Reporting Violence in the Workplace
Violence is a common theme throughout healthcare, and it isn’t going anywhere anytime soon. The purpose of this article is to only discuss the system failures, to connect the dots and not penalize institutions but to enlighten and bring positive change. Workplace violence is a combination of several different factors that start with the culture and perception of how the leadership views how the organization should be run with a combination of big business and personal perception of how care should be provided. What does this mean? Those that run the hospital have a great sense of business but the Chief Medical Officer and the Chief Nurse Officer are the voice of the trends of healthcare that are going on dialog solely from unit management and system reports. Objectively taking a step back, let me help to break this down so it will make sense. We have an ever-changing society, where health trends are tracked and monitored, in order to develop new strategies for improvements within the system.
So how did we get so connected but not connected when it comes to being bullied in the workplace by patients, even physically harmed by our own healthcare workers who take this absorbed behavior out on each other? One of the largest disconnections of relationships between administration and staff was with the implementation of the Affordable Care Act using the patient survey reimbursement system. To a degree, as being a patient, it sounds great for holding a provider accountable for the received care but who do you think became the most affected from this paradigm shift? You are absolutely right! The frontline nursing staff. There is so much to cover but believe that extensive research of my own has led to many directions that narrowing it down to one specific issue for this article’s purpose, was extremely difficult.
We have become a connected society and trends of workplace violence begin when issues such as bullying are not reported and easily traceable. The behavior that is not reported reinforces to the person creating the hostile environment that it is okay for the behavior to continue, rewarding the person creating the issues, that it is okay. To summarize, if the incident is not reported, it teaches the patient or the staff member how they can act which can start from being snarky to the individual escalating. If the person does not say anything by reporting the incident, especially due to the fear of being retaliated against, nothing will ever change. As a result, it has taught nursing staff that no matter how much the victimized staff member feels violated or not heard, that whatever created the incident, the recipient has to adapt. This leaves the individual to feel that nothing they say or do will matter anyway.
So what happens when that tracking system for reporting incidents is not connected? What happens if a workplace violence real-time data capturing system is missing or listed under a miscellaneous file? It doesn’t get counted! When the nurse manager handles the situation before the escalation, they have incident report sheets, but if the issue has been diffused, the incident is not reported and viewed as it never happened. With my findings in several hospital systems, the only time the reported incident would get counted is when the floor would call a “code grey”. This is a specific code that is called when a patient has lost control or become violent. When it has concluded, the administrator on duty would arrive, observe the procedure for handling the episode and fill out a paper report, it is not entered into the computerized system. As a result, in more cases than not, upper management penalizes staff, including the unit managers if they report high numbers of incidents versus other units. Therefore, reporting is not encouraged and frowned upon; resulting in staff to choose to be off administrations radar and steer clear of being chastised with the fear of losing their job. Ultimately, creating a culture of silence and fear among the healthcare community. It is time to end healthcare violence!
