Haley Mccullian, Human Resources Consultant, At Mercy Fitzgerald

According to Purpora and Blegen, approximately 60% of actual errors in patient care result from poor and ineffective communication (para. 3). Horizontal violence causes a decrease in effective communication between caregivers which places the patient’s safety in jeopardy. Horizontal violence decreases staff morale which leaves room for error in the workplace (Longo & Smith, 2011).

As health care workers we are under a legal obligation to protect an individual from any kind of abuse, whether it is physical, financial, emotional, sexual or psychological .Legislation, policies and procedures exist to promote a safer working environment and reduce the potential for risks occurring. They are tailored for the needs of each setting, known and understood by employers and employees and reviewed on a regular basis.

However, what some don’t know is that assaults on first responders are happening across the nation and many go unreported. Violence against EMS experts takes many forms. Most acts of brutality are not less than deadly. Statistics shows that the risk of non-fatal assault resulting in lost work time among EMS workers is 0.6 cases per 100 workers a year; the national average is about 1.8 per 10,000 workers. The National Association of Emergency Medical Technicians (NAEMT) found 4/5 medics have experienced some form of injury as a result of the job. The U.S. Department of Labor reported that about 52 percent of EMTs operating in the field have been assaulted.

A practice that has been put in place is the use of call buttons that are installed and easily available for the staff to use when dealing with escalating patients. Within this Veterans Affairs Hospital, the inpatient geriatric unit has at least 2-3 cases of patient-on-patient assault each month. For those that are very aggressive, this is currently being addressed by the use of one-on-one staff and antipsychotic medications. Clinicians are expected to be able to assess whether intervention is needed to protect other patients and staff from patients’ violence, to assess when patients pose a sufficient level of risk, and to assess when patients who have been hospitalized can be safely discharged to the community. However, surveys of practitioners suggest that many receive little formal training in violence risk assessment. (McNeil, et al. 2009) The limitations of formal training in risk assessment for violence suggested by such surveys underscore the need for education in this topic, hence the relevance of this educational training. Nurses on the front lines of care are ill-prepared to deal with this, hence the need for training. (Peek-Asa, et al.

This is relevant for me as it is for everyone in the healthcare industry. We all want to work in an environment that is free from violence especially in an environment that is already full of stress. It is good to know that there are governmental sanctions for those that violate harassment or violence regulations in the workplace. We still need management to be accountable with those under their direction, disciplining and counseling problem employees as necessary. Because of this threat that constantly hangs over our heads we as nurses should develop a process or plan

The significance of this clinical problem can be seen in the outcomes of horizontal violence which includes but not limited to; increase the rate of nurses shortage, decreased job and career satisfaction and increased emotional exhaustion. In severe cases, horizontal violence is associated with post traumatic stress disorder and poor mental and physical health, this highlights and increases the need to prevent horizontal violence especially among new graduate nurses who are most vulnerable (Read & Laschinger, 2015). Statistically

Kvas and Seljak (2015) found that establishing a violence-free workplace is essential, and is an on-going process that every organization must be on board with. Kvas and Seljak (2015) went on to say that leaders in a health care organization play an important role in violence prevention, and serve as role models that should never tolerate incivility, bullying, or workplace violence. However, managers and other health care leaders are often the perpetrators of violence, and must be held accountable for their actions (Kvas & Seljak, 2015). Not only that, but physicians are a major contributor to physical and mental abuse, and must also be held liable. With that in mind, there are many ways nurses can prevent violence from occurring in the

However, many states have adopted different laws in aims to protect nurses and other medical professionals from bullying. California, Connecticut, Illinois, Maryland, Minnesota, New Jersey, and Oregon require employer run workplace violence programs. Alabama, Arkansas, Kansas, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Indiana, Illinois, Iowa, Kansas, Louisiana, Michigan, Mississippi, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Rhode Island, Texas, Tennessee, Vermont, Virginia, Washington, and Wyoming have an established or increased penalties for assault on nurses. Unfortunately, in some states protection is only limited to mental health professionals or emergency department staff. Other attempts to reduce bullying include: posting warning signs of violent behavior in hospitals and establishing individual facility policies about code of conduct (American Nurses Association,

Nurse-to-nurse lateral violence or incivility profoundly raises occupational stress with physical, psychological, and organizational consequence(Embree, White, & Bruner, 2013). I will discuss issues of incivility, importance to nursing, a scenario, creating a healthful environment, my specialty track, and my conclusion.

Workplace bullying can take on many forms. Lateral violence among nurses is a common example of workplace mistreatment, which affects individual nurses, patient’s care, and the ethical climate of an organization. In 2008, The Joint Commission released a sentinel alert addressing lateral violence, stating, “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments” (Joint Commission, 2008). In this brief, ethical issues related to lateral violence are described with two approaches to solving this issue examined.

To better understand the epidemiology of fatal violence in the health care setting, Goodman and colleagues examined death certificates over a 10¬year period (1980–1990). During this time, 522 health care workers died of work-related injuries, 106 of which were homicides. Twenty-six of those killed were

Violence in all its forms has increased dramatically worldwide in recent decades (Balamurugan, Jose & Nandakumar, 2012). According to the Occupational Safety and Health Administration (OSHA) report, nearly two million American workers report having been victims of workplace violence each year (2011). Among those at highest risks for violence in the healthcare setting are nurses, social workers and psychiatric evaluators (OSHA, 2011). In the healthcare setting, physical assault is almost exclusively committed by patients (Balamurugan et al., 2012). Moreover, nurses have the highest rate of violent attacks out of all healthcare workers (Howerton Child & Mentes, 2010); the main reason being that nurses are alongside the patients 24-hours a day, are usually the most available caretakers and are the frontline staff members dealing with patients and their relatives whereas psychiatrists, social workers and other healthcare providers only visit from time to time (Yarovitsky & Tabak, 2009; Rowe, 2012; ALBashtaway, 2013).

“Staff turnover not only impacts the clinical unit but also the organization’s financial outlook. Because nurses are opting to leave a hostile environment, “new staff must be hired and trained, resulting in increased costs” (Blevins, 2015, p. 380) that according to Clark (as cited by Blevins) costs $300 billion annually. Paramount to the impact of incivility among nurses is the effect on patient care. Lack of teamwork, clarification, and care will lead to sentinel events that could have otherwise been

Other issues mentioned include discrimination in the workplace, the perception of subjection, anger, and power wrangles within healthcare organizations. They further conclude that health care organizations need to eradicate antecedent and equip nurses with skills and techniques required to eliminate lateral violence and improve the nursing workplace, patient health care, and nurse retention.

The Institute of Medicine’s (IOM) publication Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) delineated a patient safety issue related to nurse staffing. A postanesthesia care unit (PACU) nurse caring for five patients received report telephonically for an admission from the emergency room (ER). The PACU nurse did not want to accept the patient immediately and requested additional time to stabilize her current patients and finish completing charting from a previous admission. The ER nurse said the ER was busy and she would have the patient in the PACU in five minutes before she hung up the phone. The PACU nurse notified her supervisor who agreed to “look around” for an additional nurse to help, but she advised the PACU nurse that if she refused this admission she would be written up. The