The North Dakota Nurse - July 2022

July, August, September 2022 The North Dakota Nurse Page 9
Violence in the Healthcare Industry:
What is Being Done to Protect Healthcare Workers?
Penny Briese, PhD (c), RN, North Dakota Nurses
Association, Director of Advocacy
On Wednesday, June 1, 2022, a man walked
into The Warren Clinic, a specialty care office
within Saint Francis Hospital in Tulsa, Oklahoma,
with a gun he had purchased that very day
and opened fire. Michael Louis murdered
four people; a receptionist, a patient, and
two doctors including Dr. Preston Phillips, an
orthopedic surgeon who had recently operated
on Mr. Louis’ back. According to sources, Mr.
Louis was dissatisfied with the level of pain
following his surgery. He had sought medical
help several times in the days leading up to
the shooting and blamed Dr. Phillips for not
receiving adequate pain relief. Mr. Louis took
his own life at the scene; a letter found on his
body confirmed his intent and motive (Hanna &
Watts, 2022, June 3).
Workplace violence is not uncommon,
however it is five times more prevalent in
the healthcare industry. “According to the
American College of Emergency Physicians
and the Emergency Nurses Association, almost
half of emergency physicians and 70% of
emergency nurses reported being physically
assaulted on the job” (Skog, 2022, para. 1). In a
recent 2022 survey of 2,500 hospital nurses, 48%
reported having experienced violence in the
workplace, a 31% increase since just last year.
According to testimony given on Capitol Hill
by Todd Haines, a member of the Emergency
Nurses Association, nurses have been “bitten,
punched, knocked unconscious and strangled
with stethoscopes, all while just trying to provide
basic care to patients” (Mensik, 2022, May 5,
para. 1).
So what is being done?
Legal protections for healthcare workers are
already in place in many states. According
to the Emergency Nurses Association, 31 out
of 50 states have made it a felony to assault a
healthcare worker and they are lobbying for
it to become a felony nationwide. Wisconsin
state law already makes battery against a
healthcare worker a felony, however in March
2022 they passed a law making it a felony to
even threaten a healthcare worker. In May of
2020, Oklahoma Governor Kevin Stitt signed The
Medical Care Provider Protection Act (Senate
Bill 1290) increasing penalties from one year to
a mandatory two to five year sentence and
requiring that assaults on healthcare workers
be reported to the state health department.
(Rowland, 2020, May 20).
At the federal level, The Workplace Violence
Prevention for Health Care and Social Service
Workers Act (H.R. 1195) was introduced in
February, 2021 with strong bipartisan support.
The bill was passed in the US House of
Representatives in April of 2021 and sponsors
of the bill are pushing to have it brought to
the forefront in the US Senate. This bill would
require that healthcare facilities receiving
Medicare funds “develop and implement
a comprehensive workplace violence
prevention plan and carry out other activities or
requirements…to protect health care workers,
social service workers, and other personnel
from workplace violence” (Congress.gov, 2022,
p. 10). The bill has met with some opposition
with regard to cost to healthcare facilities and
questions as to the actual outcome of such
programs.
And here in North Dakota?
In 2015, legislation was introduced in North
Dakota that would make it a felony to assault
a healthcare worker, including by putting
excrement or bodily fluids on them. It did not
pass. In 2017, legislators in North Dakota tried
again, introducing Senate Bill 2216 which
called for an amendment and reenactment of
sections 12.1-17-01.1 (Assault), and subsection
1 of section 12.1-17-11 (Contact by bodily fluids
or excrement) of the North Dakota Century
Code. This Bill discussed assault of health care
facility providers, specifically via contact by
bodily fluids or excrement. Peace officers
and correctional institution officers working at
the North Dakota state hospital were already
covered under this section and it was, and
remains, a Class C felony to assault them while
they are acting in the course and scope of
their employment. Senate Bill 2216 called for
intentionally making contact of bodily fluids
(blood, emesis, excrement, mucus, saliva,
semen, vaginal fluid or urine) with a healthcare
provider a Class A misdemeanor “…if the victim
is employed or contracted by a health care
facility, which the actor knows to be a fact, and
the assault occurs on the health care facility
property” (Dever et al., 2017). This time, the bill
was successfully passed.
In 2021, S.B. 2268 was introduced to once
again try to amend and reenact section 12.1
17 01 of the North Dakota Century Code,
making it a felony to assault a healthcare
Face Shields and Face Coverings
worker in North Dakota (Roers et al., 2021).
Despite strong support from the North Dakota
Medical Association, this bill failed to pass. But
healthcare provider advocates and supporters
are not giving up just yet. The 68th legislative
session is due to begin in January, 2023 so don’t
be surprised if this issue is once again brought
forward. As a healthcare provider, you can be a
part of the action by lending your voice. Like so
many doctors and nurses in other states across
the nation, healthcare workers in North Dakota
deserve to be protected.
References
Congress.gov. (2022). H. report 117-14-workplace
violence prevention for health care and social
services workers act. Retrieved from https://
www.congress.gov/congressional-report/117thcongress/house-report/14/1?overview=closed
Dever, D., Burkhard, R., Nelson, C., Karls, J., Nelson,
M., & Westlind, G. (2017). Senate bill no. 2216.
Retrieved from https://trackbill.com/bill/northdakota-senate-bill-2216-an-act-to-create-andenact-a-new-subsection-to-section-12-1-17-11-ofthe-north-dakota-century-code-relating-to-thedefinition-of-a-health-care-facility-to-amendand-reenact-subsection-1-of-section-12-1-17-11-
of-the-north-dakota-century-code-relating-tocontact-by-bodily-fluids-or-excrement-and-toprovide-a-penalty/1339077/
Hanna, J. & Watts, A. (2022, June 2). Gunman
who killed at Oklahoma medical building
had been a patient of a victim, police chief
says. CNN. Retrieved from https://amp.cnn.
com/2022/06/02/us/tulsa-hospital-shotingthursday/index.html
Mensik, H. (2022, May 5). ER providers push for federal
protection against rising health worker violence.
HEALTHCAREDIVE. Retrieved from https://
www.healthcaredive.com/news/workplaceviolence-prevention-healthcare-workers-billpandemic/623244/
Roers, K., Dever, D., Heinert, J., Nelson, M., & Westlind,
G. (2021). Senate bill no. 2268. Retrieved from
https://www.ndlegis.gov/assembly/67-2021/
documents/21-0918-02000.pdf
Rowland, R. (2020, May 20). Okla. Governor signs law
to protect EMS, hospital personnel from violence.
EMS1 by Lexipol. Retrieved from https://www.
ems1.com/ems-assaults/articles/okla-governorsigns-law-to-protect-EMS-hospital-personnelfrom-violence-6OB6YzG6rspiLISv/
Skog, A. (2022, March 3). Other views: HB 4142
could reduce assaults on health care workers.
Retrieved from https://www.lagrandeobserver.
com/opinion/columns/other-views-hb-4142-
could-reduce-assaults-on-health-care-workers/
article_2205d5ea-98e1-11ec-959c-3bb7762060c7.
html
Appraised by:
Natalie Hadrava, Rachel Hill
Clinical Question:
Are face shields more effective than face
coverings and between the two options, which
face protection had a higher success rate in
preventing the spread of Covid-19?
Articles References:
Coclite, D., Napoletano, A., Gianola, S., Del Monaco,
A., D'Angelo, D., Fauci, A., & Iannone, P. (2021).
Face mask use in the community for reducing
the spread of COVID-19: a systematic review.
Frontiers in medicine, 1060.
Lindsley, W. G., Blachere, F. M., Law, B. F., Beezhold,
D. H., & Noti, J. D. (2021). Efficacy of face masks,
neck gaiters, and face shields for reducing
the expulsion of simulated cough-generated
aerosols. Aerosol Science and Technology, 55(4),
449-457.
Pooja, A., Kabir, S., & Surabhi, S. (2022, December).
Real-world assessment, relevance, and
problems in the use of personal protective
equipment in a clinical dermatology practice
in a COVID referral tertiary hospital. EBSCOhost.
Retrieved April 13, 2022.
Wendling, J.-M., Fabacher, T., Pébaÿ, P.-P., Cosperec,
I., & Rochoy, M. (2021, February 17). Experimental
efficacy of the face shield and the mask against
emitted and potentially received particles.
International journal of environmental research
and public health. Retrieved April 12, 2022.
Synthesis of Evidence:
In the review of literature, we used keywords
such as “face mask,” “face covering,” “face
shields,” and “Covid-19 prevention” in our
search engines (google scholar, Mayville State
University online library databases). To narrow
the search even further, we looked at articles
and studies that have only been conducted
in the last five years, as well as only looking at
scientific articles and studies from reputable
sources. We, as partners, chose the best articles
that we both found and used them to create an
answer to our question.
Bottom Line:
The evidence found that face coverings
are better for the prevention of the spread of
Covid-19. In all four articles, face coverings
were found to be more effective than face
shields. The best face covering to prevent the
spread of Covid-19 is the N95 respirator mask,
and face shields were ineffective when used by
themselves to prevent the spread of Covid-19.
The studies that were used had different ways
of showing how face coverings were effective,
different experiments to show the efficacy of
face coverings vs. face shields, and flaws of
wearing a face covering and a face shield.
Implications for Nursing:
Knowing this information, all healthcare
facilities should be using face coverings rather
than face shields within their facilities. If some
facilities prefer to do both, that will also work
because the face shield could stop a few
particles before they reach the face covering.
However, face shields should not be used on
their own because of their ineffectiveness. The
N95 respirator mask would be the most ideal
face covering to have due to the mask’s ability
to stop the greatest number of particles.
Bedside Reporting continued from page 7
Implications for Nursing Practice:
Implications for nursing practice include to use
bedside report rather than traditional report to
help reduce the number of errors on a shift (Small
& Fitzpatrick, 2017). Using the SBAR method will
help make sure all information is provided about
the patient (Becker et. al, 2021). During bedside
report the nurses can observe the lines, drips,
and wounds in the patient room and note if any
changes. The research including the patient in
bedside report is an effective nursing intervention
that provides better shift outcomes for patients,
allowing the patient to be a part of their care and
ask questions if needed.