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.

Accept, barricade, leave, engage.

Drawing from the effectiveness of fire-related acronyms that are well known to hospital staff, such as RACE (rescue, alarm, confine, extinguish/evacuate) and PASS (pull the fire extinguisher pin, aim, squeeze the handles, sweep back and forth), their team devised a new acronym, ABLE.

“We chose these options purposefully so that the resulting acronym, ABLE, would enhance participants’ recollection during stressful situations. The first step – as emphasized in the training – is to accept that the potential or actual violence is happening, then to react to actual violence by choosing either to barricade behind a closed door or leave the area to ensure staff and patient safety. Finally, if none of these options are viable, the remaining choice is to engage the perpetrator to disrupt or end the violence.”

The enABLE program at the hospital has evolved over several years into a four-hour training that takes place in a 10,000-square-foot simulation center away from clinical areas. This article reviews how the program developed, its essential learning points and safety features, and measures of its success. Read this compelling and sobering article (free until October 31), with accompanying video and illustrations, in this month’s AJN.