2023 14th Annual NUBE Conference

Workplace violence reports comprise 25% of our reported safety events, with the emergency department (ED) having the highest reported events in the hospital. In addition, the annual employee engagement survey reported workplace violence as a top concern since 2016. We had a 28% turnover in the last two years and was attributed to burnout due to the increased incidence of workplace violence communicated at exit interviews. Our ED team is well known in the community for its mission of head and heart together. The culture is rare; the last few years have taken a toll on the team, and our leading goal is to reignite purpose and revive the team’s spirit.Moving out of pandemic operations, we realize the long waits for care in the ED due to increased medical boarding and high hospital census impacted patient access to care resulting in lower patient experience scores. In addition, health equity needs, and case management demands outpaced resource availability. According to OSHA, psychological and physical harm related to workplace violence make it difficult for employees to perform job duties. The economic impact of workplace violence is seen mainly in high turnover, increased staffing costs, decreased morale, and poor productivity and patient outcomes (2020). Nursing leaders navigate challenging times with competitive staffing markets and stressful work environments that ultimately impact healthcare costs and patient experience. Workplace violence and bullying impede compassionate, high-quality care impacting patient quality and safety outcomes. The effects of workplace violence physically and psychologically result in lost time and potential long-term manifestations of anxiety, depression, and post-traumatic stress disorder. The chronic toll on nursing creates burnout and compassion fatigue resulting in potential medication errors, lack of engagement with patients and families, and decreased vigilance leading to patient harm (Grant et al., 2020). Fitzpatrick, et al., (2019) recommend the support of employee assistance and debrief support as the “unaddressed mental anguish” of the team decreases engagement putting quality and safety outcomes at risk (p. 188). We are realigning department goals with a workplace violence mitigation strategy that includes four quadrants including culture of safety, trauma support, community violence intervention and risk mitigation. The culture of safety spans the design of psychological and physically safe space for coworkers, a culture of respect with collegial interactions, and communicate and demonstrate safe environments to receive care for patients, families, and communities. The mitigation of risk includes a thorough assessment of campus access and work environments along with a commitment to education and updated work standards for patient care staff. Violence intervention community collaboration with county partners encompasses gun violence prevention programs and extreme temperature van and shelter coordination. Finally secondary trauma support for staff with onsite assistance, commitment to real-time debriefs and critical stress debriefings along with ongoing team morale buildings some of which include coffee shop chalkboard themes, raffles, family dinners, sports outings and rounding with leaders. We are making a difference! We have decreased our workplace violence events, increased safety huddles, committed to diversity, equity, and inclusion committees, and are building social and cultural tools to support the teams' provision of safe and effective care.

Learning Objectives:

1. Multiprong strategies to mitigate violence and create a culture of safety.
2. Community engagement with violence prevention. 
3. Overview of secondary trauma support strategies.