EP16EO
Culture of Safety EP16EO
Using the required empirical outcomes (EO) presentation format, provide one example of an improved workplace safety outcome for nurses, specific to violence (e.g. physical or psychological violence, threats of incivility) toward nurses in the workplace.
- Provide a copy of the organization’s safety strategy
Example: Decreasing Workplace Violence Toward Nurses
Problem
Workplace violence toward nurses was increasing at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) hospital.
Pre-Intervention
CHI SVHS is part of CommonSpirit Health, the country’s largest Catholic hospital system. The CHI SVHS interdisciplinary Workplace Violence (WPV) Council comprises nurse leaders, clinical nurses, and members from Security, and Quality. In alignment with the CommonSpirit Culture of Safety Toolkit (safety strategy), the CHI SVHS WPV Council analyzes all WPV events involving nurses. The toolkit includes strategies for success such as conducting unit safety huddles, which increase individual and collective accountability for patient and healthcare team safety, designate fixed times during the workday and/or shift to focus on care coordination, facilitate immediate face-to-face clarification of safety issues, result in fewer interruptions during the rest of the workday, and foster a culture of safety empowerment, engagement, and collaboration.
Unit safety huddles are a forum for efficiently providing updated information to the healthcare team to keep them safe. By sharing information and highlighting safety issues, CHI SVHS enhances the healthcare team’s ability to deliver safe care. (Evidence EP16EO-1, CommonSpirit Culture of Safety Toolkit, pages 6-7)
Through analyzing the WPV events and data, the WPV council noticed an increase in WPV toward nurses. In July 2023, the CHI SVHS rate of WPV towards nurses was 3.50. This rate is calculated by taking the number of nurses involved in WPV cases at CHI SVHS divided by the total number of nurses at CHI SVHS multiplied by 100.
The WPV Council reviewed education on Run, Hide, Fight, which are evidence-based practice tactics that originated with the Federal Bureau of Investigation (FBI), to assist employees with how to react in an emergency. This education/training was being provided to members of the healthcare team upon hire and annually. The WPV Council discussed opportunities to improve/enhance this education and training in response to the increase in WPV events against nurses.
In July 2023, the WPV Council discussed Act 313, which passed in the Arkansas State legislature, requiring the posting of a written notice that attacking a healthcare worker is a felony. The act also enables healthcare professionals to use their employer’s address and phone number when filing the charges, contributing to their safety by not having to provide their personal information.
In July 2023, based on the review of the education/training materials and Act 313, the WPV Council determined that additional evidence-based interventions to protect the staff were warranted. These interventions would include the designation of secure rooms for active shooter situations or inclement weather, outdoor evacuation rally points, Act 313 signage, and development of an assault algorithm that gives staff members step-by-step directions on how to respond during a physical or verbal assault to keep safe and how to document the event. The room designations would be indicated by a sticker with a picture to place on the upper corner of doors. For example, stickers with a picture of a tornado designate safe rooms for bad weather situations such as a tornado, and stickers with a picture of a lock would be used for rooms that are designated as safe places to hide during an event such as an active shooter.
The rally points would be specified locations for each department to go to during any event when staff members need to evacuate the building to determine who made it out safely and who is still in the building. The WPV Council created what they wanted the stickers and Act 313 signs to look like and sent them to Marketing to create the professional graphs and print.
Goal Statement
Decrease the rate of WPV toward nurses at CHI SVHS.
Participants
WPV Council Work Group
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Name/Credentials |
Discipline |
Title/Role |
Department |
Phillip Petty, BS, RN |
Nursing |
Nurse Supervisor, Chair WPV Committee |
Float Pool |
Renee Fechuch MSN, RN |
Nursing |
Clinical Director of Nursing |
Nursing Administration |
Sherry Criswell, |
Nursing |
Worker’s |
Employee Health |
Thomas Ford |
Security |
Security Supervisor |
Security |
Tanner Ross, BSN, RN |
Nursing |
Nurse Manager |
Emergency Department |
Sheila Clemens, |
Nursing |
Nurse Manager |
Medical Intensive |
Christopher Lackey |
Security |
Sergeant |
Hot Springs Police Department |
Jessica Wilson, MHA, HACP |
Quality |
Regulatory Compliance Coordinator |
Quality |
Description of the Intervention
August 2023
- Act 313, which passed in the Arkansas state legislature in July 2023, went into effect.
- Throughout August, the WPV Council collaborated with all department managers to get sign counts and poster size recommendations so Marketing could print the signage to be hung at the hospital entry points.
- Phillip Petty, RN, Nurse Supervisor, Float Pool, Chair WPV Council, and Thomas Ford, Security Supervisor, Security, educated all leaders on this new act during the August 2023 Leadership Forum. Leaders took this information back to their teams and included it in their unit daily safety huddles.
- Petty and Ford discussed secure room designations for active shooter/safety, weather, and outdoor evacuation rally points that were created by the WPV Council.
- They reviewed an assault algorithm, created by the WPV Council, that gives staff members step-by-step directions on how to respond during a physical or verbal assault to keep safe and how to document the event.
- Petty and Ford requested that all managers discuss Act 313, secure room designations, rally points, and the assault algorithms in the unit safety huddles over the next month. Unit safety huddles, part of the Culture of Safety Toolkit, are a strategy for delivering safer care for patients and staff members.
- Petty and Ford attended unit staff meetings throughout the hospital to assist with the education, using the teach-back method and enabling staff members, including nurses, to ask questions. Petty and Ford conducted a simulation in which they created a sound of gunfire in the unit staff meetings and then asked staff members what they would do next, based on their Run, Hide, Fight education, if an active shooter were in the room.
September 2023
- Leaders continued to share Act 313 education in unit daily safety huddles with all staff members.
- Petty and Ford continued to attend unit meetings to provide education using the teach-back method and simulation training and to answer questions.
- Act 313 signage was placed at all points of entry to the hospital and on all patient care units
- The stickers for designated secure rooms for active shooter/safety and weather were put up on all the doors of the designated rooms.
The interventions were fully implemented by the end of September 2023.
In alignment with the CommonSpirit CHI SVHS safety strategy, Act 313 signage, secure room designations, rally points, and an assault algorithm decreased the rate of WPV toward nurses at CHI SVHS.
References
FBI. (2018). Developing emergency operations plans: A guide for businesses. https://www.fbi.gov/file-repository/active-shooter-guide-for-businesses-march-201 8.pdf/view
SB344 bill information. Arkansas State Legislature. (2023). https://www.arkleg.state.ar.us/Bills/Detail?id=SB344&ddBienniumSession=2023%2F2023R
Workplace Violence Prevention Standards. Jointcommission.org. (2021). https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpv p-r3-30_revised_06302021.pdf
Outcome
(Evidence EP16EO-2, CHI SVHS Workplace Violence Towards Nurses Rate Graph)