Workplace Violence Prevention: From a Fragmented to an Integrated Approach

Purpose:
This presentation will describe the impact of an ED workplace violence awareness/prevention program that started with a violent triage incident in 2003 and led to a system-wide interdisciplinary approach to address the issue of workplace violence and to implement evidence based changes.

Significance:
Violence in the community is spilling into the EDs across the nation. In 2009, the U.S. Department of Justice reported an estimated frequency of 4 violent crimes per 1000 employed persons in the workplace and 10.2% of these crimes were against people in the medical field.

Strategy and Implementation:
An initial survey of emergency department nurses in an inner city hospital was completed regarding safety in the workplace. The survey included questions regarding violent experiences, perceptions about workplace violence in the emergency departments, and whether staff felt safe. Additionally, a security analysis of the hospital was completed that included input from local law enforcement. Interventions were developed that included: an interdisciplinary emergency department workplace violence committee, enhanced physical security, education, development of a reporting tool, post-incident debriefings, flagging violent patient charts while maintaining confidentiality, de-escalation training, secure training and increasing security presence. Education emphasized that with heightened awareness and early intervention violent situations may be avoided, diffused and/or better managed.

Evaluation:
Outcomes:increased awareness/reporting of violence, a stronger relationship with law enforcement, and workplace violence prevention as a consideration in facility design. One nurse testified before the state senate; at her urging a law was passed to increase the penalty for assault of ED workers.

Implications for Practice:
An interdisciplinary approach is effective in addressing issues of healthcare violence. The involvement of local law enforcement is imperative to ensure safety, enforce the law, and make changes that directly affect the amount of violence in the hospital and the community for which it serves.