Nursing resilience and workplace safety: Solutions that address root problems

July 24, 2018
Terry Zysk, CEO, LiveProcess

In April, the Joint Commission1 addressed physical and verbal violence against healthcare workers in its publication, Sentinel Event Alert, revealing some worrying statistics:

  • Of the 25,000 workplace assaults reported to the Occupational Safety and Health Administration (OSHA) annually, 75% were in healthcare and social service settings
  • Workers in healthcare settings are four times more likely to be victimized than workers in private industry

It’s not surprising, then, that the Nursing Executive Center (NEC) named reducing concerns about workplace safety as one way healthcare leaders can create an environment to support a resilient workforce.

Nursing burnout is driven by feelings as well as overwork

In an earlier blog post, we met FRED: Frantically Running Every Day. FRED is a physical phenomenon resulting from heavy demands on nurses to be in many places at once. But FRED can also be emotional. The Frantic in FRED reflects both the logistical reality of nursing and the high levels of adrenaline that contribute to burnout.

Drawing from interviews with frontline nurses and nursing leaders, NEC wrote “nurses don’t feel equipped to respond to point-of-care safety threats.”

Nurses are prepared to react quickly, skillfully, and consistently in stressful healthcare situations. To maintain resilience, however, they need to feel confident that they, their coworkers, and their facility are also prepared for other kinds of emergencies.

Healthcare communication technology helps prepare for faster, more appropriate responses

Nurses often care for people who are experiencing fear, vulnerability, anger, or shock. Older or heavily medicated patients may become disoriented and anxious. Those extreme emotions can fuel situations in which a caregiver feels unsafe. Many nurses report incidents2 of abusive language and physical assault, including spitting, biting, punching, choking, or using medical equipment as a weapon.

Hospitals can ameliorate this issue by establishing clear communication protocols. Key elements of successful programs included getting the right staff members to assist, and having them assist quickly, before a situation turns violent.

Calling in and justifying the need for help slows the process and discourages action. Having safety codes and alert notifications pre-templated in a communication solution allows a nurse to call the alert to safety personnel with one touch, so help arrives quickly.

Pre-created groups based on role or skillset can also ensure that both nurse and patient are assisted by the appropriate responders. Possible response groups could include one or more of the following:

  • Security

Often the need for security arises not from the patient but from visitors. When visitors agitate a patient or interfere with care, a nurse can alert security to escort visitors away.

  • De-escalation team

Joint Commission standards3 do not allow security to intervene with patients unless clinical staff is present. When patient behavior is the cause, a de-escalation team comprised of security staff, a nurse supervisor, and trained de-escalation responders can provide more appropriate support.

  • Behavioral emergency response team (BERT)

Many patients come to the hospital with a behavioral health condition, such as depression, anxiety, addiction, or psychosis, which can impact behavior and treatment. A specialized response team trained in defusing mental health crises, with or without chemical or physical restraints, can minimize danger.

  • Using mobile healthcare communication for reducing incidents, relieving stress

For most of these episodes, choosing silent, mobile notifications will have significant advantages over an overhead page. For example, a multi-modal communication platform allows nurses to use the communication device nearest at hand, whether that’s a computer on wheels (COW), a mobile phone, or even a panic button. Notifications to and from mobile devices are more discreet, which may help with de-escalation efforts.

Using mobile communication devices also permits two-way communications. If a nurse can see that the message has been received and supporters are responding, tension will already begin to decrease. Even when a nurse is unable to view responses immediately, receipt and response information is recorded in the platform. This tracking can also create documentation for later analysis to adjust staffing levels or other factors contributing to workplace safety.

Hospitals interviewed by the NEC reported excellent results from implementing specialized response teams:

  • 36% decrease in workplace violence injuries
  • 69% decrease in workers’ compensation budget

Most notably, these hospitals could report that staff felt safer, more supported, and more prepared. For example, after the implementation of BERT, surveyed staff indicated:

  • 75% felt safer at work
  • 75% felt comfortable working with patients experiencing a behavioral health emergency
  • 90% believed that BERT helped them improve their own de-escalation skills

With anxieties about workplace safety reduced, nurses will still be busy, but they are less likely to be Frantically Running. Nurses can deliver care efficiently and compassionately with FRED out of the way, so they are less likely to experience burnout.

References 

  1. https://www.jointcommission.org/assets/1/18/SEA_59_Workplace_violence_4_13_18_FINAL.pdf
  2. https://www.statnews.com/2015/11/20/nurses-patient-violence/
  3. https://www.jointcommission.org/assets/1/6/05_02_Security_Role_Patient_Management.pdf

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