According to the U.S. Bureau of Labor Statistics, health care workers are 5 times more likely to experience workplace violence than other workers. That is especially true for nurses, who spend more time with patients and their families than any other member of the health care team.
It is an issue of growing concern for many at UPMC, but especially Maribeth McLaughlin. She leads and is responsible for UPMC’s thousands of nurses.
There has been an alarming escalation in workplace violence against nurses. What is the cause of this national crisis?
As a nurse for nearly 39 years, I can recall many incidences of workplace violence that happened to me and other nurse colleagues. But the problem has become far more prevalent and severe today. In many ways, it is a sad reflection of how we have evolved as a society and as humans. Over the last few years, our ability to be kind and decent, to have grace for each other, has diminished.
When people are stressed and struggling to deal with an illness or injury, they are especially vulnerable and emotional. Patients and families may feel powerless, unable to get answers, concerned about care delays, or worried about costs. Anger and frustration can spill out.
It is a problem we have always seen in nursing. Too often, we rationalized and accommodated such behavior. My goal is to help build awareness of this issue, encourage reporting, and provide our nurses with the appropriate skills and training they need to be safe.
Why are we just now becoming aware of this issue?
It is largely because we are finally talking about the problem. In the past, there was an unspoken understanding that this was part and parcel of being a nurse. Nurses were expected to just say, “I’m OK,” and move on. But it was not acceptable then, and it is not acceptable now. Thankfully, these behaviors are being reported far more today.
According to a 2021 Press Ganey survey, two nurses are assaulted every hour in acute care settings. Is workplace violence worse in hospitals, or is it an issue across the board? What is considered an act of workplace violence against nurses?
The reality is that workplace violence occurs everywhere health care is provided. But we care for our sickest and most complex patients in acute care settings, where violence is most prevalent.
Workplace violence does not just affect nurses. It happens to doctors, residents, medical students, and trainees. It also impacts diagnostic and support staff. But in the acute care setting, nurses spend the most time with patients, so they are most frequently exposed.
Workplace violence can escalate quickly or happen with little or no warning. Physical abuse can include punching, kicking, hair pulling, and spitting, as well as more violent assaults. Verbal abuse is also considered workplace violence, and nurses can experience this in person, over the phone, and via telemedicine.
Why should patients — and the general public — be concerned about this growing trend?
In the midst of a major nursing shortage in our country, we cannot afford to lose nurses at the bedside. There are multiple reasons affecting this shortage, but workplace violence is a contributing factor. It is estimated that 1 in 4 nurses has experienced physical violence and 1 in 2 has been the target of verbal abuse.
Nursing engages both the brain and the heart. Nurses put so much heart into caring for their patients. Most enter the profession to connect to a purpose. Workplace violence strikes right at the core of what they do and who they are. It becomes a source of internal conflict for our nurses: They struggle with what they could have done to avert the situation. They question whether the behavior was simply an outburst or intentionally directed at them.
Workplace violence has been associated with anxiety, depression, absenteeism, job dissatisfaction, and burnout. I often hear nurses say, “This isn’t what I thought it would be like as a nurse.” A longtime UPMC nurse recently asked, “What happened? We used to be our patients’ heroes.”
In addition to affecting current nurses, workplace violence deters people from entering the profession. No one wants to feel unsafe, disrespected, or abused when they are doing their best to do their job.
What are some of the personal and workplace costs of workplace violence against nurses?
There are countless costs related to workplace violence that ultimately impact quality patient care. Nurses can suffer emotional and physical injury that prevents them from working for weeks or months as they recover. Worse, their injuries may not allow them to ever return to their job.
And when workplace violence prompts a nurse to change jobs or leave the profession entirely, we lose the kind of skills, insights, and clinical decision-making that only come with experience — and we are faced with the costs of recruiting and training a replacement.
There is the added issue of how to provide safe care for both the patient and staff involved after an incident of workplace violence.
How is UPMC leadership working to create a culture of safety to protect nurses and other care providers — as well as patients?
I am deeply committed to addressing the challenges our nurses and health care workers face due to workplace violence. That begins by affirming that workplace violence is unacceptable at any level at UPMC. There is no stigma in reporting a problem. In fact, it is the only way we can work together to create solutions and help prevent future occurrences.
It is also important that we give our nurses and health care workers the tools they need to de-escalate situations and get help. Workplace violence is not something nurses should be expected to manage on their own. The problem goes far beyond one person and one patient.
We are working to develop added resources and tools to help train nursing staff, including:
- Orientation training for new nurses in how to de-escalate potential situations — something not typically covered in nursing school.
- “Condition Support” access to a rapid response team when a patient or visitor exhibits hostile, aggressive, or threatening behaviors.
- Follow-up support whenever a staff member experiences workplace violence, including:
- UPMC Life Solutions, which offers counseling, legal support, and other resources.
- Medical and workers’ compensation support should an injury occur.
Additionally, we are developing ways to connect our nurses to the expertise of behavioral health staff to help them identify and manage some patient behaviors.
How can federal and state governments help address this problem?
On a state and national level, we need to continue to look at creative ways to protect and support our nurses and health care workers.
Currently, there are no federal laws that protect health care employees from workplace violence or intimidation. UPMC supports the passage of the bipartisan Safety from Violence for Healthcare Employees (SAVE) Act. It establishes legal protections to help deter violence in hospitals. It is now under consideration in the U.S. House of Representatives.
Here in Pennsylvania, UPMC supports the Health Facility Employee Violence Prevention Act, as proposed in Pennsylvania Senate Bill 849. It endorses the creation of violence prevention committees in hospitals — something UPMC already has in place.
Ultimately, for the sake of both nurses and patients, it is important that everyone — from the health care industry and nursing professional groups to the government and the public — embrace measures to work together and find solutions to this growing problem.