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Violence by patients and family members, towards nurses in the healthcare setting, is rising at an alarming rate. This violence, maybe a result, in issues pertaining to a societal breakdown. The rise in patients with mental illness and substance abuse problems, are contributing factors to the violence towards nurses. Breakdowns in the family moral structure, along with unrealistic social media relationships, give rise to unstable adults. Many nursing organizations are pushing for state and federal lawmakers to pass legislation, that will protect nurses from this threat.
Nurses are experiencing high levels of stress and burnout, in relation to the increasing dangers faced on the job. These violent situations influence the nurse's decision to seek new employment, or leave healthcare altogether. This results in nursing shortages and high nurse-to-patient ratios, which can directly affect patient care and outcomes. Controversial hospital policies limit how nurses can defend themselves, if attacked in the workplace. Strategies used to limit violence towards nurses are broad, and geared towards de-escalation, with less emphasis on prevention.
If any strides towards resolving this issue plaquing our healthcare system are to be made, the voices of the nurses have to be heard.
Keywords: nurses, patients, violence, healthcare
This paper will examine, societal breakdown and the effect it has on the nursing profession through violence. Furthermore, there are strategies that the nurse may utilize to influence how the nursing practice is applied, regarding current trends and controversies on the issue. Frequently, nurses encounter situations in which they are yelled at, spit on, bitten, shoved, and kicked by patients or visitors.
Violence in healthcare, not only includes the physical aspect, but verbal abuse as well. We live in a society, which faces many issues, dealing with increased mental health problems, substance abuse, lack of interpersonal skills due to social media, and breakdown of both family and moral values. Could these be contributing factors in the increase of violence towards nurses in the healthcare setting today?
Many problems surface regarding the causes of violent behavior towards nurses. Mental health issues are on the rise. Mental health patients, whether by genetics or by choice due to drug addiction, are found seeking treatment in hospital settings due to lack of financial resources for needed medications and care. This is changing the dynamics of nursing care. These patients have been out of their medications for an extended period of time. They are often treated on medical floors due to sickness, or overcrowding of psych units. Medical floors are not equipped to protect nurses from violent outbursts, compared to psychiatric units. Nurses are often not trained to pick up on cues, that could alert them the patient may become violent. Adding to the fact, that the elderly are living longer, which increases the dementia and Alzheimer statistics. These patients become agitated, and pose a danger to themselves and nurses. They develop sundowning at night, and try to wonder off the unit, only to be coerced back by nursing staff. They become increasingly combative towards nursing staff striking, hitting, and spitting to name a few. Mentally ill and confused patients, out of the usual psychiatric lock down unit, pose a serious threat to nurses. Our Nation is experiencing a rise in substance and alcohol abuse, which affects the nursing profession. These patients visit, or are admitted to the hospital settings, without access to their drug or drink of choice. They become confused, angry, and often times combative, while detoxing on a medical floor. This is a potentially volatile situation, for nurses to be required to work in. Another problem worth mentioning, abuse, includes a lack of interpersonal skills due to social media. Social media apps such as Facebook, create a deficiency in person to person communication skills, and the ability to resolve conflicts with others in an appropriate manner. Social media users may have 1,000 friends on their friends list, but these connections are limited, and usually not meaningful. The last issue to consider, comprises the breakdown of family and moral values in today's society. Mental illness, substance, and alcohol abuse are smothering the family structure. Absent and emotionally distant parents perchance, create socially dysfunctional children, who then have the likelihood to become angry, socially difficult adults. Individuals have become preoccupied with trivial insignificant matters, in a world that is shifting, to an it's all about me based mindset. These morals are silently being passed on within the family structure, with no regard to the generational effect it may have on the future of society as a whole. The deterioration of the family structure, with no regards to moral accountability, potentially produces disrespectful, angry adults.
In 2015, the American Nurses Association (ANA) organized a professional issues panel on workplace violence (ANA, 2019). This panel formed the #endnurseabuse, and is responsible for setting the zero-tolerance policy, shedding light on the growing violence towards nurses (ANA, 2019). A review completed in 2018, by the ANA, discovered that 62 percent of nurses were subjected to physical and verbal abuse in the healthcare setting (ANA, 2019). The ANA continues to advocate for nurses through updating policies, legislating state and federal government, and creating resources to end violence towards nurses. The North Carolina Nurses Association (NCNA) pushed hard for House Bill 560, that was signed into law in 2015, making it a felony to assault any hospital worker on hospital property (NCNA, 2019). Although we have many agencies in our corner, violence against nurses in the workplace still has many drawbacks that need to be addressed.
Advancements in healthcare fluctuate at a rapid pace. An important bill, currently approved to move forward to the House of Representatives in June, 2019, is H.R. 5233-Healthcare Workplace Violence Prevention Act (NNU, 2019). The National Nurses United (NNU) is urging House leadership to vote swiftly in an effort to move the bill ahead quickly, as they feel lives are at stake with the rise in violence towards nurses in the healthcare setting (NNU, 2019). According to the NNU (2019), this bill will force OSHA to require employers in healthcare facilities to develop specific workplace plans to prevent violence towards healthcare workers.
The issue of violence towards nurses is significant to the nursing practice and profession. We are a profession that works hard and we are dedicated to helping others. We advocate often for our patient's health and well-being. When nurses are verbally or physically attacked, while working so hard to keep patients safe, they begin to feel defeated. According to Phillips (2016), after an occurrence of workplace violence, nurses tend to have an increase in missed workdays due to stress and fatigue, which results in burnout. Nurse burnout decreases productivity, and ultimately patient care and outcomes suffer. Sadly, a decline in the nurse-to-patient ratio becomes a concern, due to nurses seeking employment opportunities elsewhere, due to stress and safety concerns.
According to OSHA (2019), workplace violence consists of an act or threat of physical violence, harassment, intimidation, or other threatening conduct whether physical or verbal. These types of incidences, are increasing at an alarming rate within the healthcare setting, yet are rarely reported (Joint Commission, 2019). Violence, especially verbal abuse, happens so frequently in the hospital environment that most nurses feel it is part of the job. As violence in the workplace rises, the quality of the nurse's patient care declines (Gillespie et al., 2015).
An increasing controversy concerning violence towards nurses, is the fear of reprisal by administration if the nurse defends herself, and thus causes harm to the patient. Many hospitals have policies in place that carry strict disciplinary actions, up to the firing of a nurse. Often, nurses working in environments where violent episodes occur on a regular basis, are made to feel that it's just part of the job (Martinez, 2016). These types of rationales, are a few of the reasons, most workplace violence incidents towards nurses is underreported.
Strategies should be put in place to reduce incidents in violence against nurses. Education is one of the strongest approaches, and should be mandatory every year. The use of specialized teams, called upon when a patient or family member is acting out verbally or physically towards a nurse, has proven to be effective. This team usually consists of security staff, a nursing supervisor, and a psych nurse. The use of violent or non-violent restraints as a tool is available, but should only be utilized as the least restrictive means necessary. Metal detectors are a great resource for healthcare facilities, deflecting the potential violence towards nurses with weapons such as firearms, knives, or any other metal weapons (Phillips, 2016).
As a nurse working in bedside patient care for the past 10 years, I have seen a noticeable decline in the respect patients and family members show nurses. Many of my co-workers blame this on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which is a patient satisfaction survey requirement for hospitals by the Centers for Medicare and Medicaid Services (CMS). In their opinion, the HCAHPS has resulted in needy patients, who seem to think the hospital is a four-star hotel, and nurses have become nothing more than glorified butlers and maids. I however, continue to perceive the decline in respect for nurses, and the increase in violence as a societal breakdown.
The societal breakdown has created the perfect storm, in regards to the violence we see towards nurses in healthcare today. Mental illness and drug abuse patients, have no choice but to be treated in non-psychiatric units, due to lack of funding and resources. The decline in family morals, along with social media misconceptions, give rise to unstable adults. Physical and verbal abuse towards nurses is on the rise in the workplace. As a profession, nurses need to demand change. Nurse association groups, along with state and federal legislation, is vital to making the needed changes. Keeping current on significant issues and trends, regarding violence in healthcare, can help develop the needed strategies to potentially save yourself or a coworker.
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