreasing workplace violence as well.

Joe Gaccione 7:24
Are there any post-COVID numbers or, I guess, technically still COVID numbers that show incidents increasing over the past couple years?

Kayla Sullivan 7:34
So I haven't seen any like in the official published research quite yet, but during my DNP project, I did survey nurses and asked, “Did you feel like workplace violence increased during COVID, stayed the same, or you don't know?” And about 68%, I believe that's number, of nurses said that they felt that it had increased during Covid.

Joe Gaccione 7:56
That was locally?

Kayla Sullivan 7:57
Locally, yeah. Locally in, in Vegas. So that's a pretty big number as well. And then you had, I had some that said they weren't really sure. Part of the factors in that is that those nurses that responded that way weren't in areas that have more highly prevalent with workplace violence, so that could have been like a contributing factor, is that maybe they didn't see it that often anyways, so it wasn't something that was, you know, like a trigger with them.

Joe Gaccione 8:26
Right. And I guess it's a good time as any to mention that the purpose of this topic isn't to scare potential nurses away, to scare young nurses away and think they're going into a, a hostile work environment. It's merely just to show that like any profession, these things can happen, but especially in nursing because of the circumstances surrounding the work, it can be more likely than other professions. What can a nurse do to de-escalate situations? You mentioned before communication.

Kayla Sullivan 8:53
So we're always trying to prevent things and related to like other topics such as falls or skin breakdown, we're doing assessment tools, so we're assessing the patient and determining, entering it into a formula, and it gives us XYZ number, and it says, “Okay, well that number tells us that this patient is at a moderate risk for falls.” Okay, well, they haven't fallen yet, so let's put some interventions in place to prevent them from falling, whether that be, in the hospital, we have yellow gowns, sticky socks, a notification on the door stating, “This patient is at high risk for falling, everyone kind of be more on their toes.” So, that is something that is becoming more popular in the research with workplace violence is implementing screening tools. So, instead of reacting to someone becoming violent, we're being preventative and we are looking at certain behaviors and determining “Okay, that this patient is on the road to potentially becoming violent, this patient is at a moderate risk for becoming violent, or this patient is already violent.” So, I think that we need to really educate and get those tools into the American healthcare system because there's other countries that are using them, for example, a lot of the research that I worked with was from Australia and Switzerland, so they are already doing these things. And it becomes part of like a rollover shift report to where anytime you are handing a patient off or getting a new patient, you are being told, “Here's their score for their potential to become violent.” So that way we're not caught off, you know, blindsided by it. We are prepared and we can implement tools to hopefully prevent it.

Joe Gaccione 10:41
Does that scoring apply to family members as well, or guests when you have to determine, you're not assessing them necessarily for their health, but also making a note saying, “By the way, this person's father or sister, they've been aggressive since they've came in”?

Kayla Sullivan 10:56
Yeah, so it's something that can be applied to a family friend that's there, just differently is that we wouldn't be like charting it in this system, right? Because it's not in that patient's chart. But family violence and patient violence is a little bit different because if a family member, friend, whatever the situation is, is violent, they usually get kicked out of the hospital and they're not allowed to return unless they are having a medical situation and have to come as a patient, right? So, it's easier to mitigate friend/family violence because they get escorted out by security typically versus a patient. And we don't ever want to do that, you know, we don't wanna separate people because people need people to heal. So, but it, it is something that we can kind of encompass altogether, and it would be more of something that like the nurses are aware of, not something that we're officially documenting anywhere, but just saying, giving like a heads up, “Hey, this event happened during my shift, just so you're aware of it.”

Joe Gaccione 12:00
Let's say you've tried prevent, you know, you have preventative measures, but let's say it's in the moment because sometimes you can't always prevent those, sometimes they just happen as a nurse, you know? Is it just as simple as calling security? Do you try to get as far as restraining someone, if it gets to that point? I mean, do you, do you recommend that for nurses or do you caution, you know, “Don't get involved unless it's absolutely necessary”?

Kayla Sullivan 12:21
So in the hospital setting, typically, you get trained on how to like physically defend yourself, how to safely, physically, like bring someone down to the ground, right? Safely so you don't get injured, so the patient doesn't get injured, and that we're not causing any harm to the patient because sometimes you do get patients that are like, not only are they causing harm to their environment and their surroundings, but they're at potential risk to themselves as well. So we do get trained for that. In my personal experience, it can be difficult to execute that training when it's not something that you're used to doing. If I'm not used to not, not really, I don't wanna say a fighter, but, you know, if someone gets violent with me, I'm not used to regularly getting into those moves. So I personally focus on de-escalating with trying to, with communication. And then calling security is, usually, we have panic buttons in the hospital, so if something were to go wrong, you literally just press a button and they get notified, notified where it is, so they know where to come to help.

Joe Gaccione 13:33
What are available resources out there for people that may wanna learn more about this? Are there local resources centers? Are there national links that you recommend based on your research? For people that are like, “Hey, if I'm a nurse and I wanna know more about this,” are there specific trainings for this?

Kayla Sullivan 13:48
So I would say the best thing to do is gonna be determined on like the hospital system and facilities that you work in and the area, right? So, if you're working in an emergency department or an acute psych facility, you're gonna be at more risk for those workplace violence incidents, whether it be verbal or physical. So really knowing where you're working and what they offer to you and what's available, and how they handle and manage, you know, incidents, that's really what I would suggest to any new nurse, is just being aware of how the place that you're gonna work operates and what they have implemented to keep patients safe and yourself safe.

Joe Gaccione 14:33
And as of this recording, Dr. Sullivan's research is getting more recognition. In fact, your abstract on managing workplace violence was recently accepted for the Western Institute of Nursing. Is that correct?

Kayla Sullivan 14:46
Yeah, that is. I'm really excited to present and, you know, share my knowledge on the topic with fellow nurses and nurse scientists, and hopefully we can one day get to a point where we can have, you know, a standardized assessment tool that we can use to really help prevent this.

Joe Gaccione 15:07
Well, that is all the time we have. Dr. Sullivan, thank you so much for coming in.

Kayla Sullivan 15:11
Thank you for having me.

Joe Gaccione 15:12
Thanks for listening out there. Hope you have a great day.