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CE: Professional Issues High-risk healthcare environments should provide increased security for patients, family, and workers. All patients must be disarmed prior to evaluation and interview. Healthcare professionals who are exposed to violence in the workplace can have nightmares or difficulty sleeping, poor job performance, chronic pain, or feelings of helplessness and irritability. 7,8 Nurses who have been verbally or physically assaulted have a higher level of anxiety, depression and substance abuse. 7,8 Violence in the healthcare setting takes a significant toll on all parties involved. In addition to the psychological or physical direct effects on the victim, negative effects include financial loss from insurance claims, legal expenses, property damage and staff replacement cost. When healthcare workers leave because of assaults or threats of violence, this contributes to the overall healthcare workforce shortage. Applicable Laws In 2010, the New York Legislature added nurses to its list of occupations to be protected by law. Prior to this, assaults against nurses were charged as misdemeanors. They are now charged as Class D felonies, carrying a sentence of 2 1/3 to 7 years in prison. 9 The law states that any person with the intent to cause physical injury to a registered nurse or a licensed practical nurse during the time the clinician is performing an assigned duty will be charged accordingly. The district attorney’s office for each county or municipality is the decision-making body to investigate the degree of assault or harassment. Although no federal laws have been passed to prevent violence against nurses, 30 states have enacted laws that increase the penalties for people convicted of assaulting a nurse or other healthcare professional. The Violence Prevention in Healthcare Facilities Act mandates that each healthcare facility provide a comprehensive violence prevention program for its employees. 9 Policies for Assault Victims The Emergency Nurses Association recommends a zero-tolerance policy for violence against nurses. Safety within the healthcare institution should be the institution’s first priority, the association states. If a physical or verbal assault occurs, it is important for the healthcare professional to immediately seek medical evaluation. Documentation of the event is crucial because the impact of the assault on the victim may not be immediate; therefore, proper documentation might be important in the future. Every employee who is assaulted is entitled to immediate medical care and first aid by the employer. Each individual agency’s policy and procedures should be available for guidance on reporting the incident. All assaults must be reported and recorded. The victim’s supervisor and employee health department should provide the nurse with all the benefits and rights that are available to protect them during this difficult time. Recommendations Clinicians are largely underprotected and underprepared to prevent and manage violent patients. Up to 50% of healthcare providers are victims of some sort of violence throughout their careers. Emergency departments have seen that drug and alcohol intoxication (or withdrawal from those substances) is one of the most common causes of severe agitation. Combative patients must be thoroughly assessed for medical stability, and a complete evaluation will indicate any dangerous medical rationale for increased agitation and altered mental status. By following basic safety measures, the risk of assault can be significantly decreased. n References 1. National Institute for Occupational Safety and Health: Violence Prevention Training for Nurses. Centers for Disease Control and Prevention. http://www.cdc.gov/ niosh/topics/violence/training_nurses.html 2. National Intitute for Occupational Safety and Health: Violence Occupational Hazards in Hospitals. Center of Disease Control and Prevention. http://www.cdc.gov/ niosh/topics/violence/ 3. Occupational Safety & Health Administration: OSHA updates guidance for protecting healthcare and social service workers from workplace violence. United States Department of Labor. https://www.osha.gov/SLTC/ workplaceviolence/index.html 4. Gacki-Smith J, et al. Violence against nurses working in U.S. emergency departments. J Nurs Adm. 2009;39:340-349. 5. Good B, et al. Assessment of the acute psychiatric patient in the emergency department: legal cases and caveats. West J Emerg Med. 2014;15(3):312-317. 6. Dubin WR, Jagarlamudi K. Safety in the evaluation of potentially violent patients. Psychiatric Times. 2010. http://www.psychiatrictimes.com/special-reports/safetyevaluation-potentially-violent-patients 7. Assessment and emergency management of the acutely agitated or violent adult. UpToDate. 2015. http:// cursoenarm.net/UPTODATE/contents/mobipreview. htm?30/45/31441 8. Stokowski LA. Violence: Not in my job description. Medscape. http://www.medscape.com/viewarticle/7277144_print 9. Assault of a nurse on duty is a felony. Emergency department violence surveillance study. Emergency Nurses Association. Accessible to members at: https://www.ena.org/government/State/Documents/ StateLawsWorkplaceViolence Jennifer Oakley is the lead nurse planner for the ADVANCE for Nurses continuing education program. She works in the emergency department at the Hospital of the University of Pennsylvania in Philadelphia and is an adjunct professor at Drexel University. She has completed a disclosure statement and reports no relationships related to this article. TAKE EXAM ONLINE • This CE offering expires May 2, 2018 ▶ Nurses can earn 1 contact hour of continuing education credit after reading this article and earning a passing score on the associated quiz. Take tests for all CE courses at www.advanceweb.com/NurseCE. No written tests are processed; all tests are scored online. Merion Matters is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This continuing education offering sponsored by The University of Phoenix School of Nursing. www.phoenix.edu 40 ADVANCE FOR NURSES n MAY 2016 n www.advanceweb.com/Nurses
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