Workplace Violence: Whose Problem Is It?

By allyaubry/via Flickr

Once upon a time, I was the assured quality (AQ) representative for a nursing unit. I attended monthly AQ committee meetings with members from medicine, pharmacy, laboratory, and respiratory therapy to review incident reports. We developed processes for improving patient safety and work flow. Agenda items changed monthly, except for the paper towel dispenser problem.

The unit had a paper towel dispenser, which operated by a lever. It was noisy, disturbing the patients. It did not hold enough paper towels for 24 hours. Since housekeeping did not staff to fill paper towel holders on night shift, physicians and nurses entering the room found them empty after washing their hands in the morning. This angered everyone, so it went on the AQ committee’s agenda.

The unit needed new towel dispensers. However, the committee could not determine whose job it was to research replacements. No one knew which department was responsible for ordering new dispensers, or whose budget would pay for them. Since there were other agenda items to discuss, every month the towel dispenser problem was “parked” for the next meeting. This continued for the entire time I served on AQ. The problem remained unresolved when I moved on.

Workplace violence toward nurses feels like the “irresolvable dilemma” of the paper towel dispenser. Over the years, statistics have consistently shown that social workers and health care workers, particularly nurses, are several times more likely to experience workplace assault than other types of workers. At the same time, it’s often been reported that nurses are afraid to report workplace violence because of lack of institutional support.  

Whose problem is it? The U.S. Occupational Safety and Health Administration (OSHA) has guidelines for preventing such violence,  and the U.S. Health Resources and Services Administration’s National Advisory Council on Nurse Education and Practice makes recommendations as well, but neither makes concrete a requirement that employers take action.

So whose job is it to protect nurses from workplace assault? I believe it begins with nursing schools, and depends as well on health care employers. 

• Nursing schools should teach personal safety techniques along with such advice as “don’t recap needles.” Assessing a patient’s potential for violence should become part of clinical rotations, just like assessing pressure ulcers using the Braden Scale. For example, I was well over the 15-year mark as a nurse before a security officer taught me that I should never put a patient between an exit and myself, even with security present. He said that if the patient grabbed for me, he couldn’t get to me first. I use his advice every shift, but I should have learned it in school.
• Health care employers should report and study all incidents of workplace violence, then pass the information to staff—just as the Federal Aviation Administration processes data of plane crashes and then provides the information to pilots so everyone learns and preventable causes can be eliminated.
• Panic buttons should be installed in all patient care areas, just as in banks. It’s employees they’re protecting, not the money, right?
• If more nurses isn’t the answer, then more security on units is.
• Nurses need the authority to refuse treatment to potentially violent patients when security isn’t present.

A few states require health care employers to track incidences of workplace violence and create prevention programs, but until protection is mandated, it is unlikely the problem will improve. Requiring health care employers to protect nurses is better than stiffer penalties for perpetrators after the fact, because prevention is always preferable to cure.

And there is no earthly reason it is so difficult to replace a paper towel dispenser either.

Julianna Paradisi blogs at JParadisi RN; her artwork appeared on the cover of the October 2009 issue of AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February issue.