Breaking the rules of ordinary nurse behavior.

Have you ever thrown a fire extinguisher at a hospital visitor?

In this issue, “Workplace Violence Training Using Simulation” describes how one Ohio health system employs classroom learning, hands-on defense techniques, and simulated violence scenarios to prepare staff for potentially violent situations, including the presence of an active shooter.

Part of this training involves learning how to break the rules of ordinary behavior. This is hard for nurses, because it’s so ingrained in us to protect and never to harm. Grabbing a fire extinguisher to throw at someone, even if that person is holding a gun, is not the initial reaction most of us would have in this situation.

“People often freeze or panic in response to acts of aggression, assault, or other violence, including shots fired,” note authors Robin Brown and colleagues. The remarkable workplace violence training that they have developed at their hospital aims to empower staff to respond effectively in dangerous situations. Key points of discussion include learning to

• recognize the potential for violence in a patient or visitor,
• identify our own behaviors that may trigger a person who already is upset,
• and perhaps most importantly, overcome our panic and take action.

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