ANA\California Member and media-trained nurse, Dr. Anna Dermenchyan, , PhD, RN, CCRN-K, CPHQ, discusses how registered nurses can advocate for proactive solutions to workplace violence, from both patients and staff.
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Jared Fesler 0:14
Welcome to the Amplified RN News Show where we're turning up the volume on nursing news in California. Today we're going to be diving into the topic of workplace violence in healthcare. And we're joined by Anna Dermenchyan an ANA\California member and media trained nurse. Thank you for joining us, Anna. Please introduce yourself and tell us a little bit about why you're an expert on this topic.
Anna Dermenchyan 0:36
Thank you, Jared. Thank you for having me. Hi, everyone. I'm Anna Dermenchyan. I am a doctorally prepared critical care nurse who is the current director of quality for the Department of Medicine at UCLA Health. In this role, I lead improvement initiatives strategic planning, program development and execution and organizational processes and processes and policy improvements. I'm happy to join you.
Jared Fesler 1:01
Thank you, Anna. So it's a pretty well-known statistic that nurses face some of the highest rates of violence and the workplace one in four, and that might be underreported. Can you tell us a little bit more about this problem and why this is happening?
Anna Dermenchyan 1:16
Yes, unfortunately, workplace violence is all too common in healthcare settings. And we see this around this workplace violence, unfortunately, is a problem. It's an unacceptable situation. But yet, it's a reality for many nurses. I just want to share a few statistics if that's okay. According to the Bureau of Labor Statistics, workers in health care and social assistance settings are five times more likely to be targeted of non fatal assaults, or violent acts than the average worker in all other occupations. So we're in a high risk position. And then according to the Occupational Safety and Health Administration, OSHA, as all of us know, the number of violent events in healthcare workplace equals the number of all the other industries combined. So knowing this number we know we are at risk of facing each of us, you know, are at risk facing workplace violence. When the American Nurses Association did a recent study, they found that 43% of registered nurses reported being verbally and or physically threatened by a patient or a family member of a patient. And in COVID, during COVID pandemic, we know the numbers got worse. Another organization, National Nurses United found that 10% increase of what was reported pre COVID of hospitals experiencing nurses experiencing violence due to COVID restrictions.
Jared Fesler 2:50
This doesn't sound like a new problem, correct?
Anna Dermenchyan 2:53
No, it's not a new problem. It's been around for a long, long time, but it is under reported. So we don't really know the true number. The numbers I report to our estimates, but we think the problem is larger than what I've said. Unfortunately.
Jared Fesler 3:11
Why do you think that is what attitudes in the workplace or is this stemming from leadership? Can you give us a little context as to why this continues to happen?
Anna Dermenchyan 3:21
First of all, for nurses specifically, we comprise the largest healthcare sector. So when we look at all of health care nurses are the majority of health care workers. We have 4 million nurses in the United States. So we are the primary providers of hospital patient care and deliver most of nation's long term care. So we interact with patients and their loved ones during their sickest time, like the most vulnerable time of their lives. And then there's this prevailing attitude that, you know, it's part of the job that, you know, we are seeing patients when they're sick, so they might be dementia involved delirium, and all kinds of substance abuse that kind of contributes to certain behaviors. So it's accepted, and it's kind of an accepted part of the job. But unfortunately, it isn't, you know, we shouldn't tolerate it. The other issue. During the pandemic, a lot of things got escalated. So there's reports of additional bullying and assault against nurses assault against nurses and other health care workers over frustration over the health care system. Staffing has been affected, you know, we have low levels, so we don't meet patients needs, as they require. Some times we have very sick patients. We've had visitor restrictions. All of these areas have contributed to this epidemic of violence in health care.
Jared Fesler 4:53
Well, it seems rather well documented. What are the solutions that are being proposed, it seems like nurses are being frankly attacked on both sides from patients, but also maybe even internal staff as well, what is being done, what are best practices that leadership can implement?
Anna Dermenchyan 5:18
Yes, I recommend the some of the best practices and these are put forward through Cal OSHA and California or OSHA in general, we need to have preventative preventative tools in place. So resources processes in place for all of our employees, all of our nurses to know how to be in this situation and how to de escalate certain violent situations. And if something like this happens, to get a team involved, so some of the best practices that nationally people have used hospital screeners, it's important to have like security, to make sure people visitors that are coming in are assessed and are given a badge and are shared the rules of the hospital, then proactively communicating our expectation of what we have for visitation guidelines, like during COVID lot of it was restricted, you could only have sometimes not even have a family member, you know, at the bedside.
Anna Dermenchyan 6:19
So being able to share this widely that these are our policies, and the reason why we have these policies, because it is the best interest of the patient, at the end of the day, having crisis prevention, intervention training, so targeting units, specific trainings, if there are certain clinics or units that are impacted, because of like neurological patient unit or some kind of a unit psychiatric patient unit, they are more likely to deal with situations like this.
Anna Dermenchyan 6:50
So having everyone trained, having everyone do their annual competencies around this, it's really important. And then really facing this as a team based approach. It's not just on one healthcare worker, or what one branch of, you know, just on nurses to deal with this. This affects physician colleagues, respiratory therapists, everyone we work with, and having a team based approach if something like this happens when we have early signs of someone becoming physically or verbally abusive, which most likely will turn into violence, if we don't do something to de escalate it. We get like security involved, we get even risk management involved.
Anna Dermenchyan 7:33
If it's a long term patient, we talk to our C suite colleagues even you know if there is something that the system doesn't have a policy or a process to deal with. So I think it's important to think of what are the resources within our healthcare systems. And if we don't have a reporting structure, a data gathering structure and a way to support our nurses when they are facing situations like this to start putting it in place?
Jared Fesler 8:04
It seems like there are some best practices here, but perhaps they're not all being implemented. That's what it sounds like, Right?
Anna Dermenchyan 8:12
Correct. The basic requirement is to have a prevention guidebook or prevention mod model within each organization, but how much of it is utilized or taught to everyone in the system is probably not optimal?
Jared Fesler 8:31
Fair point? And what can patients be doing differently?
Anna Dermenchyan 8:37
Yes, for patients and for everyone else, we all need to be role models. Because when we are in situations like this, we realize, Oh, I'm not that person. I wouldn't get angry in a clinic while I'm waiting for my primary care physician for 30 minutes. But we're all human. And we do have these situations where, you know, we're running late, or we're having certain expectations and they're not met. It's taking ownership and being a role model, how we display positive behavior. If there's a moment when there's anger to step away, and really take a break before you come back and try to deal with the situation.
Anna Dermenchyan 9:18
So don't act in anger, take action. If you do see this happening. Call for help. Speak up. Don't Don't just let that situation happen between two people step in and be an active bystander try to de escalate the situation and really don't participate in civility and get help get others involved. So we deal with it in the moment, because the harmful effects of workplace violence. We see people leaving the profession, we see people who become disabled when they're physically abused. And this has happened to my own aunt who worked in the One of the units psychiatric unit where the patient acts actually hit her and now she's been disabled for life. So it is real. It affects our families, it affects our colleagues and loved ones. So I encourage all of us to take ownership and advocate for policies and practices in our own institutions that then workplace violence.
Jared Fesler 10:23
There's such great points there.
Jared Fesler 10:25
Anna, thank you so much for sharing that there have been legislative efforts across the nation relative to workplace violence. Hopefully, we'll be able to see something similar here in California. I want to thank you, Anna, for your time and highlighting this issue around workplace violence. Such an important topic today. Thank you for those who are tuning into us here during Nurses Week and nurses month for the Amplified RN News Show. Stay tuned to another episode. Thank you so much.
Anna Dermenchyan 10:53
Thank you.