WEBVTT 00:00:16.000 --> 00:00:18.470 position:50% align:middle - [Maryann] Welcome back, everyone. 00:00:18.470 --> 00:00:27.960 position:50% align:middle We are now going to embark upon another serious conversation, violence in the workplace. 00:00:27.960 --> 00:00:32.560 position:50% align:middle I'd like to begin by having our panelists introduce themselves. 00:00:32.560 --> 00:00:33.000 position:50% align:middle Tim. 00:00:33.000 --> 00:00:35.080 position:50% align:middle - [Timothy] Yeah, my name is Timothy Tull. 00:00:35.080 --> 00:00:42.250 position:50% align:middle I'm the Vice President of Safety and Security at Rochester Regional Health System in New York. 00:00:42.250 --> 00:00:44.620 position:50% align:middle - [Kathleen] I'm Kathleen Poindexter. 00:00:44.620 --> 00:00:49.570 position:50% align:middle I'm currently Interim Associate Dean for Academic Affairs at Michigan State University, 00:00:49.570 --> 00:00:54.010 position:50% align:middle College of Nursing, and Immediate Past Chair of the National League for Nursing. 00:00:54.010 --> 00:00:57.430 position:50% align:middle - [Gary] Good morning. I'm Gary Lescallett. 00:00:57.430 --> 00:01:01.630 position:50% align:middle I'm the Deputy Regional Administrator for OSHA here in Chicago, Illinois. 00:01:01.630 --> 00:01:02.750 position:50% align:middle - [Bogdan] Good morning. 00:01:02.750 --> 00:01:04.010 position:50% align:middle My name is Bogdan Catalin. 00:01:04.010 --> 00:01:10.174 position:50% align:middle I'm the Enforcement Programs Coordinator here in OSHA Region 5, Chicago. 00:01:10.174 --> 00:01:10.920 position:50% align:middle - [Kristin] Good morning. 00:01:10.920 --> 00:01:12.180 position:50% align:middle My name Kristin Benton. 00:01:12.180 --> 00:01:16.040 position:50% align:middle I'm the Executive Director with the Texas Board of Nursing. 00:01:16.040 --> 00:01:23.610 position:50% align:middle We regulate over 500,000 licensed vocational nurses, registered nurses, and advanced practice nurses. 00:01:23.610 --> 00:01:30.090 position:50% align:middle And we also regulate over 200 pre-licensure nursing education programs. 00:01:30.090 --> 00:01:31.710 position:50% align:middle - Thank you all. 00:01:31.710 --> 00:01:40.060 position:50% align:middle Before we begin, I'd like to introduce a video that was sent to us by Congressman Joe Courtney of Connecticut. 00:01:40.060 --> 00:01:45.290 position:50% align:middle He wanted to be here today, but unfortunately, his schedule conflicted, 00:01:45.290 --> 00:01:46.800 position:50% align:middle and he sent us a short message. 00:01:46.800 --> 00:01:49.880 position:50% align:middle - [Cong. Courtney] This is Congressman Joe Courtney. 00:01:49.880 --> 00:01:52.140 position:50% align:middle I wish I could be with you in person. 00:01:52.140 --> 00:01:58.050 position:50% align:middle The issue of workplace violence is something which, as a member of the Education and Labor Committee, 00:01:58.050 --> 00:02:01.520 position:50% align:middle myself and others have been working on for a number of years. 00:02:01.520 --> 00:02:08.240 position:50% align:middle We asked, again, I think it's about eight years ago, to have a Government Accountability Office to do 00:02:08.240 --> 00:02:18.220 position:50% align:middle a study, to try and really get a clear picture of what the rates and frequency of workplace violence that's 00:02:18.220 --> 00:02:19.980 position:50% align:middle happening in this profession. 00:02:19.980 --> 00:02:27.230 position:50% align:middle And the GAO report, which took a number of years, they're really the gold standard in terms of research, 00:02:27.230 --> 00:02:37.040 position:50% align:middle in terms of different agencies here on Capitol Hill, presented a very strong and somewhat disconcerting 00:02:37.040 --> 00:02:42.830 position:50% align:middle but clear picture about the fact that compared to other sectors of the U.S. 00:02:42.830 --> 00:02:51.790 position:50% align:middle economy, the frequency of workplace violence far exceeds, again, any other profession or occupation. 00:02:51.790 --> 00:02:58.180 position:50% align:middle And I think many of you know the sort of depressing statistics that it's five times more frequent in the 00:02:58.180 --> 00:03:01.580 position:50% align:middle health care sector than it is in any other sectors in the economy. 00:03:01.580 --> 00:03:05.370 position:50% align:middle A totally unacceptable level of violence. 00:03:05.370 --> 00:03:09.660 position:50% align:middle There's a lot of reasons that's driving that, which many of you are familiar with in terms 00:03:09.660 --> 00:03:14.830 position:50% align:middle of behavioral health issues, the opioid crisis. 00:03:14.830 --> 00:03:20.310 position:50% align:middle It verified the fact that we really have a situation that has to be addressed with the 00:03:20.310 --> 00:03:22.340 position:50% align:middle public policy response. 00:03:22.340 --> 00:03:30.200 position:50% align:middle And prevention is clearly the best approach in terms of avoidance of risk and avoidance of injury. 00:03:30.200 --> 00:03:38.200 position:50% align:middle And from that GAO report, we crafted legislation, the Workplace Violence Prevention for Health Care 00:03:38.200 --> 00:03:42.740 position:50% align:middle Workers and Social Workers, legislation which has been introduced and reintroduced 00:03:42.740 --> 00:03:45.570 position:50% align:middle over the last number of Congresses. 00:03:45.570 --> 00:03:54.820 position:50% align:middle The good news is there's a huge coalition out there of folks from different parts of the health care setting 00:03:54.820 --> 00:03:59.520 position:50% align:middle that have banded together in terms of pushing this legislation forward. 00:03:59.520 --> 00:04:04.750 position:50% align:middle Another encouraging sign is that it's bipartisan and bicameral. 00:04:04.750 --> 00:04:11.100 position:50% align:middle We have had actually a number of votes in the House when Democrats were in control, 00:04:11.100 --> 00:04:16.850 position:50% align:middle which had a very respectable bipartisan tally in terms of getting the bill off the floor of the House, 00:04:16.850 --> 00:04:18.980 position:50% align:middle and up to the Senate. 00:04:18.980 --> 00:04:20.920 position:50% align:middle And that continues today. 00:04:20.920 --> 00:04:23.880 position:50% align:middle We have introduced a bill for the 118th Congress. 00:04:23.880 --> 00:04:32.530 position:50% align:middle Again, it uses tried and true practices in terms of reducing risk in the health care setting. 00:04:32.530 --> 00:04:42.020 position:50% align:middle And we know, again, from anecdotal evidence that using smart, intelligent measures to make sure that people 00:04:42.020 --> 00:04:45.820 position:50% align:middle are not alone with high risk patients, that there's training, 00:04:45.820 --> 00:04:51.250 position:50% align:middle real training in terms of what to do, since most folks in the nursing profession are really 00:04:51.250 --> 00:04:55.280 position:50% align:middle not equipped to sort of respond to acts of violence. 00:04:55.280 --> 00:05:01.800 position:50% align:middle And there's also good data collection in terms of really trying to find out where the hotspots are. 00:05:01.800 --> 00:05:10.500 position:50% align:middle But I believe that our bill is the swiftest way to really get a regulatory framework that is not onerous 00:05:10.500 --> 00:05:12.230 position:50% align:middle to health care providers. 00:05:12.230 --> 00:05:13.410 position:50% align:middle We've run the numbers. 00:05:13.410 --> 00:05:20.510 position:50% align:middle This is really just a fraction of the overhead and administrative costs of health care in terms of getting 00:05:20.510 --> 00:05:23.170 position:50% align:middle these measures put into place. 00:05:23.170 --> 00:05:26.560 position:50% align:middle And we need all the help that we can get. 00:05:26.560 --> 00:05:33.850 position:50% align:middle So to the extent that the State Council and the National Council of State Boards wants to embrace 00:05:33.850 --> 00:05:36.890 position:50% align:middle this effort, we really welcome it. 00:05:36.890 --> 00:05:40.880 position:50% align:middle I'll just end by saying that, unfortunately, two weeks ago in my congressional district 00:05:40.880 --> 00:05:47.560 position:50% align:middle in Eastern Connecticut, a home health nurse lost her life in a home visit 00:05:47.560 --> 00:05:51.040 position:50% align:middle for someone who was on a sex offender list. 00:05:51.040 --> 00:05:57.410 position:50% align:middle She was alone at the time that she entered the dwelling. 00:05:57.410 --> 00:06:04.930 position:50% align:middle And unfortunately, it's an example of where different kinds of practices where she was not going to be alone 00:06:04.930 --> 00:06:10.870 position:50% align:middle with a high-risk patient that had been clearly identified, really could have literally meant the 00:06:10.870 --> 00:06:12.470 position:50% align:middle difference between life and death. 00:06:12.470 --> 00:06:16.970 position:50% align:middle And it just is a reminder, like so many of these incidents, 00:06:16.970 --> 00:06:20.860 position:50% align:middle is that we can't sort of let this issue just slide by. 00:06:20.860 --> 00:06:27.600 position:50% align:middle We've really got to focus together as like-minded people to get this measure passed. 00:06:27.600 --> 00:06:37.970 position:50% align:middle And I hope this panel and this National Council meeting will really give us additional strength in terms 00:06:37.970 --> 00:06:40.570 position:50% align:middle of accomplishing this end goal. 00:06:40.570 --> 00:06:42.750 position:50% align:middle So thank you for listening. 00:06:42.750 --> 00:06:49.140 position:50% align:middle If you or other folks have follow-up questions, please feel free to reach out to my office. 00:06:49.140 --> 00:06:50.300 position:50% align:middle Thank you for listening. 00:06:50.300 --> 00:06:53.970 position:50% align:middle And again, I hope you have a great panel discussion. 00:06:53.970 --> 00:07:00.080 position:50% align:middle - Well, Congressman Courtney, we're certainly grateful to you for championing this 00:07:00.080 --> 00:07:01.970 position:50% align:middle very important issue. 00:07:01.970 --> 00:07:07.100 position:50% align:middle And now I'm going to turn to our panel. 00:07:07.100 --> 00:07:13.870 position:50% align:middle Gary, Bogdan, I'm going to read you some statistics. 00:07:13.870 --> 00:07:22.850 position:50% align:middle The U.S. Bureau of Labor Statistics found that health care workers account for 73% of all nonfatal workplace 00:07:22.850 --> 00:07:27.110 position:50% align:middle injuries and illnesses due to violence. 00:07:27.110 --> 00:07:36.850 position:50% align:middle Registered nurses suffer a disproportionate share of this violence, with violent events accounting for 12% 00:07:36.850 --> 00:07:44.730 position:50% align:middle of all injuries to RNs, approximately 3 times greater than the rate of violent 00:07:44.730 --> 00:07:48.000 position:50% align:middle offense for all occupations. 00:07:48.000 --> 00:07:56.330 position:50% align:middle Estimates suggest workplace violence causes 17% of nurses to leave their job every year. 00:07:56.330 --> 00:07:58.340 position:50% align:middle This is a significant problem. 00:07:58.340 --> 00:08:03.550 position:50% align:middle What types of violence are we seeing? 00:08:03.550 --> 00:08:11.340 position:50% align:middle - I can share with you that just this week, Bogdan and I were on a call with our Workplace Violence 00:08:11.340 --> 00:08:13.680 position:50% align:middle coordinators from across the country. 00:08:13.680 --> 00:08:21.880 position:50% align:middle And at any one given time, we probably have...I will say maybe four to eight 00:08:21.880 --> 00:08:29.280 position:50% align:middle workplace violence incidents being actively investigated in each of our regions. 00:08:29.280 --> 00:08:38.600 position:50% align:middle Probably the most common incidents that we see, biting, punching, scratching are not uncommon, 00:08:38.600 --> 00:08:41.590 position:50% align:middle but those go clear up to sexual assaults. 00:08:41.590 --> 00:08:50.800 position:50% align:middle Some very, very unfortunate situations with what we'll call the forgotten shift. 00:08:50.800 --> 00:08:55.070 position:50% align:middle The second shift and third shifts in the institutions. 00:08:55.070 --> 00:08:59.450 position:50% align:middle I don't know if there are any other examples, Bogdan, that you'd like to share. 00:08:59.450 --> 00:09:00.210 position:50% align:middle - Certainly. 00:09:00.210 --> 00:09:07.770 position:50% align:middle We see a lot of patient-on-staff violence as well as visitor-on-staff violence. 00:09:07.770 --> 00:09:10.590 position:50% align:middle That's not uncommon. 00:09:10.590 --> 00:09:18.580 position:50% align:middle And certainly we see trends in the overnight shifts and weekends when, unfortunately, 00:09:18.580 --> 00:09:21.020 position:50% align:middle there is a staff shortage. 00:09:21.020 --> 00:09:27.040 position:50% align:middle - Kristin, is this a regulatory issue? 00:09:27.040 --> 00:09:28.890 position:50% align:middle - Absolutely. 00:09:28.890 --> 00:09:35.300 position:50% align:middle We know that workplace violence creates an unsafe environment for practice, 00:09:35.300 --> 00:09:38.090 position:50% align:middle and can lead to errors in patient care. 00:09:38.090 --> 00:09:48.530 position:50% align:middle - So it's really a serious problem that I think a lot of people outside the health care industry are not 00:09:48.530 --> 00:09:50.410 position:50% align:middle really aware of. 00:09:50.410 --> 00:09:54.680 position:50% align:middle So let me ask you, what is being done to prevent this? 00:09:54.680 --> 00:09:58.600 position:50% align:middle Tim, you come from a hospital setting. 00:09:58.600 --> 00:10:02.400 position:50% align:middle Tell us about the prevalence, if you experience it there, 00:10:02.400 --> 00:10:04.300 position:50% align:middle and what you're doing to prevent it. 00:10:04.300 --> 00:10:09.200 position:50% align:middle - Yeah, if it's okay before I do, I want to touch on something that the 00:10:09.200 --> 00:10:10.560 position:50% align:middle congressman had mentioned. 00:10:10.560 --> 00:10:11.660 position:50% align:middle - Absolutely. 00:10:11.660 --> 00:10:14.270 position:50% align:middle - It's a complicated environment that we're dealing with. 00:10:14.270 --> 00:10:16.600 position:50% align:middle This isn't just in brick and mortar. 00:10:16.600 --> 00:10:22.540 position:50% align:middle On a daily basis, we send out about 450 nurses to home health and hospice, meaning they're 00:10:22.540 --> 00:10:24.040 position:50% align:middle out in somebody else's home. 00:10:24.040 --> 00:10:26.820 position:50% align:middle It's an uncontrolled environment for me. 00:10:26.820 --> 00:10:31.490 position:50% align:middle So in the hospital, I can add some infrastructure to make things a little safer, 00:10:31.490 --> 00:10:34.790 position:50% align:middle and we can have a sense of teamwork and support for each other. 00:10:34.790 --> 00:10:39.390 position:50% align:middle But when you're in a home by yourself, it's a different environment. 00:10:39.390 --> 00:10:44.400 position:50% align:middle And so for us, because of that, part of our emphasis is empowering our staff. 00:10:44.400 --> 00:10:46.690 position:50% align:middle And we're doing that through a lot of training. 00:10:46.690 --> 00:10:49.770 position:50% align:middle So we're offering a de-escalation course. 00:10:49.770 --> 00:10:53.410 position:50% align:middle We're offering situational awareness, how to be aware of your environment, 00:10:53.410 --> 00:11:01.580 position:50% align:middle and understand the cues maybe that there's a violent issue potentially. 00:11:01.580 --> 00:11:02.950 position:50% align:middle And on top of the... 00:11:02.950 --> 00:11:06.090 position:50% align:middle And we try to do that in a very practical way. 00:11:06.090 --> 00:11:13.270 position:50% align:middle The de-escalation class that we offer for all staff comes from actually my law enforcement background. 00:11:13.270 --> 00:11:17.250 position:50% align:middle I taught a tactical communication class at the police academy. 00:11:17.250 --> 00:11:20.980 position:50% align:middle We've kind of morphed that and made it practical for health care. 00:11:20.980 --> 00:11:26.780 position:50% align:middle And then we offer a reality-based training that accompanies that de-escalation, 00:11:26.780 --> 00:11:31.170 position:50% align:middle meaning I would teach all of you, we'll talk about conceptually what de-escalation 00:11:31.170 --> 00:11:36.230 position:50% align:middle looks like, and how to do that successfully, and when to recognize that maybe it's not going to work 00:11:36.230 --> 00:11:38.910 position:50% align:middle and you need to disengage and get help. 00:11:38.910 --> 00:11:43.030 position:50% align:middle And then at the conclusion of that conversation, we send you down the hall with some role players, 00:11:43.030 --> 00:11:46.360 position:50% align:middle and we actually have you go through that process so that it's ingrained. 00:11:46.360 --> 00:11:47.810 position:50% align:middle People learn in different ways. 00:11:47.810 --> 00:11:50.300 position:50% align:middle We want to make sure that we touch everybody as best we can. 00:11:50.300 --> 00:11:52.970 position:50% align:middle - How long does it take to learn that? 00:11:52.970 --> 00:11:55.370 position:50% align:middle - Oh, my goodness, I'm still working on it. 00:11:55.370 --> 00:11:56.150 position:50% align:middle It's a lifetime. 00:11:56.150 --> 00:11:58.720 position:50% align:middle I'm always trying to improve and do a little better, right? 00:11:58.720 --> 00:12:04.880 position:50% align:middle But the course we offer is a half-day course to get people, at least initially, up to speed and understand. 00:12:04.880 --> 00:12:08.540 position:50% align:middle And then there's levels from there that they can actually come and attack. 00:12:08.540 --> 00:12:13.080 position:50% align:middle - Do nurses volunteer to come, or is it a requirement? 00:12:13.080 --> 00:12:16.160 position:50% align:middle - That's a great question. 00:12:16.160 --> 00:12:21.320 position:50% align:middle They volunteer mostly, but we really emphasize hard for our home health staff, 00:12:21.320 --> 00:12:28.070 position:50% align:middle in particular our ED staff, we're encouraging all of them to come very strongly. 00:12:28.070 --> 00:12:31.480 position:50% align:middle Labor and delivery seems like sometimes there's some issues up there. 00:12:31.480 --> 00:12:38.510 position:50% align:middle So the hotspots that we see where we have a lot of violence, it's still voluntary, 00:12:38.510 --> 00:12:41.930 position:50% align:middle but there's an emphasis placed on it. 00:12:41.930 --> 00:12:49.190 position:50% align:middle - Have you seen any reduction or fewer incidences because nurses are taking that course? 00:12:49.190 --> 00:12:49.720 position:50% align:middle - I think we are. 00:12:49.720 --> 00:12:53.070 position:50% align:middle We're seeing some successful de-escalation. 00:12:53.070 --> 00:12:57.750 position:50% align:middle And part of the de-escalation process is actually teamwork. 00:12:57.750 --> 00:13:01.420 position:50% align:middle One has to recognize the de-escalation class isn't just how to calm somebody down. 00:13:01.420 --> 00:13:02.370 position:50% align:middle It's not that. 00:13:02.370 --> 00:13:05.670 position:50% align:middle It's how to recognize when there's potential violence coming. 00:13:05.670 --> 00:13:07.190 position:50% align:middle It's how to address that violence. 00:13:07.190 --> 00:13:12.460 position:50% align:middle It's also dealing with your own biases and triggers to make sure you're not actually unintentionally 00:13:12.460 --> 00:13:14.000 position:50% align:middle escalating a problem. 00:13:14.000 --> 00:13:19.700 position:50% align:middle But it's also understanding if I'm...you and I are coworkers, and I'm hearing the language that 00:13:19.700 --> 00:13:22.990 position:50% align:middle you're using, there's triggers that are going to let me know, "Oh, you need help." 00:13:22.990 --> 00:13:23.150 position:50% align:middle Right? 00:13:23.150 --> 00:13:25.130 position:50% align:middle And I'm going to stop what I'm doing and I'm going to help. 00:13:25.130 --> 00:13:27.510 position:50% align:middle So we have a big emphasis on teamwork as well. 00:13:27.510 --> 00:13:28.290 position:50% align:middle - Okay. 00:13:28.290 --> 00:13:29.460 position:50% align:middle One final question. 00:13:29.460 --> 00:13:30.210 position:50% align:middle - Please. 00:13:30.210 --> 00:13:38.400 position:50% align:middle - Should a nurse be going into a home situation by herself or himself? 00:13:38.400 --> 00:13:39.810 position:50% align:middle - It's such a great question. 00:13:39.810 --> 00:13:44.580 position:50% align:middle And that's a difficult thing that we wrestle with because there's...the solution is hard. 00:13:44.580 --> 00:13:48.880 position:50% align:middle We have a program right now where, one, we want them to listen to their intuition. 00:13:48.880 --> 00:13:52.570 position:50% align:middle So if you pull up to a home, and you're going to go in to see a patient, 00:13:52.570 --> 00:13:54.470 position:50% align:middle and for whatever reason you're not comfortable. 00:13:54.470 --> 00:13:56.060 position:50% align:middle The environment's not right. 00:13:56.060 --> 00:13:57.500 position:50% align:middle It feels tense. 00:13:57.500 --> 00:13:59.970 position:50% align:middle There's other people there that you didn't expect. 00:13:59.970 --> 00:14:02.930 position:50% align:middle Whatever the thing is, we want you to listen to your intuition, 00:14:02.930 --> 00:14:06.880 position:50% align:middle we want you to call your supervisor, let them know the situation. 00:14:06.880 --> 00:14:11.170 position:50% align:middle And then we have the ability to send two people out. 00:14:11.170 --> 00:14:14.000 position:50% align:middle So an extra RN might go with you. 00:14:14.000 --> 00:14:20.980 position:50% align:middle And we also, for some of the more high-crime areas and some of the homes that we've had repeat issues, 00:14:20.980 --> 00:14:25.420 position:50% align:middle we have the ability to send security out with you actually. 00:14:25.420 --> 00:14:26.880 position:50% align:middle But it's difficult. 00:14:26.880 --> 00:14:27.520 position:50% align:middle It's not easy. 00:14:27.520 --> 00:14:28.850 position:50% align:middle There's logistical problems. 00:14:28.850 --> 00:14:31.310 position:50% align:middle When you call and tell me, "I'm at a house and I'm not comfortable." 00:14:31.310 --> 00:14:32.950 position:50% align:middle Now I have to get somebody to you. 00:14:32.950 --> 00:14:36.460 position:50% align:middle I've got a 20-minute, half-hour delay before that person arrives where you're 00:14:36.460 --> 00:14:37.500 position:50% align:middle just waiting in the car. 00:14:37.500 --> 00:14:39.120 position:50% align:middle And meanwhile, the day has backed up. 00:14:39.120 --> 00:14:43.060 position:50% align:middle So there's the practical application we still wrestle with. 00:14:43.060 --> 00:14:44.110 position:50% align:middle It's a little difficult. 00:14:44.110 --> 00:14:47.820 position:50% align:middle But it's an area that we are still pursuing. 00:14:47.820 --> 00:14:57.580 position:50% align:middle - Kathleen, I'm sure your school has a community rotation where students have to go into people's homes. 00:14:57.580 --> 00:15:00.520 position:50% align:middle Do you do anything to prepare them for that? 00:15:00.520 --> 00:15:03.680 position:50% align:middle - And again, that's a wonderful question. 00:15:03.680 --> 00:15:07.920 position:50% align:middle And we were actually discussing this prior to our meeting here. 00:15:07.920 --> 00:15:09.850 position:50% align:middle And it is a challenge. 00:15:09.850 --> 00:15:12.120 position:50% align:middle And for nursing students, we know that they're even in more 00:15:12.120 --> 00:15:14.340 position:50% align:middle of a vulnerable position. 00:15:14.340 --> 00:15:18.600 position:50% align:middle Less than 19% of violence issues are reported. 00:15:18.600 --> 00:15:26.220 position:50% align:middle And students probably report even less, and they're put in truly a power over position. 00:15:26.220 --> 00:15:29.330 position:50% align:middle And we know that health care is moving into the communities. 00:15:29.330 --> 00:15:34.200 position:50% align:middle We're seeing more hospitals at home, and there's a lot of pressure to prepare the future 00:15:34.200 --> 00:15:36.880 position:50% align:middle workforce for that type of a workplace environment. 00:15:36.880 --> 00:15:40.350 position:50% align:middle And it is a concern, is how can we keep them safe? 00:15:40.350 --> 00:15:46.090 position:50% align:middle Talking with some of our health care partners, they have tracking systems in place where there's 00:15:46.090 --> 00:15:51.070 position:50% align:middle emergency response buttons that they can call that they're piloting at this time. 00:15:51.070 --> 00:15:54.470 position:50% align:middle Perhaps looking at that same type of tracking system with their students. 00:15:54.470 --> 00:15:58.940 position:50% align:middle But I think most important, it's giving our students the tools to, one, 00:15:58.940 --> 00:16:06.030 position:50% align:middle recognize and the security to say...that psychological safety, to say, "It's okay to say you're 00:16:06.030 --> 00:16:08.580 position:50% align:middle not comfortable, you don't feel safe." 00:16:08.580 --> 00:16:13.610 position:50% align:middle And that we will listen and we'll respond to that concern, and provide the tools. 00:16:13.610 --> 00:16:20.130 position:50% align:middle We know de-escalation does have some positive impact. 00:16:20.130 --> 00:16:22.600 position:50% align:middle Prevention has more. 00:16:22.600 --> 00:16:28.580 position:50% align:middle But it's really a systems organization issue, and it shouldn't be put on the individual who is 00:16:28.580 --> 00:16:31.230 position:50% align:middle essentially the victim of the violence. 00:16:31.230 --> 00:16:36.640 position:50% align:middle And as mentioned earlier, nurses, students are under severe stress. 00:16:36.640 --> 00:16:43.160 position:50% align:middle And we know that stress, and anxiety, and potential depression also escalates it. 00:16:43.160 --> 00:16:46.900 position:50% align:middle Patients are under that same type of adverse situation. 00:16:46.900 --> 00:16:49.660 position:50% align:middle And you put those two situations together. 00:16:49.660 --> 00:16:54.080 position:50% align:middle It's a bigger systems issue that does take policy, it does take organizations, 00:16:54.080 --> 00:16:56.920 position:50% align:middle and it takes the individual as well. 00:16:56.920 --> 00:16:58.630 position:50% align:middle - Absolutely. 00:16:58.630 --> 00:17:03.260 position:50% align:middle So I want to pick up on that word, prevention. 00:17:03.260 --> 00:17:09.550 position:50% align:middle Kristin, I know you're on a workgroup in Texas that addresses this issue. 00:17:09.550 --> 00:17:12.900 position:50% align:middle You address things about prevention and talk about... 00:17:12.900 --> 00:17:13.870 position:50% align:middle Tell us about that. 00:17:13.870 --> 00:17:15.230 position:50% align:middle - Sure. 00:17:15.230 --> 00:17:23.100 position:50% align:middle So several legislative sessions back there was a bill passed that required our Texas Center for Nursing 00:17:23.100 --> 00:17:29.800 position:50% align:middle Workforce Studies to conduct a study on workplace violence, both from the nurse perspective and 00:17:29.800 --> 00:17:33.380 position:50% align:middle the employer perspective. 00:17:33.380 --> 00:17:38.160 position:50% align:middle And not surprisingly, the results demonstrated that this is a significant 00:17:38.160 --> 00:17:42.510 position:50% align:middle safety issue and a significant issue that can affect patient care. 00:17:42.510 --> 00:17:48.880 position:50% align:middle So following that session, another bill was passed that now prevents a 00:17:48.880 --> 00:17:51.530 position:50% align:middle prevention grant program. 00:17:51.530 --> 00:18:00.940 position:50% align:middle And that grant program is funded through a portion of each nurse's licensure renewal fee every two years. 00:18:00.940 --> 00:18:05.240 position:50% align:middle And we're entering into the fourth cycle of that program. 00:18:05.240 --> 00:18:12.220 position:50% align:middle It's not a huge program, but it does provide funding for facilities who may not 00:18:12.220 --> 00:18:19.390 position:50% align:middle have the resources to buy panic buttons for their staff, to put security lighting in the parking lot 00:18:19.390 --> 00:18:27.440 position:50% align:middle where they've had a violent event, embed assessment tools into the electronic health care 00:18:27.440 --> 00:18:34.240 position:50% align:middle record to identify patients who have a history of aggression toward health care workers. 00:18:34.240 --> 00:18:42.440 position:50% align:middle So while they're not full fledged research studies, we are beginning to see some outcomes and beginning 00:18:42.440 --> 00:18:45.120 position:50% align:middle to see some differences. 00:18:45.120 --> 00:18:58.500 position:50% align:middle And each cycle of the grant program, we have all of the grantees provide a webinar 00:18:58.500 --> 00:18:59.780 position:50% align:middle to share their outcomes. 00:18:59.780 --> 00:19:06.550 position:50% align:middle And of course, there's a...you have to have a legislative report to document the details 00:19:06.550 --> 00:19:12.090 position:50% align:middle of each project, and how it went, and what the outcomes were. 00:19:12.090 --> 00:19:16.600 position:50% align:middle And those are all available to the public on the Workforce Center's website. 00:19:16.600 --> 00:19:19.840 position:50% align:middle - How did that group get started? 00:19:19.840 --> 00:19:23.560 position:50% align:middle - So that group got started... 00:19:23.560 --> 00:19:25.910 position:50% align:middle The Workforce Center? 00:19:25.910 --> 00:19:26.030 position:50% align:middle - No, no. 00:19:26.030 --> 00:19:26.840 position:50% align:middle - The grant? 00:19:26.840 --> 00:19:27.540 position:50% align:middle - Yes. 00:19:27.540 --> 00:19:34.790 position:50% align:middle - So the grant program was really the result of collaborative work with the Workforce Center, 00:19:34.790 --> 00:19:39.690 position:50% align:middle the Board of Nursing, and our Nurses Association, the Texas Nurses Association. 00:19:39.690 --> 00:19:45.590 position:50% align:middle They've been looking at this issue for well over a decade, and working really hard to make 00:19:45.590 --> 00:19:47.740 position:50% align:middle some policy changes. 00:19:47.740 --> 00:19:53.160 position:50% align:middle This past session, another policy change that took place, unfortunately, 00:19:53.160 --> 00:20:00.530 position:50% align:middle on the heels of a tragic incident in Dallas where a nurse and a social worker were both killed on a labor 00:20:00.530 --> 00:20:09.650 position:50% align:middle and delivery unit by a felon on parole who cut off his ankle bracelet and entered the facility. 00:20:09.650 --> 00:20:20.830 position:50% align:middle We now can join the other states that expand the criminal penalty from a misdemeanor to a felony in any 00:20:20.830 --> 00:20:22.900 position:50% align:middle department within a health care facility. 00:20:22.900 --> 00:20:28.140 position:50% align:middle - So that is really something that all states could do. 00:20:28.140 --> 00:20:35.200 position:50% align:middle The Board of Nursing could join forces with the professional organizations, the workforce center, 00:20:35.200 --> 00:20:38.110 position:50% align:middle and really put a program like that into place. 00:20:38.110 --> 00:20:47.340 position:50% align:middle - Yes, we're very proud that we're able to find such a program that has such promise to protect patients and, 00:20:47.340 --> 00:20:49.440 position:50% align:middle of course, protect health care workers. 00:20:49.440 --> 00:20:54.700 position:50% align:middle - So I'm going to turn now to Gary, you and Bogdan. 00:20:54.700 --> 00:21:01.070 position:50% align:middle What else can be done to prevent these incidents from happening in health care? 00:21:01.070 --> 00:21:08.120 position:50% align:middle - Well, let's just say that we can all agree that no health care employer wants to see their staff 00:21:08.120 --> 00:21:09.610 position:50% align:middle victimized or assaulted. 00:21:09.610 --> 00:21:10.360 position:50% align:middle Right? 00:21:10.360 --> 00:21:17.100 position:50% align:middle But from a regulatory perspective, I think the solution goes beyond making available 00:21:17.100 --> 00:21:21.370 position:50% align:middle mental health and stress resources, or de-escalation training, 00:21:21.370 --> 00:21:23.540 position:50% align:middle or physical restraint training. 00:21:23.540 --> 00:21:30.980 position:50% align:middle From the investigations that we've conducted in Region 5 and nationwide, we can tell you that there are a 00:21:30.980 --> 00:21:40.060 position:50% align:middle number of deficiencies that we commonly encounter, usually with the implementation and execution 00:21:40.060 --> 00:21:43.400 position:50% align:middle of existing workplace violence prevention programs. 00:21:43.400 --> 00:21:50.620 position:50% align:middle And a lot of that focus is on the incident investigation and after action. 00:21:50.620 --> 00:21:53.650 position:50% align:middle Allow me to offer some examples here. 00:21:53.650 --> 00:21:58.360 position:50% align:middle In terms of incident investigation, we find that incidents of workplace violence are either 00:21:58.360 --> 00:22:04.830 position:50% align:middle not investigated, or perhaps input is not solicited from all the involved parties. 00:22:04.830 --> 00:22:11.880 position:50% align:middle Management, frontline health care workers, security, hospital security, if that was summoned. 00:22:11.880 --> 00:22:21.300 position:50% align:middle We find that incidents are not tracked, and logged, and analyzed for trends and patterns. 00:22:21.300 --> 00:22:28.950 position:50% align:middle And certainly, we find that sometimes the health care systems, the hospitals do not follow up on their own 00:22:28.950 --> 00:22:36.290 position:50% align:middle findings by allocating resources, usually in the form of additional staffing. 00:22:36.290 --> 00:22:41.180 position:50% align:middle And again, I'm providing a general overview of areas where more can be done. 00:22:41.180 --> 00:22:42.670 position:50% align:middle - Absolutely. 00:22:42.670 --> 00:22:44.920 position:50% align:middle Gary, do you have anything to add? 00:22:44.920 --> 00:22:50.950 position:50% align:middle - I think one of the biggest challenges... 00:22:50.950 --> 00:22:55.560 position:50% align:middle I'd heard a panelist earlier talk about being a hero. 00:22:55.560 --> 00:23:05.700 position:50% align:middle And there are very few industries where you're trying to help someone, and while you're trying to help them, 00:23:05.700 --> 00:23:10.700 position:50% align:middle they may be coming at you for one reason or another. 00:23:10.700 --> 00:23:17.380 position:50% align:middle The techniques to seek help, when Tim was talking about it, some facilities, 00:23:17.380 --> 00:23:21.700 position:50% align:middle the procedure is to call 911. 00:23:21.700 --> 00:23:26.900 position:50% align:middle Other procedures, it's in-house security. 00:23:26.900 --> 00:23:32.720 position:50% align:middle We've had cases where the nurses have been discouraged from reaching out to 911, 00:23:32.720 --> 00:23:44.680 position:50% align:middle and having the public perception of the police officers at their facility over and over and over again. 00:23:44.680 --> 00:23:50.510 position:50% align:middle And so talking through those issues, and trying to come up with an internal plan can 00:23:50.510 --> 00:23:53.720 position:50% align:middle sometimes help alleviate that fear of reporting. 00:23:53.720 --> 00:23:55.510 position:50% align:middle I guess I would share that. 00:23:55.510 --> 00:23:58.330 position:50% align:middle - Well, thank you. 00:23:58.330 --> 00:23:58.930 position:50% align:middle Kathleen... 00:23:58.930 --> 00:24:00.000 position:50% align:middle - I am just... 00:24:00.000 --> 00:24:01.310 position:50% align:middle Go ahead. 00:24:01.310 --> 00:24:09.330 position:50% align:middle - Is there anything that you're doing to prepare students for entering the workplace that might help 00:24:09.330 --> 00:24:11.430 position:50% align:middle prepare them for this? 00:24:11.430 --> 00:24:17.770 position:50% align:middle - I was just going to say, and build on what he said, one is the critical importance of allowing the students 00:24:17.770 --> 00:24:23.120 position:50% align:middle who will be the future health care providers the ability to say when they feel 00:24:23.120 --> 00:24:25.480 position:50% align:middle that psychological unsafety. 00:24:25.480 --> 00:24:30.490 position:50% align:middle That they know that they can go someplace, and that they'll be heard and that they 00:24:30.490 --> 00:24:32.110 position:50% align:middle will be supported. 00:24:32.110 --> 00:24:37.140 position:50% align:middle So not only that de-escalation training, because so often that's too late, 00:24:37.140 --> 00:24:38.870 position:50% align:middle but how can they prevent and mitigate? 00:24:38.870 --> 00:24:44.930 position:50% align:middle How can it be okay to say and recognize in yourself that you're feeling stressed, you're feeling anxious, 00:24:44.930 --> 00:24:48.550 position:50% align:middle that you need to address these symptoms that you have? 00:24:48.550 --> 00:24:54.730 position:50% align:middle Because we know that not only impairs learning, but it also impairs our responses and reduces our 00:24:54.730 --> 00:25:00.500 position:50% align:middle tolerance to situations that may escalate quickly. 00:25:00.500 --> 00:25:05.040 position:50% align:middle The other thing is to look at our future leaders, not just in the new nurses, 00:25:05.040 --> 00:25:07.450 position:50% align:middle but in our graduate programs. 00:25:07.450 --> 00:25:08.640 position:50% align:middle Who are our future leaders? 00:25:08.640 --> 00:25:15.660 position:50% align:middle And what is the importance of recognizing this in your future staff, or in your colleagues, or in your peers? 00:25:15.660 --> 00:25:21.910 position:50% align:middle And what can you do and implement within your programs mitigation strategies to prevent the core 00:25:21.910 --> 00:25:23.460 position:50% align:middle issues from occurring? 00:25:23.460 --> 00:25:25.280 position:50% align:middle We are a microcosm of society. 00:25:25.280 --> 00:25:27.110 position:50% align:middle You just have to look at the news. 00:25:27.110 --> 00:25:30.220 position:50% align:middle So we're dealing with it on multiple different fronts. 00:25:30.220 --> 00:25:35.910 position:50% align:middle And we need to be able to create not only those prevention, but what can we do to address it? 00:25:35.910 --> 00:25:44.040 position:50% align:middle Where is the safety net that those nurses, or those students, or faculty can go to to know 00:25:44.040 --> 00:25:44.930 position:50% align:middle that they're okay? 00:25:44.930 --> 00:25:51.490 position:50% align:middle - It's interesting, when I hear the wellness panel and when I hear you all talk, 00:25:51.490 --> 00:25:58.830 position:50% align:middle it seems simple a nurse to reach out and say, "I need some assistance. 00:25:58.830 --> 00:26:04.700 position:50% align:middle This scenario that I'm walking into doesn't feel right." 00:26:04.700 --> 00:26:10.100 position:50% align:middle But that is such a different mindset from what nurses have. 00:26:10.100 --> 00:26:12.860 position:50% align:middle Nurses don't really think that way. 00:26:12.860 --> 00:26:18.350 position:50% align:middle And it really shows that we need a change in the culture, a change in education, 00:26:18.350 --> 00:26:24.790 position:50% align:middle and a change in what we teach nurses how to be and what to do. 00:26:24.790 --> 00:26:26.570 position:50% align:middle We have a few minutes left. 00:26:26.570 --> 00:26:35.140 position:50% align:middle I want to talk about bullying because this also falls under the realm of violence in the workplace. 00:26:35.140 --> 00:26:37.090 position:50% align:middle Some of it can get pretty bad. 00:26:37.090 --> 00:26:42.610 position:50% align:middle Some of it is related to racial and ethnic issues. 00:26:42.610 --> 00:26:44.570 position:50% align:middle What can we do about that? 00:26:44.570 --> 00:26:50.520 position:50% align:middle It seems as though there should be a no tolerance policy in most institutions. 00:26:50.520 --> 00:26:54.120 position:50% align:middle But let me open it up to the group. 00:26:54.120 --> 00:26:56.850 position:50% align:middle Anyone want to take a stab at it? 00:26:56.850 --> 00:27:02.160 position:50% align:middle - I'll just start by saying, as you said, it needs to be a zero tolerance. 00:27:02.160 --> 00:27:08.410 position:50% align:middle And that needs to be obvious and tangible to anyone who steps foot into a facility. 00:27:08.410 --> 00:27:13.220 position:50% align:middle Signage, training, it has to be ongoing. 00:27:13.220 --> 00:27:17.360 position:50% align:middle It can't be a one-time event that checks off the box. 00:27:17.360 --> 00:27:19.360 position:50% align:middle It has to be embedded into the culture. 00:27:19.360 --> 00:27:22.560 position:50% align:middle - I agree with that totally. 00:27:22.560 --> 00:27:27.280 position:50% align:middle You've got to have that type of training, that teamwork training, managerial training. 00:27:27.280 --> 00:27:29.290 position:50% align:middle It has to be from the top down. 00:27:29.290 --> 00:27:33.840 position:50% align:middle And it can't just be expected from those at the front line. 00:27:33.840 --> 00:27:36.720 position:50% align:middle It has to be embedded in the entire culture. 00:27:36.720 --> 00:27:44.360 position:50% align:middle And the understanding of how microaggressions can occur, and how they can be harmful, 00:27:44.360 --> 00:27:48.270 position:50% align:middle and how they can hurt and grow into bigger scenarios. 00:27:48.270 --> 00:27:55.400 position:50% align:middle So, yes, it is not an easy answer, but it is shown to be the root cause of many of the 00:27:55.400 --> 00:27:57.850 position:50% align:middle violent episodes that we see in health care. 00:27:57.850 --> 00:28:02.650 position:50% align:middle And unfortunately, amongst our own horizontal violence in our own profession. 00:28:02.650 --> 00:28:06.030 position:50% align:middle We can start that training again in academia. 00:28:06.030 --> 00:28:13.390 position:50% align:middle - Are you encountering any of the situations where staff actually are issue, 00:28:13.390 --> 00:28:22.340 position:50% align:middle are the problem with causing some type of issues in the workplace that are difficult for nurses to handle? 00:28:22.340 --> 00:28:23.570 position:50% align:middle - We do see that. 00:28:23.570 --> 00:28:27.540 position:50% align:middle I don't think it's the most predominant issue for us, but we see it. 00:28:27.540 --> 00:28:33.230 position:50% align:middle And to the point made earlier, we have a mechanism of tracking workplace violence, 00:28:33.230 --> 00:28:43.180 position:50% align:middle and we divide it into various categories so that we can focus on the most predominant issues that we're seeing, 00:28:43.180 --> 00:28:46.910 position:50% align:middle and make sure we're addressing the things that are most commonly happening. 00:28:46.910 --> 00:28:49.100 position:50% align:middle We do have a Workplace Violence committee. 00:28:49.100 --> 00:28:55.050 position:50% align:middle We have a law enforcement liaison actually that sits on that committee with us, and helps us understand, one, 00:28:55.050 --> 00:28:56.570 position:50% align:middle what's happening in the community. 00:28:56.570 --> 00:29:00.840 position:50% align:middle But it also provides us a mechanism of getting community support. 00:29:00.840 --> 00:29:03.280 position:50% align:middle And that's a difficult thing for us. 00:29:03.280 --> 00:29:09.230 position:50% align:middle A minute ago, we talked about some institutions maybe are frowning on calling 911. 00:29:09.230 --> 00:29:10.760 position:50% align:middle We certainly aren't that group. 00:29:10.760 --> 00:29:16.670 position:50% align:middle We want them to be able to call for law enforcement or community support if they need it. 00:29:16.670 --> 00:29:18.450 position:50% align:middle But I'll draw a parallel for you. 00:29:18.450 --> 00:29:21.930 position:50% align:middle Law enforcement right now is one of the same issues that we're having. 00:29:21.930 --> 00:29:22.710 position:50% align:middle They're stressed out. 00:29:22.710 --> 00:29:23.990 position:50% align:middle They're overworked. 00:29:23.990 --> 00:29:31.730 position:50% align:middle Our local law enforcement is missing about a third of its staffing right now. 00:29:31.730 --> 00:29:37.360 position:50% align:middle And so when we do call 911, this is important for us because when you have a home 00:29:37.360 --> 00:29:42.090 position:50% align:middle health worker, they call 911 because there's a problem, and it takes 2 hours to get an officer because they 00:29:42.090 --> 00:29:43.670 position:50% align:middle don't have anybody available. 00:29:43.670 --> 00:29:49.320 position:50% align:middle And that perception from our staff member then is, "Nobody cares because nobody came quick." 00:29:49.320 --> 00:29:49.500 position:50% align:middle Right? 00:29:49.500 --> 00:29:51.450 position:50% align:middle And so we have to combat that. 00:29:51.450 --> 00:29:54.690 position:50% align:middle And how we do that is just through communication with that liaison. 00:29:54.690 --> 00:29:57.760 position:50% align:middle We want people to understand they're in the same environment we are. 00:29:57.760 --> 00:29:58.140 position:50% align:middle Right? 00:29:58.140 --> 00:29:59.720 position:50% align:middle - Right. 00:29:59.720 --> 00:30:00.970 position:50% align:middle Well, thank you. 00:30:00.970 --> 00:30:06.126 position:50% align:middle I'm going to open this up now to our audience for questions. 00:30:21.000 --> 00:30:22.620 position:50% align:middle - [Dr. Lyon] Thank you. 00:30:22.620 --> 00:30:23.870 position:50% align:middle Thank you all very much. 00:30:23.870 --> 00:30:26.680 position:50% align:middle This has been so fascinating. 00:30:26.680 --> 00:30:29.500 position:50% align:middle But it's something we're all worried about. 00:30:29.500 --> 00:30:31.340 position:50% align:middle I have two questions I'd like to ask. 00:30:31.340 --> 00:30:32.300 position:50% align:middle Karen Lyon. 00:30:32.300 --> 00:30:36.470 position:50% align:middle I'm a regulator from the Board of Nursing in Louisiana. 00:30:36.470 --> 00:30:39.510 position:50% align:middle We had a new workplace violence law passed last year. 00:30:39.510 --> 00:30:41.620 position:50% align:middle I don't think it's as robust as Texas. 00:30:41.620 --> 00:30:46.220 position:50% align:middle But two things we're seeing from a regulator standpoint. 00:30:46.220 --> 00:30:50.290 position:50% align:middle We have our nurses who are victims of violence who don't want to press charges. 00:30:50.290 --> 00:30:51.740 position:50% align:middle They don't want anything reported. 00:30:51.740 --> 00:30:55.810 position:50% align:middle They're worried that people are going to find them, and come, and threaten their families so they 00:30:55.810 --> 00:30:57.420 position:50% align:middle won't even report. 00:30:57.420 --> 00:30:59.210 position:50% align:middle They won't even take action. 00:30:59.210 --> 00:31:05.670 position:50% align:middle The second thing from a disciplinary standpoint, we're having more nurse-on-nurse and nurse-on-patient 00:31:05.670 --> 00:31:08.760 position:50% align:middle violence being reported to us. 00:31:08.760 --> 00:31:12.570 position:50% align:middle And anyone on the panel can comment on either of those two things. 00:31:12.570 --> 00:31:18.530 position:50% align:middle I mean, literally where nurses are losing it and taking their microaggressions out on patients, 00:31:18.530 --> 00:31:26.330 position:50% align:middle and particularly in psych mental health units, and in our extended care facilities where we have our 00:31:26.330 --> 00:31:30.440 position:50% align:middle most vulnerable patients. 00:31:30.440 --> 00:31:35.540 position:50% align:middle - I'll start, and I'll respond to Karen's first question. 00:31:35.540 --> 00:31:43.770 position:50% align:middle I will say that another bill that passed during our last session that was championed by a senator who is a 00:31:43.770 --> 00:31:52.050 position:50% align:middle registered nurse and also a physician, it emulates a lot of the elements in the federal bill. 00:31:52.050 --> 00:31:55.420 position:50% align:middle It requires a committee, it requires a policy. 00:31:55.420 --> 00:32:01.190 position:50% align:middle It specifies membership to include nurses and security personnel. 00:32:01.190 --> 00:32:07.350 position:50% align:middle One element that I think is key in this legislation is that it absolutely prohibits 00:32:07.350 --> 00:32:09.940 position:50% align:middle retaliation from reporting. 00:32:09.940 --> 00:32:19.410 position:50% align:middle And it includes an enforcement section that someone who retaliates against an individual for reporting 00:32:19.410 --> 00:32:26.090 position:50% align:middle an incident of workplace violence can be disciplined by their licensure board. 00:32:26.090 --> 00:32:33.920 position:50% align:middle And then to Karen's second question, I don't know that we've seen an increase in nurse 00:32:33.920 --> 00:32:42.280 position:50% align:middle against patient or nurse-nurse violence, but it's definitely something to watch and trend. 00:32:42.280 --> 00:32:44.490 position:50% align:middle - Can I add a little bit to that? 00:32:44.490 --> 00:32:46.390 position:50% align:middle So we do see that occasionally. 00:32:46.390 --> 00:32:51.710 position:50% align:middle I don't know that that's necessarily a predominant issue for us, though. 00:32:51.710 --> 00:32:56.170 position:50% align:middle But one thing that we are very focused on is with everybody's level of fatigue, 00:32:56.170 --> 00:33:01.480 position:50% align:middle and with the level of burnout right now, a big piece of the training that we offer is how 00:33:01.480 --> 00:33:04.470 position:50% align:middle to keep that in check, and how to watch your triggers when those things are 00:33:04.470 --> 00:33:05.530 position:50% align:middle happening for you. 00:33:05.530 --> 00:33:10.640 position:50% align:middle Because it's really easy when you're in that situation, burned out, and fatigued, and tired, 00:33:10.640 --> 00:33:12.750 position:50% align:middle and maybe even a little bit ornery. 00:33:12.750 --> 00:33:13.950 position:50% align:middle Right? 00:33:13.950 --> 00:33:19.870 position:50% align:middle And it's really easy to say the right thing in the wrong tone with the wrong body language, 00:33:19.870 --> 00:33:23.440 position:50% align:middle and escalate a situation that you intended to de-escalate. 00:33:23.440 --> 00:33:24.070 position:50% align:middle Right? 00:33:24.070 --> 00:33:26.470 position:50% align:middle And so we're paying a lot of attention to that. 00:33:26.470 --> 00:33:30.510 position:50% align:middle So any time we have a workplace violence issue or something has happened, 00:33:30.510 --> 00:33:33.200 position:50% align:middle we're going all the way back to how did the conversation started? 00:33:33.200 --> 00:33:35.000 position:50% align:middle What happened at the beginning? 00:33:35.000 --> 00:33:40.390 position:50% align:middle And paying a lot of attention to, "Can we do better in that overall process? 00:33:40.390 --> 00:33:43.810 position:50% align:middle What's causing the issue to escalate?" 00:33:43.810 --> 00:33:46.840 position:50% align:middle I hope that helps. 00:33:46.840 --> 00:33:49.670 position:50% align:middle - Can I respond very quickly? 00:33:49.670 --> 00:33:54.350 position:50% align:middle Is we're seeing increased students from nurse-to-student violence. 00:33:54.350 --> 00:34:00.820 position:50% align:middle And that's been a major concern that we're beginning to track the number of incidents and occurrences, 00:34:00.820 --> 00:34:04.960 position:50% align:middle not only from the patients to the students but from the nurses to the students. 00:34:04.960 --> 00:34:10.780 position:50% align:middle And again, I think it's reflective of the stressful environment that they're under at the moment. 00:34:10.780 --> 00:34:13.040 position:50% align:middle And it's unfortunate. 00:34:13.040 --> 00:34:15.960 position:50% align:middle - Yeah, absolutely. 00:34:15.960 --> 00:34:16.330 position:50% align:middle Yes. 00:34:16.330 --> 00:34:21.140 position:50% align:middle - [Charlie] Charlie O'Hara from the research team at NCSBN. 00:34:21.140 --> 00:34:28.610 position:50% align:middle Wanted to thank all of you for all of your insightful thoughts, and kind of all the other panelists, 00:34:28.610 --> 00:34:36.670 position:50% align:middle as I think one of the themes we've been seeing throughout all of these panels is we have a 00:34:36.670 --> 00:34:39.800 position:50% align:middle lot...nurses are understaffed. 00:34:39.800 --> 00:34:46.520 position:50% align:middle They have to keep working, and they end up getting burnt out because there's not 00:34:46.520 --> 00:34:54.140 position:50% align:middle enough time to take a 15-minute break, or do other things. 00:34:54.140 --> 00:35:01.100 position:50% align:middle And then how do we...when we're talking about reporting workplace violence, I can imagine a lot of situations 00:35:01.100 --> 00:35:05.050 position:50% align:middle where if you're a nurse, these recordings are low because you're 00:35:05.050 --> 00:35:06.220 position:50% align:middle already burnt out. 00:35:06.220 --> 00:35:10.310 position:50% align:middle You're already under so much workload. 00:35:10.310 --> 00:35:18.350 position:50% align:middle And now someone did something to me, but I don't have the time to fill out all 00:35:18.350 --> 00:35:19.880 position:50% align:middle of these...this report. 00:35:19.880 --> 00:35:21.850 position:50% align:middle It wasn't that big of a deal. 00:35:21.850 --> 00:35:30.000 position:50% align:middle How do we encourage nurses to have the time and improve reporting numbers in these types of situations? 00:35:30.000 --> 00:35:35.420 position:50% align:middle - I think the time is partly an obstacle, but a bigger thing is just the culture. 00:35:35.420 --> 00:35:42.390 position:50% align:middle And when I came to health care from law enforcement, I was amazed to see this parallel between the two. 00:35:42.390 --> 00:35:45.560 position:50% align:middle When I came over to health care, it was considered part of the job. 00:35:45.560 --> 00:35:47.860 position:50% align:middle "This is just how things are in the ED. 00:35:47.860 --> 00:35:48.780 position:50% align:middle This is what happens. 00:35:48.780 --> 00:35:49.590 position:50% align:middle We get assaulted. 00:35:49.590 --> 00:35:51.080 position:50% align:middle It's part of the deal. 00:35:51.080 --> 00:35:52.090 position:50% align:middle And life just goes on." 00:35:52.090 --> 00:35:54.240 position:50% align:middle And so they're not encouraged to report it. 00:35:54.240 --> 00:35:59.070 position:50% align:middle And so we work feverishly to help them, and encourage them to report that, 00:35:59.070 --> 00:36:04.190 position:50% align:middle and make it as easy as we possibly can, because the reporting is important. 00:36:04.190 --> 00:36:07.230 position:50% align:middle Without the data, without the information, there's nothing to address. 00:36:07.230 --> 00:36:07.490 position:50% align:middle Right? 00:36:07.490 --> 00:36:08.840 position:50% align:middle I don't know what I'm looking at. 00:36:08.840 --> 00:36:11.320 position:50% align:middle So we need that intel. 00:36:11.320 --> 00:36:17.280 position:50% align:middle And that work gets done often through our Workplace Violence Committee, like that whole group, 00:36:17.280 --> 00:36:22.550 position:50% align:middle which is co-led, by the way, with our department lead for the ED, 00:36:22.550 --> 00:36:25.560 position:50% align:middle and our security director for each site. 00:36:25.560 --> 00:36:27.410 position:50% align:middle They co-chair those meetings. 00:36:27.410 --> 00:36:30.000 position:50% align:middle So, yeah, we're doing the best to encourage them. 00:36:30.000 --> 00:36:34.020 position:50% align:middle I think it's more the culture than the time, to be honest. 00:36:34.020 --> 00:36:34.740 position:50% align:middle - Yeah. 00:36:34.740 --> 00:36:38.830 position:50% align:middle And like we have said, this is all connected. 00:36:38.830 --> 00:36:42.380 position:50% align:middle And that's why we have to get to the heart of these issues to fix them. 00:36:42.380 --> 00:36:52.200 position:50% align:middle - [Female] Just in follow up to what Maryann just said, and actually Charlie's point as well. 00:36:52.200 --> 00:36:57.400 position:50% align:middle The first two panels, the things that they were talking about, 00:36:57.400 --> 00:37:05.270 position:50% align:middle short staffing and challenges to nurses' mental wellness, that has to lower the threshold of your 00:37:05.270 --> 00:37:09.310 position:50% align:middle awareness of these threats that you're educating nurses about. 00:37:09.310 --> 00:37:13.890 position:50% align:middle If you're too busy and you're stressed out, you're trying to get your work done, 00:37:13.890 --> 00:37:22.000 position:50% align:middle you might not be really aware of the signs and signals of someone that's going to maybe cause a problem. 00:37:22.000 --> 00:37:26.900 position:50% align:middle I'd just like to hear your comments on my perception of what I've learned today. 00:37:26.900 --> 00:37:34.800 position:50% align:middle The other thing I question I have is as a nurse, you have to be physically close to patients often. 00:37:34.800 --> 00:37:40.730 position:50% align:middle You are approaching the patient from a perspective of care and compassion, and that makes you vulnerable. 00:37:40.730 --> 00:37:48.320 position:50% align:middle And how do we teach nurses to embrace what they need to do and who they are as nurses, 00:37:48.320 --> 00:37:50.340 position:50% align:middle and yet allow them to protect themselves? 00:37:50.340 --> 00:37:53.020 position:50% align:middle I hope that makes sense. 00:37:53.020 --> 00:37:53.420 position:50% align:middle - Yeah. 00:37:53.420 --> 00:37:57.590 position:50% align:middle - So I'll take a stab at the second part of her question. 00:37:57.590 --> 00:38:06.240 position:50% align:middle More from a regulatory perspective, again, we feel that there is a lot of opportunity to reduce or 00:38:06.240 --> 00:38:12.410 position:50% align:middle mitigate the risk of workplace violence through a worksite analysis, and hazard 00:38:12.410 --> 00:38:13.750 position:50% align:middle identification and control. 00:38:13.750 --> 00:38:21.350 position:50% align:middle And you look at the working environment where nurses are, whether that means redesigning the nurse stations, 00:38:21.350 --> 00:38:26.460 position:50% align:middle or providing them an opportunity to escape in case they're being cornered. 00:38:26.460 --> 00:38:31.170 position:50% align:middle Whether that means a triage room that has two exits. 00:38:31.170 --> 00:38:39.890 position:50% align:middle Whether it means installing security cameras and mirrors to avoid having a blind spot, 00:38:39.890 --> 00:38:47.440 position:50% align:middle or having the nurse stations in a central location with direct line of sight to every room or every 00:38:47.440 --> 00:38:48.560 position:50% align:middle patient care area. 00:38:48.560 --> 00:38:49.830 position:50% align:middle Or mobile stations, right? 00:38:49.830 --> 00:38:54.080 position:50% align:middle That can be located in the hallways. 00:38:54.080 --> 00:38:57.310 position:50% align:middle Clinicians that do not see each other cannot help each other. 00:38:57.310 --> 00:38:58.180 position:50% align:middle Right? 00:38:58.180 --> 00:39:05.570 position:50% align:middle And then we go back to communications, and panic buttons, and the radio communications. 00:39:05.570 --> 00:39:10.690 position:50% align:middle We've encountered situations where we had [inaudible 00:39:08] You guys are familiar with it. 00:39:10.690 --> 00:39:14.490 position:50% align:middle I had to educate myself as to what they are. 00:39:14.490 --> 00:39:19.760 position:50% align:middle That had radio dead zones in the facility. 00:39:19.760 --> 00:39:22.740 position:50% align:middle So they could not call for help. 00:39:22.740 --> 00:39:26.920 position:50% align:middle Like Gary mentioned, we've seen sometimes challenges 00:39:26.920 --> 00:39:29.970 position:50% align:middle with the communication protocols. 00:39:29.970 --> 00:39:32.180 position:50% align:middle Who actually summons security? 00:39:32.180 --> 00:39:32.980 position:50% align:middle Right? 00:39:32.980 --> 00:39:39.490 position:50% align:middle And then we find instances where the security is actually located closer to the emergency 00:39:39.490 --> 00:39:46.650 position:50% align:middle room department, not closer to, say, the mental health unit of the hospital. 00:39:46.650 --> 00:39:51.440 position:50% align:middle So security would have to jump in a car, drive all the way around in the camp. 00:39:51.440 --> 00:39:54.620 position:50% align:middle So there are a lot of opportunities there. 00:39:54.620 --> 00:39:58.210 position:50% align:middle Now, we like to call them engineering controls. 00:39:58.210 --> 00:40:04.560 position:50% align:middle There is also administrative controls like, let's just say, avoiding the feeling 00:40:04.560 --> 00:40:06.220 position:50% align:middle of negative progress. 00:40:06.220 --> 00:40:11.410 position:50% align:middle As a patient, when you move through the facility, you're being triaged, 00:40:11.410 --> 00:40:14.380 position:50% align:middle and then you're being brought back into the waiting area. 00:40:14.380 --> 00:40:18.170 position:50% align:middle That tends to generate negative feelings as a patient. 00:40:18.170 --> 00:40:20.960 position:50% align:middle So these are some of the things we've observed. 00:40:20.960 --> 00:40:25.440 position:50% align:middle None of the things I said are a one size fits all. 00:40:25.440 --> 00:40:30.750 position:50% align:middle It won't fit every single medical unit. 00:40:30.750 --> 00:40:33.720 position:50% align:middle What works for ICU may not work for a mental health unit. 00:40:33.720 --> 00:40:40.770 position:50% align:middle - So what you're saying is each institution should assess their own circumstances and address 00:40:40.770 --> 00:40:42.130 position:50% align:middle their unique problems? 00:40:42.130 --> 00:40:43.370 position:50% align:middle - Absolutely. 00:40:43.370 --> 00:40:46.200 position:50% align:middle - Can I expound on it a little bit, too? 00:40:46.200 --> 00:40:53.290 position:50% align:middle For us, the situational awareness class that we teach is really an added piece that I don't think RNs 00:40:53.290 --> 00:40:55.460 position:50% align:middle typically get in their educational process. 00:40:55.460 --> 00:40:56.110 position:50% align:middle Right? 00:40:56.110 --> 00:41:00.690 position:50% align:middle And so what we want to talk to them about is identifying a weapon. 00:41:00.690 --> 00:41:03.360 position:50% align:middle And it's not always...it's not the weapon that you would think, right? 00:41:03.360 --> 00:41:05.950 position:50% align:middle Like what in this room is a weapon to you? 00:41:05.950 --> 00:41:07.850 position:50% align:middle And we help them understand that. 00:41:07.850 --> 00:41:12.910 position:50% align:middle We want them to change the concept of their environment. 00:41:12.910 --> 00:41:15.870 position:50% align:middle Are you always paying attention to your ingress and egress? 00:41:15.870 --> 00:41:17.720 position:50% align:middle What are proxemics to the patient? 00:41:17.720 --> 00:41:22.600 position:50% align:middle You can still take care of the patient while maintaining a route of egress. 00:41:22.600 --> 00:41:24.980 position:50% align:middle But all of those things are important to us. 00:41:24.980 --> 00:41:32.160 position:50% align:middle And I don't think that it's training that is mandatory, or typical in an RN's education. 00:41:32.160 --> 00:41:36.780 position:50% align:middle And so we're offering that to everybody so that when you come into the room, you're already thinking, 00:41:36.780 --> 00:41:40.650 position:50% align:middle every day, every moment you're thinking about your own personal security. 00:41:40.650 --> 00:41:46.780 position:50% align:middle To his point about the position of security on the campus, I've got an enormous campus and I've got 8 or 00:41:46.780 --> 00:41:49.310 position:50% align:middle 12 security guys on on a daily basis. 00:41:49.310 --> 00:41:52.540 position:50% align:middle It's impossible for me to be everywhere all the time. 00:41:52.540 --> 00:41:57.970 position:50% align:middle And so we empower our staff because it's everybody's responsibility to maintain safety and security 00:41:57.970 --> 00:41:59.260 position:50% align:middle on that campus. 00:41:59.260 --> 00:42:00.650 position:50% align:middle Security can't do it alone. 00:42:00.650 --> 00:42:01.400 position:50% align:middle So I hope that helps. 00:42:01.400 --> 00:42:02.450 position:50% align:middle - Thank you. 00:42:02.450 --> 00:42:04.410 position:50% align:middle We have one minute left. 00:42:04.410 --> 00:42:10.090 position:50% align:middle I want to once again go around to this panel, and allow you to say one lasting thing, 00:42:10.090 --> 00:42:13.890 position:50% align:middle one thing you want the audience to remember from this discussion. 00:42:13.890 --> 00:42:14.450 position:50% align:middle - Yeah. 00:42:14.450 --> 00:42:18.760 position:50% align:middle For me, it's all about collaboration, and teamwork, and empowering our staff. 00:42:18.760 --> 00:42:21.450 position:50% align:middle So I would focus on those goals. 00:42:21.450 --> 00:42:23.030 position:50% align:middle - Kathleen. 00:42:23.030 --> 00:42:24.230 position:50% align:middle - I would say the same thing. 00:42:24.230 --> 00:42:28.210 position:50% align:middle It's all about preparing them, providing them with the tools to support 00:42:28.210 --> 00:42:29.410 position:50% align:middle and protect themselves. 00:42:29.410 --> 00:42:35.020 position:50% align:middle But also knowing that they are in an environment that cares about their psychological and physical safety, 00:42:35.020 --> 00:42:38.710 position:50% align:middle and we'll be there to support them. 00:42:38.710 --> 00:42:44.260 position:50% align:middle - My message would be, one, the whistleblower and retaliation. 00:42:44.260 --> 00:42:48.530 position:50% align:middle People are afraid to communicate and report some of these incidents. 00:42:48.530 --> 00:42:54.020 position:50% align:middle Almost every incident investigation that we do, when we interview the staff, 00:42:54.020 --> 00:42:59.530 position:50% align:middle there's generally several other incidents that have occurred that didn't get recorded. 00:42:59.530 --> 00:43:04.180 position:50% align:middle It's almost, I would say, 90% plus of the cases. 00:43:04.180 --> 00:43:10.460 position:50% align:middle - So for me, I recognize that it's a challenge to address workplace violence, 00:43:10.460 --> 00:43:15.950 position:50% align:middle but that doesn't mean it cannot be mitigated through certain engineering, administrative controls, 00:43:15.950 --> 00:43:19.540 position:50% align:middle removing weapons of opportunity, to go back to the previous question. 00:43:19.540 --> 00:43:23.890 position:50% align:middle But it takes a team to address it. 00:43:23.890 --> 00:43:25.310 position:50% align:middle - Kristin. 00:43:25.310 --> 00:43:33.220 position:50% align:middle - I think it's important to keep in mind that workplace violence is not an individual problem. 00:43:33.220 --> 00:43:35.780 position:50% align:middle It's a holistic, systemic problem. 00:43:35.780 --> 00:43:43.530 position:50% align:middle And it is our ethical and moral imperative to make a health care facility a safe place. 00:43:43.530 --> 00:43:48.170 position:50% align:middle We need our patients to know that they can get treatment, and they can walk out safely, 00:43:48.170 --> 00:43:52.830 position:50% align:middle and that their staff are professionals and treated as such. 00:43:52.830 --> 00:43:54.830 position:50% align:middle - Thank you all very much. 00:43:54.830 --> 00:44:02.750 position:50% align:middle I really think, to sum up all our panels today, what this all comes down to is awareness. 00:44:02.750 --> 00:44:08.490 position:50% align:middle And we want every institution in this country to be aware of these problems, 00:44:08.490 --> 00:44:16.440 position:50% align:middle to assess what is going on in their own environment, and take the necessary steps to help retain our nursing 00:44:16.440 --> 00:44:20.170 position:50% align:middle workforce and make it better for the future. 00:44:20.170 --> 00:44:27.270 position:50% align:middle So with that, I would like to thank each and every one of you for being here, and to all of our attendees, 00:44:27.270 --> 00:44:29.830 position:50% align:middle and those watching digitally. 00:44:29.830 --> 00:44:31.030 position:50% align:middle Thank you.