A plan for nurse safety

Everyone of the nurses I spoke with for my story on the violence nurses face on the job had either experienced physical violence themselves, or knew someone who had. While unacceptable, some of the violence seems inevitable given the conditions in emergency rooms and psychiatric facilities. But, I was told, a lot can be done with a careful assessment of the surroundings and training that includes drills on typical scenarios. You can read my story in today's Philadelphia Inquirer by clicking here.

Consider the story of Connie Snavely, 52, an emergency room nurse at Temple University Hospital who said she was punched while on the job. In the spring of 2009, she was at work on a typically busy day when patients coming to the ER for non life-threatening illnesses could expect to wait six to eight hours for care. Not optimum, or even acceptable. 

Snavely said that one young woman was "quite angry she had to wait. She got verbally abusive," Snavely said, describing the verbal abuse as an every day occurrence in the emergency room.

To picture the scenario, you have to envision layout in the ER. There is a triage office in the middle of the ER where the nurses who make the initial assessment have their desks. It's a busy spot, because patients are constantly coming up to the office, which is like command central, to find out when they'll be seen. "We are out there with the patients," she said. "The door is open and there is very easy access to us."

So, like many others, the young woman was standing at the door of the office yelling, Snavely said, about the slowness of the situation in the emergency room. Snavely tried to get into the office, but the woman was blocking the door. Snavely tried to excuse herself to walk around the woman, but she wouldn't budge. Snavely managed to slip by her into the office, but "I must have hit her arm or something," she said.

"She turned around and hit me. She hit me in the arms and was in my face screaming," Snavely said. Security, meanwhile, was busy with a fight between two mothers in the pediatric ward. "After hitting me several times, it spilled into the emergency room." Eventually Temple's police came and arrested the young woman.

Terrible situation. 

But there are other elements: The design of the triage office. It does have, Snavely said, a panic button, but it is hard to get reach. It does have an exit door on the other side, but because the office is too small and too crowded, it's hard to get to it in time for an escape. The office is so small, Snavely said, that someone has to set with her back to the open door. "The door is right open and one nurse has her back to the door. That's how it's set up. You are a sitting duck," she said.

Of course, she said, the triage station needs a redesign, but maybe Snavely's wish isn't realistic given budget restraints. Still a committee of ER nurses and security people could probably figure out some measures to improve the situation. Maybe there's a way to reconfigure the furniture or to clean out stuff or to easily wire more panic buttons in that room so they are more accessible from a variety of places in the room. How hard would that be? Maybe there's a way to change the work flow. Maybe there can be a window instead of a door. The key is to get the people involved who work in that department, not just some random committee of people in other areas. You need people who are truly familiar with the workflow and you also need outsiders who can question old assumptions and propose new ideas unhampered by tradition. In that combination, in my opinion, lies the best chance for success.   

What Snavely would like to see is increased security in the emergency room, but it's not just a matter of muscle. What would also be helpful, she said, is someone who could talk to the patients, like an ambassador. By doing that, she said, the ambassador would be able to give people information and that alone would diffuse tensions in the emergency room. Also, by taking on that non-clinical task, the ambassador would free the nurses to do what they do, which is medical work taking care of people.

Temple University officials acknowledge that violence is a possibility at the hospital, just as it is in many workplaces, and they say they consider their workers' safety important. They say they have a committee, but in a brief statement issued yesterday, they did not say when the committee met last and what, if any actions, it has taken about the emergency room situation. And by the way, it's just not at Temple. It's everywhere -- I interviewed a nurse from Wilkes Barre who has experienced the same thing in his hospital.

 Today Snavely's union, the Pennsylvania Association of Staff Nurses and Allied Professionals, is holding a daylong seminar on workplace violence in healthcare. Featured speakers are nurses from the Massachusetts Nurses Association, which has made this issue a priority. I'll write more about this topic in my blog tomorrow. Check back.