Background: OSHA defines workplace violence (WPV) as any act or threat of physical violence, harassment, intimidation or disruptive behavior. Healthcare-related WPV is often under-reported and healthcare workers are five times more likely than other professionals to be affected.1 Beyond the immediate trauma, negative outcomes can include low morale and productivity, and increased job stress and turnover.2 Most hospitals have reactive systems in place that mobilize security personnel in response to such incidents, including overhead alerts or the use of panic buttons. There are limited systems in place for preventing these events.
Purpose: An anonymous WPV survey of dedicated staff (nurses and patient care associates) on one general medicine unit at our institution revealed that 100% of responders experienced name-calling, 83% were threatened physically or verbally, 66% experienced physical assault, and 50% were sexually harassed. Responses also indicated that 40% felt concerned for their safety daily to a few times weekly, only 17% felt supported by the medical team, and 33% strongly disagreed when asked if they felt supported by hospital security personnel. Not surprisingly, 67% felt anxious, stressed or demoralized daily to a few times weekly. As such, we implemented a multi-disciplinary quality improvement initiative to target WPV and improve organizational perception of safety.
Description: Our 2-week intervention occurred on one general medicine unit in October 2023. We focused on the night shift (7pm-7am) given the inherent vulnerabilities stemming from fewer staff, visitors, and leadership in the overnight hours. While security personnel already perform nightly rounds to confirm functionality of the unit’s panic button, our intervention called for twice nightly proactive rounding by security, which included participation in informal huddles with the charge nurse. Proactive rounding aimed to increase the visibility of security presence for both staff and patients on the unit. Informal huddles served as a forum for staff to escalate impending safety concerns. A post-intervention anonymous survey of security personnel found that 94% agreed/ strongly agreed that proactive rounding was useful to reassure staff and that the initiative should continue. Eighty-one percent agreed/ strongly agreed that increased security presence could reduce incidences of WPV. The majority also agreed that the initiative did not negatively impact workflow. Similarly, anonymous surveys of the unit staff revealed that 80% agreed/ strongly agreed that increased security presence was reassuring and could reduce incidences of WPV. Allowing for the confounder of changing respondents, 50% felt anxious, stressed or demoralized daily to a few times weekly–an improvement from 67% pre-intervention. Unit staff respondents unanimously favored continuation of the initiative.
Conclusions: Workplace violence in healthcare impacts multiple inter-related domains of staff morale, burnout, turnover, and productivity. While a reactive approach to such incidents is often employed, we demonstrated that partnering with hospital security personnel for proactive rounding and team huddles was feasible, favorably received, did not add cost, and could ease the perception of workplace violence. Next steps include expansion to the day shift, inclusion of medical staff, and quantifying the impact of this initiative on the frequency of WPV incidents.