Workplace violence incidents in healthcare are seemingly on the rise. Let's take a look at why, according to these nurse leaders.
Nurses across the country are experiencing record levels of workplace violence.
According to a National Nurses Unitedreport, in 2023, eight in 10 nurses experienced at least one type of workplace violence within the past year. Additionally, 45.5% of nurses reported an increase in workplace violence on their unit in the previous year.
The nurses involved in the report cited many types of violence, with 67.8% reporting verbal threats and 38.7% reporting physical threats. Nurses experienced being pinched, scratched, punched, kicked, spat on, and groped at alarming rates. Only 18.4% of participants reported no experiences of workplace violence.
CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they come up with innovative ways to prevent workplace violence.
Understanding the numbers
According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, it's hard to say one way or another that the incidents are rising, but it has become a more publicized issue.
"I'm not sure we have a have a good baseline to even say that [incidents are] increasing," Kingston said. "With that being said, it certainly feels as though things are increasing and we’re hearing about it more and more."
However, Kingston explained that in health systems implementing basic measures to prevent workplace violence, there have been improvements. Those measures include training and better reporting processes that can help identify where issues are, so health systems can target their approach. Health systems should also have risk and assessment processes, mobile duress technology, and behavioral health response teams.
"There's a number of basic foundational things that we can put in place to help keep all those providing care safe," Kingston said, "and not just those providing care, but everybody in the whole environment safe."
"Historically, nurses sort of accepted that there was a certain amount of abuse that they would have to take as part of their job," Schuetz said, "so it was and is drastically under reported."
Schuetz also said that the lack of resources for people with mental health conditions might also be contributing to the issue.
"If someone has a challenging life situation that requires some type of care in a facility, those facilities are not always available," Schuetz said, "and so the hospital becomes kind of the de facto place to put the patients so that they're kept safe."
Identifying the root cause
CNOs and other leaders need to first identify the reasons workplace violence is occurring in their health systems. For Kingston, it's important to consider the patient's perspective.
"It could be fear of the unknown or a fear of diagnosis that causes them to react, or pain," Kingston said. "Sometimes it can result from frustrations in some of our processes, [such as] long wait times."
For other patients, it could be cognitive difficulties or behavioral health issues. However, Kingston emphasized that it's important not to stereotype those patients.
"This is not to say that it is patients who have behavioral health problems are the ones that cause violent incidents all the time," Kingston said, "and I think sometimes we do jump to that decision, but there are certainly circumstances."
Kingston also mentioned that recently, there has been a general lack of boundaries between patients and nurses. CNOs must work to reemphasize the role of the patient and the nurse in a healthcare environment, and reinforce those boundaries between the patient and their care team.
"So again, [there are] many, many reasons [that workplace violence occurs]," Kingston said, "which makes it difficult to have the formula to say here's what we can do in every situation to prevent or to mitigate."
Training the workforce
One of the best things CNOs and other nurse leaders can do for their nurses is prepare and train them properly. According to Schuetz, nurses need to know how to identify and assess patients that may be at risk for violence. It's critical that nurses use the proper assessment tools so that they can get the support they need.
"Coming into the hospital, you might have a patient that has not and does not appear to be violent or have violent tendencies," Schuetz said. "The added stress of being in the hospital often just brings out the worst in people that already have a propensity to act out in certain situations."
Nurses also need to be aware of their environments and know the proper procedures for when incidents do occur. De-escalation training is crucial, according to Kingston and Schuetz.
"We have yearly training around how to de-escalate patients that are escalating," Schuetz said. "Sometimes, we're inadvertently causing patients to be escalated."
"It's really about listening and trying to understand what's going on before something erupts," Kingston said. "Practicing with de-escalation, even having folks act in the patient role and being able to practice that, I think is important."
Kingston believes more advanced training is necessary for nurses who work in high-risk areas, including self-defense.
"I don't know that everyone needs that, but certainly de-escalation and more of a focus on trauma informed care," Kingston said, "understanding where that patient is at as they're coming in…so that we can try to understand [and] mitigate before it becomes very difficult."
Peer support training is also key, so that nurses know how to help each other in the workplace setting.
"That to me is so important because [in] these situations, if our response is elevated and the patent is not as elevated yet, they will rise up to meet us," Kingston said.
According to Kingston, training should start as soon as possible while the nurses are in their undergraduate degree programs. To Schuetz, it comes down to looking at the tools that are available to you, and utilizing both mandatory and optional training.
"For nursing, there's so many things that we have to teach and train," Schuetz said. "Healthcare workers are just inundated with information and so they don't always know what's available to them."
Ultimately, it comes down to communication and using a combination of methods to try and prepare the nurses for what they might face.
"I'm a firm believer that it's a million little things that make a difference," Schuetz said. "If there was one thing that could solve this, that would have happened many, many moons ago."
Part two of this piece will be published on Monday, July 8, 2024.
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HealthLeaders spoke to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, about how to communicate with nurses about AI and its purpose. Tune in to hear her insights.
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The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
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AI has been all over the news recently, especially when it comes to nurses.
Many have questions about implementation and ethics, and it is up to CNOs and other nurse leaders to communicate with their workforce about what AI means for nurses.
Concerns
According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, there are three main concerns that nurses have with AI. The first is about the ethics of generative AI.
"We've not explored this too much in nursing workflows," Rocchio said, "so taking a look at some of those ethical considerations and getting out ahead of it may help us a little bit."
The second concern is job displacement.
"While we have no plans on it taking out jobs, I do think it is informing, a little bit, how we practice," Rocchio said, "which can make some just a little bit nervous."
The third is loss of human touch and connection with the patients.
"Nursing depends on us being up close and personal with the patient," Rocchio said. "Sometimes nurses think that some of these automated, generated things may get between that relationship with the patient."
Nurses also have concerns about how AI will integrate with their workflows. Since AI implementation is so new, many health systems do not know where they will use it yet.
"That unknown entity of how we might use it in the future might be driving some of the trepidation behind AI," Rocchio said.
Settling doubts
The purpose of generative AI implementation in nursing, according to Rocchio, generally consists of these three key points:
"I think the purpose is going to be around leveraging technology to optimize nursing practice to assist some nurses with [getting] information out of our EHR directly to the front lines, [and] to help us improve outcomes for patients," Rocchio said.
Rocchio mentioned three ways that Mercy is communicating to their workforce, to help nurses understand AI's relationship with their workflows.
The first is through education and training. Nurses are used to receiving a lot of education and training, Rocchio explained, but not usually around process issues.
"We're going to have to start thinking about [incorporating gen AI] into our training programs," Rocchio said. "There are going to be applications where we use it in healthcare and many nurses may not even be aware that we are using it in certain circumstances today."
The leaders at Mercy are also trying to emphasize that when AI is placed into workflows to help quicken information delivery and documentation processes, it frees up nurses to spend more time with patients.
"That [loss of] human touch they're so worried about can be mitigated [by] giving them back more time at the bedside," Rocchio said.
Additionally, Rocchio said they try to engage nurses directly with the AI implementation process on the front lines.
"When you're thinking about what may help them at the front lines, [in] that implementation phase," Rocchio said, "they should be directly responsible and [involved] in some of that."
Beyond AI
It's important for nurse leaders to communicate about all new forms of technology and integration, beyond just AI, so that nurses can understand what's coming next. According to Rocchio, one of the best things to do is talk about what regular communication patterns will look like between leaders and nurses.
"Nurses need to know what to expect and where the communication source is coming from," Rocchio said, "not just from nursing leadership, but [also from] our office of transformation."
Nurse informaticists and the rest of the digital team should be a part of the communication process as new technologies are deployed. Rocchio said that the communication patterns that come from nurse leadership and digital leadership should be consolidated into one single framework so that nurses can consume it.
Mercy has also launched a learning module around some of the new technologies.
"Nurses are starting to learn that there are going to be different ways to do things within our learning management system," Rocchio said, "so we're using what they're used to getting education and communication patterns with…to talk about AI."
Transparency
CNOs must be clear with nurses about the implementation process, goals, and outcomes, Rocchio explained.
"Being transparent about our plans for the new technologies as well as our timelines and goals and our expected outcomes," Rocchio said, "and then making sure we provide regular updates on [if we are] hitting the goals."
Leaders also need to be clear about when problems arise.
Rocchio explained how when they launched their emergency department to inpatient handoff process with AI, they did not get it right the first time. When the pilot was launched on one unit, the AI had a couple "hallucinations," where the incorrect data was pulled into the format.
"We were very transparent with the nurses," Rocchio said. "We showed them how it happened, and we went back and corrected it, so they could see ethically that we were doing the right thing."
Leadership visibility and accessibility are also key.
"When we launched our workforce platform with AI in the background, the other thing we did was make sure that leaders and individual caregivers were there to make decisions around how that AI was put into the system," Rocchio said.
"I think both of those things are really important to make sure that those key messages are consistent across all platforms," Rocchio said.
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Virtual nursing will address workforce shortage issues, say these nurse leaders.
Virtual nursing will open up a whole new realm of possibilities.
From admissions and discharges to patient monitoring, mentoring, and even at-home care, virtual care technology will push healthcare into the future.
The HealthLeaders Virtual Nursing Mastermind program participants met last week in Atlanta to discuss their virtual nursing programs and outcomes. There are several key points that CNOs can take back to their health systems and integrate into their own virtual nursing programs.
Building the workforce
First and foremost, virtual nursing is going to expand the capabilities of the nursing workforce. Many of the participants agreed that virtual nursing is one of the only answers to the nursing shortage.
According to the participants, tenured nurses are able to extend their careers virtually when working at the bedside is no longer a viable option. New graduate nurses from the next generation who expect to work digitally will be able to do so, and licensed nurses from all over can work remotely and provide care to other parts of the country.
Health systems should do what they are capable of when it comes to operationalizing virtual nursing programs. Some participants use a central telemedicine hub in their health systems for the virtual nurses, while others use telemedicine stations on or near the floor. Some are also exploring work-from-home strategies.
Many of the virtual nurses in the participants' health systems are centralized and working off of a task queue, and can move freely throughout the system to complete their work. Several of the participants agreed that shift flexibility is also necessary, to give nurses who have external needs the opportunity to work when it is best for them.
Choosing the technology
Technology is obviously one of the largest pieces of the virtual care puzzle. It is critical that CNOs and other leaders invest in the right technology that will help them meet their goals, while also remaining cost effective. Leaders should not be surprised, however, to get it wrong on the first try.
According to the participants, leaders have several options for virtual care technology. Many started simply with iPads and carts, which they said aren’t long-termbut do enable them to get their programs off the ground.
When upgrading technology or starting at the beginning, several participating health systems outsourced to a third-party vendor, while others developed the technology in-house. One dilemma is whether to lease or buy the technology, since new devices are frequently updated to include the newest bells and whistles.
Most importantly, CNOs and other leaders should invest in technology that will actually be used by the care team. According to the participants, the nurses' experience with the platforms should provide them with a better, more efficient experience, because if they don't like the technology, it will not be used.
Gaining buy-in
One of the biggest challenges that CNOs and other nurse leaders will face when implementing virtual nursing programs is gaining buy-in from the rest of the C-suite.
CEOs and CFOs are largely concerned about ROI and how virtual nursing programs will save money. The participants recommended starting with concrete metrics like decreased discharge times to prove ROI. However, most metrics will depend on each health system's needs, and how they define ROI.
CNOs also need to provide their support to virtual nursing programs. According to the participants, there have been some concerns about ratio changes and nurses getting taken off the floor, and about how the technology will interfere with nurse workflows, which worries the nurses. This is why proper messaging, education, and a clear roll-out plan are critical, according to the participants.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
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TheHealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders CNO Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Health systems are brainstorming new ideas for how to build and improve virtual nursing programs.
The Virtual Nursing Mastermind program participants are meeting in Atlanta, Georgia, to discuss the ins and outs of implementing virtual nursing programs.
The program consists of CNOs and other nurse and technology leaders from 12 health systems across the country who are all at various stages in their virtual nursing journeys, and who are innovating with new technologies and solutions.
Implementation
One of the biggest hurdles for virtual nursing is program adoption and implementation. The participants discussed how to gain buy-in from the other C-suite members, particularly the CFO and CIO, and how to introduce the program to the nursing workforce.
There's also a call for defining terms, which the participants say will help with buy-in. The participants were clear that "nursing" needs to come out of "virtual nursing." The tasks being done virtually, like certain documentation functions, do not necessarily need to be completed by a nurse. Health systems should be looking at other departments or positions who can complete those types of processes. This new technology will also enable many other departments in the health systems to also use the platforms for their various needs.
The participants also shared how they have operationally set up their virtual nursing programs. Many have centralized hubs with dedicated buildings where their virtual nurses are based, and others have virtual nurses working from home. The participants noted that they believe virtual nurses need to be at least technologically proficient to take on the position and that those working from home have a private space they can use with a reliable internet connection.
Lessons learned
ROI and improved clinical outcomes are a crucial piece of the puzzle. The participants spoke about what outcomes and efficiencies they are seeing so far and the metrics they are using to track progress. Some of the top metrics include timely discharges, turnover rates, incremental overtime, HCAHPS, and other nurse sensitive quality indicators.
Every health system is going to have different needs and different ways to measure ROI, so according to the participants, it is important to start with a metric like timely discharges. Leaders should look at traditionally "soft" ROI metrics and assign dollars to them so that the rest of the C-suite will get on board with implementing virtual care programs. Additionally, if a system is going to launch a virtual care pilot, it should directly address the chosen ROI metric that will solve the problems that the health system is focusing on.
The participants said the possibilities are endless with virtual nursing technology. The programs are set to expand well beyond just documentation and more into patient monitoring, nurse mentorship, and into more forms of digital care. The ultimate goal is to leverage virtual technology to create sustainable care models of the future.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
