Nursing Resilience and Workplace Safety: Addressing Root Problems in Healthcare
In April the Joint Commission issued an alert [pdf] identifying physical and verbal violence against healthcare workers as a sentinel event, an issue that requires further investigation and response from healthcare organizations. The alert cites some worrying statistics:
- Of the 25,000 workplace assaults reported to the Occupational Safety and Health Administration (OSHA) annually, 75 percent were in healthcare and social service settings.
- Workers in health care 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 of four ways healthcare leaders can create an environment to support a resilient workforce.
In an earlier blog post, I discussed the role of healthcare communication technology for another of the NEC’s recommendations: providing time to recover from stressful events. In this post, I’ll explain how the same healthcare communication technology can address workplace safety.
Nursing burnout is driven by feelings as well as overwork
Last month, we met FRED: Frantically Running Every Day. Primarily FRED is a physical phenomenon resulting from heavy demands on nurses to be in many places at one time. But FRED can also be psychological and emotional. The Frantic in FRED reflects both the logistical reality of nursing and the high levels of adrenaline that contribute to eventual nurse burnout.
The specific wording of the NEC’s workplace violence observation is worth noting. Drawing from interviews with frontline nurses and nursing leaders, they say that “nurses don’t feel equipped to respond to point-of-care safety threats.”
Providing additional security or installing metal detectors may prevent certain extreme situations. To meet the goal of supporting nurses’ sense of resilience, however, healthcare delivery organizations will also need to take actions that empower nurses themselves and give nurses a greater sense of calm and control in potentially dangerous situations they face more frequently.
Training prepares nurses to react quickly, skillfully and consistently in stressful healthcare situations. To maintain nursing resilience in the workplace, they need to feel confident that they, their coworkers and their facility are well-prepared for other kinds of emergencies.
How healthcare communication technology helps prepare for faster, more appropriate responses
Nurses often care for people who are experiencing fear, vulnerability, anger or shock. Family members and friends who visit may bring along their own strong feelings or desires to get involved. Older or heavily medicated patients may become disoriented and anxious. These extreme emotions can sometimes fuel situations in which a caregiver feels unsafe.
Many nurses report incidents of abusive language and even physical assault, including spitting, biting, punching, choking, or using medical equipment like needles or an IV pole as a weapon.
Nurses naturally feel unsafe when they may be subject to such abuse. Hospitals interviewed for the NEC report ameliorated this issue by establishing clear communication protocols for any case in which a nurse may feel unsafe. Knowing that the training and tools are already in place reinforces nurses’ confidence in their competence and in their support network.
Key elements of successful programs included getting the right staff members to assist, and having them assist quickly before a situation turned violent. A protocol in which nurses must call in a long explanation justifying the need for help not only slows the process but discourages action. Instead, having safety codes and alert notifications pre-templated in a healthcare communication technology solution such as LiveProcess allows a nurse to call the alert to safety personnel with one touch, so help arrives quickly.
In addition, 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 would depend on an individual facility’s needs, and could include one or more of the following:
Security: Often the need for security arises not from the patient but from visiting family or friends. When too many visitors in a patient’s room begin to agitate a patient or interfere with patient care, a nurse can call a code alerting security to escort the visitors away.
De-escalation team: Joint Commission standards for hospital security do not allow security to intervene with patients unless clinical care staff are present. In those situations where patient behavior is the cause of a nurse’s unease, a de-escalation team comprised of security staff, a nurse supervisor, and specially trained de-escalation responders can provide more appropriate support.
Behavioral emergency response team (BERT): An increasing number of patients come to the hospital with a behavioral health condition, such as depression, anxiety, addiction or psychosis. While these conditions may not be the cause of a patient’s hospital visit, they can still impact behavior and treatment. A specialized response team with training in recognizing and defusing mental health crises, with or without chemical or physical restraints, can minimize danger.
Benefits of mobile healthcare communication technology for reducing incidents and relieving stress
For most of these episodes, choosing a method of silent, mobile notification will have significant advantages over an overhead page. For example, a multi-modal communication system 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. In comparison, an overhead page may add to the level of tension and stress, and could dissuade nurses from using the code.
[Read the blog post, Why Silent Mobile Notification Is the Future of Hospital Communication Systems to learn more.]
Using mobile communication devices on a platform such as LiveProcess also permits two-way communications. If a nurse is able to see that the message has been received and supporters are responding, tension will begin to decrease. In cases where a nurse is unable to view responses right away, receipt and response information will be available on the platform dashboard for supervisors and other team leads. This tracking information can also create documentation for later analysis, such as 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 a behavioral emergency response team (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
Emergency preparedness for incidents that escalate beyond the scope of hospital security
Situations that call for backup from law enforcement, such as an active shooter, are very rare. Still, having a plan in place can increase staff confidence and sense of security. Healthcare organizations that are up to date with the CMS emergency preparedness rule that took effect in November 2017 will have communication and response plans for this and other threats.
Incident response plans are easier to activate when they employ the same protocols and technology that staff use regularly for workplace safety. For example:
- Pre-created groups can accelerate communication and response from law enforcement, press and media, or hospital leadership. LiveProcess can also support the creation of ad hoc groups, for situations that require a different level of emergency management or discretion.
- Templated messages can be created to call out codes for an active shooter or other threats. Because these codes can be called silently and viewed on mobile devices — such as a phone, tablet, or COW — only the intended recipients will be aware, preventing panic among patients.Using a single platform such as LiveProcess for communications creates a coherent, complete event log that can be rolled up to other emergency responders for shared situational awareness.
Nurses can focus on nursing when they know that the support of their facility is behind them. 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, with less likelihood of nurse burnout.
Over the next several weeks on our blog, we’ll identify more ways to keep FRED out of your hospital.
Learn about developing a CMS-compliant communication plan for emergency preparedness.
Read blog posts about healthcare communication technology.
Learn about the LiveProcess Communicator healthcare delivery coordination tool.
An abbreviated version of this blog originally appeared in Health Management Technology