After 22 years of employment with a local hospital, Barbara LaPierre’s life changed dramatically one April night in 2010. While working in the psychiatry division of the emergency room, known as the “crisis center," LaPierre, R.N., B.S.N., endured a painful, violent injury that has required several surgeries and resulted in permanent disability and scarring.
“This male patient was not mine, " LaPierre exlains, "instead his nurse was busy caring for a true medical patient who required intubation and her full attention. I was asked by a physician to administer Haldol [used to treat psychotic disorders or severe behavioral problems such as explosive, aggressive behavior] since he was loud, screaming, and acting out."
In September 2005, Charles Kunkle was paged to the St. Mary Medical Center emergency room (ER) to find that a patient had shot and killed one local police officer, and wounded another officer and one of the hospital employees.
Kunkle, R.N., director of Emergency and Trauma Services at St Mary, learned a painful lesson first hand about violence against nurses in the workplace. He has since dedicated himself to improving the situation.
"Bucks County is the third oldest county in the state, and although we are not a city hospital, violence comes from many avenues—psychiatric patients, aging patients with dementias, drug withdraw, etc. No facility can ignore the problem,” Kunkle says.
Kunkle, now travels nationwide, speaking at conferences about workplace safety, sharing the lessons he has learned.
Two weeks ago, I posted the story of an emergency room nurse at a center city hospital, who was attacked by a patient. Today, a similar tale from a different setting - a 130-bed suburban psychiatric hospital.
This story is about a nurse with 37 years of experience, who has practised as a licensed practical nurse (LPN) at a doctor’s office, a nursing home, and a drug and alcohol rehabilitation facility. For the past 6 years, she has worked at the psychiatric hospital.
“I was assaulted by an intoxicated 20-year-old male as I took the patient to the phone to call his mother for a ride home. He passed me the phone and immediately punched me in the side of the face.”
These are the words of Stanley Johnson, a Temple University nurse for nearly 20 years. In August of 2011, while working night shift in the Emergency Department, he became a victim of violence, a problem that is too familiar to many nurses.
In December, I wrote about a nurse in Alabama who was assaulted at work. That lead me to some remarkable nurses in this area who were willing to share similar, personal accounts of violent assault, so that a face could rise from behind the statistics.
I'm going to share their stories over the next few weeks. Why?
Because violence is not part of our job as nurses. We need to stand together to convey a "No Tolerance Policy."
Immediately following his attack, Johnson tells me that his peers responded first followed by the security guards (employed by an outside company), who restrained the patient. Since the attack was considered an assault, the 25th police district in Philadelphia arrested the patient.
"The Philly police support us whether it’s physical or verbal violence," Johnson reports. "The night I was assaulted, the female [police] officer knew my face didn’t normally look like that because we work so closely night to night. She immediately went right into the patient’s room and handcuffed the guy."
Lieutenant Ray Evers of the Philadelphia Police public affairs office says, "Nurses need to be protected, too. Safety is always an important element of the streets and these same dangers are walking directly into our ER's without warning."
Lieutenant Evers recommends that nurses use common sense and caution, always go to a patient bedside with another nurse, be aware of their surroundings, and recognize early signs of aggression.
For its part, Temple University Hospital System (TUHS) notes that it is working hard to lower incidences of violence.
"Temple takes seriously the issue of violence in the workplace – as the safety of our employees, patients and visitors is a key priority," the hospital said in a statement. "Within the past year, Temple, working through its Workplace Violence Committee, has developed and implemented training programs and other security-related enhancements designed to reduce the number of violence-related incidents. Through our Employee Assistance Program, TUHS is able to dispatch a group of specially-trained counselors to any location in order to provide group or individual counseling to employees involved in a violent encounter. We can report a significant decline in the average number of complaints received about workplace violence – from about three every month to one every other month."
Since the preliminary hearing, Johnson also had an official meeting with Temple University administration, but he thinks more can be done. Despite mandatory self defense classes, Johnson, an active member of the nurse's union, still feels unprotected at work. He reports that there is no stationed police officer in the ER after 11 p.m., and the security officers are unarmed.
Johnson followed up with a report through the 25th district the night of the assault. He filed an incident report, and had photographs taken of his face. (He experienced pain and swelling.) In early December, he had a preliminary hearing with the assistance of the District Attorney’s office prosecuting the patient. His trial recently concluded and the defendant was sentenced to a lesser crime of simple assault, following a guilty plea. He received two-years probation, 50 hours of community service, mandated attendance at anger management classes and a drug and alcohol assessment.
What did Johnson learn from his experience? “Laws have been passed that make violence a Level 2 felony and nurses need to be aware of their rights and safety.”
Please contact me if you are a nurse who has been a victim of workplace violence. Several nurses in addition to Johnson have already spoken. I need your help to properly represent the magnitude of this problem in our community and identify solutions.
Want to learn more? The Emergency Nurses Association has been championing this topic in health care with much research trending the problem, educational opportunities and a strong media campaign.
The call came from a distant neighbor on a beautiful Friday night in September 2004. 7:22 p.m. I was giving a report at work after a busy 12-hour shift. My father had collapsed in our driveway. He was not breathing, had a tube in his throat to keep it clear, and was en route for my hospital, with my younger sister following behind the ambulance. I wanted to be optimistic but this distant neighbor was a nurse at a local emergency room and her voice gave me no hope. He was not going to survive.
I had to call my mother and older sister with the news. My mother was out of town and told me to call her when the doctors evaluated him. I had to be blunt. I told her his heart stopped, and he was not breathing on his own. She sped home.
My dad, age 54, just months after retiring from a 31-year career with Peco and weeks after passing his cardiac stress test, was pronounced dead immediately on arrival to my ER. No one slept that night.
Communication breakdowns in healthcare are often the leading cause of serious mistakes reported to the Joint Commission’s Sentinel Event Root Cause Database. The Joint Commission defines ‘communication’ as that which is “oral, written, electronic, among staff, with/among physicians, with administration, with patient or family.” In nursing, if a message is not clear or perceived inaccurately, patient care can suffer.
So I ask, what methods have hospitals found most successful to communicate new information, policies or procedures to large numbers of staff? Staff in the hundreds or thousands -- specific to a department or hospital wide, often on several campuses, working day shift, night shift, per diem, and/or are travelers -- creates many obstacles for effective communication.
The Joint Commission’s 2012, National Patient Safety Goals, addresses improved staff communication. Staff must be informed at a pace that keeps up with the abundance of information. The most frequent form of communication between nurses occurs at shift change when patient reports are given. The outgoing nurse is exhausted, has multi-tasked all day, but need to give an accurate summary of her patient’s history and care. If not, treatments, medications, and more may be missed. Another example of poor patient reporting that I often see in the ER setting occurs when a patient arrives from a nursing home and appears confused. It is vital to know how cognitive impaired versus mildly confused versus demented a patient is at baseline so that the next nurse does not over-react. ‘Over-reacting’ often exposes a patient to more, unnecessary tests, radiation and needle sticks.
Christmas debt, endless bills, a suffering economy and paying for higher education will stress anyone. If you know where to look, there is money available to assist with tuition and further your nursing education. The reality is that nurses are facing this financial hardship many years after becoming a nurse. Many are raising a family or holding senior positions, yet a higher nursing degree is a common career necessity. Whether for job security, a higher salary, greater nursing knowledge or a career change, colleges are offering RN-to-Master programs, BSN-to-PhD programs and many other fast-paced classes to meet nurses needs.
The Future of Nursing Report: Leading Change, Advancing Health sets a high standard for the educational goals of the nursing profession. The report by the Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF),states:
“The committee recommends that the proportion of nurses with baccalaureate degrees be increased to 80 percent by 2020. While it anticipates that it will take a few years to build the educational capacity needed to achieve this goal, the committee maintains that it is bold, achievable, and necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research, and health policy…. Bridge programs and educational pathways between undergraduate and graduate programs—specifically programs such as LPN-to-BSN, ADN-to-BSN, and ADN-to-MSN—are designed to facilitate academic progression to higher levels of education. The ADN-to-MSN program, in particular, is establishing a significant pathway to advanced practice and some faculty positions. Financial support to help build capacity for these programs will be important, including funding for grants and scholarships for nurses wishing to pursue these pathways.”
Registered nurses (RNs) constitute the largest healthcare occupation, with 2.6 million jobs. Chances are that a nurse may be on your holiday shopping list. With less than 2 weeks left before the holidays, I wanted to suggest some great gift ideas for nurses. Whether you are a nurse or know a new grad, nursing student or senior nurse, there are some essential nursing products that are practical and move nurses into the future with technology geared to their needs.
First, nurses are tired of the traditional uniform and have largely become open-minded to scrubs being “stylish.” A custom pair of scrubs make a great gift. A seasonal print jacket or scrubs with your favorite sports team logo (Phillies or Eagle gear are a favorite) are always appreciated. Grey's Anatomy scrubs are available if you or someone you know is a series fan! Check out Lydia’s uniforms, Scrubs and Beyond, and/or Tafford uniforms for sales, gift cards with a purchase and other buying incentives. Don’t wait too long or the gift may not be available or arrive in time to make it under the tree!
Also consider a pair of comfortable shoes. A popular trend for nurses are clogs or a slip-on shoe, often in a pattern design to add some personality to a very routine uniform. Tie-shoes seem to be less popular but realize that nurses spend 12 or more hours on their feet, so look for elements of comfort. A wrist watch also make a great practical gift since nurses always need to record times. There is a wide range of watches that would make a nurse very happy and don’t need to cost a fortune. I suggest finding a watch with clearly displayed seconds and one that is waterproof due to our need for frequent handwashing. Otherwise, leave the realm of conservative and have fun picking out a great watch!
» More Tis the Season, Out with the Nursing Caps … in with the APPS !
On Tuesday afternoon, I was driving in New Jersey with my 14-month-old son and my car was T-boned by another women's vehicle that failed to stop at the stop sign. After the impact and coming to a screeching stop, knowing that my son and I were alright (despite my heart palpitations!), I jumped out of the car, went immediately to her driver’s side door, and said “is everyone alright?”
An appropriate question as I am thankfully observing that no airbags were deployed, damage was moderate and she was soon walking, problem free, and talking on her cell phone without any hesitation. Her response was… “You from Philly?”
Maybe I was overly sensitive, but I was ready to lay out this women. Not only did her careless driving put me, my son and other drivers in harm but her inconsiderate response immediately put me on the defensive. I was about to pull up my sleeves and make her very aware that I was from Philly. Truthfully, I couldn’t hurt a fly but this woman pissed me off. I was inconvenienced, I am now without my car for 2 weeks, and I had nothing nice to say to her so I returned to my car and called the cops. Whether it was maternal instinct, Philly attitude, or simply my Italian upbringing, this woman was on my “list.”
» More Woman's first response after car crash: "You from Philly?"
An Alabama ER nurse, Tammy Mathews, was working a late-night shift when an intoxicated and medicated patient grabbed her around the neck, choked her until she couldn’t breathe and spit in her face. She survived, MSNBC reported, but found that her employer wanted her to drop assault charges against her attacker. Then when she refused, she said officials fired her.
Accounts like these compel me to keep talking about violence directed at nurses.
While violent fatalities in the workplace are on the decline, healthcare workers remain at high risk of violent injuries. The Emergency Nurses Association (ENA) reports that “workplace violence (not exclusive to nursing) accounts for approximately 900 deaths and 1.7 million non-fatal assaults each year in the United States.” In 2004, half of non-fatal injuries to workers from assaults and violent acts occurred in healthcare settings, the Bureau of Labor Statistics (BLS) reported.
