From the Massachusetts Nurse Newsletter
September 2006 Edition
By Evelyn Bain, M Ed, RN, COHN-S
Associate Director/Coordinator, Health & Safety
The 2004–2007 agreement between the MNA and Providence Hospital in Holyoke resulted in contract language addressing workplace violence and workplace violence prevention.
Shortly after signing the contract in 2004, a joint labor/management committee was formed that met periodically for about 18 months. At one point, however, management changes at the hospital threatened to sidetrack the process, but MNA members held the course.
As a result of this work, guidelines were developed for all staff at Providence Hospital that included algorithms for prevention and intervention for workplace violence in all hospital areas, i.e.: in-patient departments caring for children, teens and adults; in the detox unit; and in the outpatient methadone programs.
Some items in the algorithm are consistent throughout the facility, while others are specific to the patient population. One consistency is training and education and a second is post-event treatment and follow-up. In the prevention phase of the algorithm, it is stipulated that the guidelines must be available and communicated to all employees through unit-based training programs. This would assure that staff and management would be on the same page for prevention, intervention and follow up actions, should an incident occur.
On June 12, 2006 an incident occurred that involved a nurse/MNA member. The nurse was assaulted by a female juvenile during a time when other clients and staff were in the gym. The extent of her injuries required immediate follow-up in the emergency department (ED) of Mercy Hospital, a sister hospital to Providence Hospital. She was examined and her injuries (cervical neck sprain time and extensive contusions to her face) were documented. She was referred to the facility’s occupational health provider (OHP). The nurse did not take photos of her injuries.
Holding perpetrators of violence accountable
After being treated in the ED, the nurse went to the police department to file a criminal complaint as a result of the assault. As the police questioned the injured nurse, they documented in the police report the type and extent of her physical injuries. This documentation was essential for the court proceedings and the outcome that were to follow.
The morning after the assault, the nurse went to the OHP at Mercy Hospital as directed, and was immediately referred to a licensed clinical social worker for evaluation and counseling for post traumatic stress. Originally, the injured nurse did not think that this was necessary, but the OHP explained the value of this type of intervention following assaults and she agreed to participate.
In discussions with MNA staff following the event, the nurse felt that the intervention related to post traumatic stress was an important component of her recovery. She noted that as the social worker prepared her to return to work she stated in the accommodations that she was not to work on the same floor with the patient who had assaulted her.
The injured nurse returned to work within days of the assault, the court case is still in process. The nurse noted that she felt supported by her manager and co-workers as well as.
The manager of the unit followed the accommodation as described by the social worker and supported her decision to address this as a criminal action. He assisted her in obtaining necessary documents that were required by the court.
Due to the lack of placement options for juvenile females, the hospital was not able to transfer the juvenile immediately. On July 10, nearly one month following the assault, at the show cause hearing, the police determined to arraign the juvenile immediately. She was held on bail at the DYS lockup. The nurse believed that the police report and the description of her injuries were critical pieces of information in this court decision.
When asked what was the most difficult aspect of this incident? The nurse replied “Having others [the young patients] witness this violence when they were in a setting that should be healing them from other violence they have experience.”
Lessons learned
- Take photos of physical injuries: The MNA strongly recommends taking photos whenever there are physical signs of an injury, whether from an assault, a dermatitis or an allergic reaction. These have great impact on future outcomes, particularly since the evidence fades over time.
- Speak out and follow through: Healing is accomplished by speaking out and following the guidelines. The injured nurse believes she is in a good place now and is empowered and not victimized by this incident.
The nurse noted that more staffing on the unit might have reduced the probability of this incident. Research shows that low staffing levels—during mealtimes, outings and breaks—is associated with workplace violence, particularly in psychiatric settings.
She also stated that keeping more space between herself and the client would be a future consideration, always keeping in mind that even though the client may not have been assaultive for a long period of time during this admission, the client had a history of violence. Research shows that a history of violence is the best predictor of future violence.
- Develop plans for an organized response for emergency situations: the MNA bargaining committee and staff members who worked on developing the guidelines and algorithms that were utilized in this event believe that the time spent in discussions and planning with the management at Providence Hospital was time put to good use. The outcome here was beneficial to the injured nurse, to the hospital and probably to the clients. Holding perpetrators of this type of violence accountable sends a strong message that you will be held accountable for your behavior, yes, even in a hospital.
These guidelines for prevention and intervention of workplace violence were showcased in 2005 at a workers health and safety conference that was sponsored by the University of Lowell, PHASE project. These guidelines have since been presented at other OSHA training programs related to workplace violence prevention.
Second successful outcome with this contract language
Previously there was an article in the Massachusetts Nurse describing another nurse at Mercy Hospital in Springfield, a hospital also in the Sisters of Providence network, with similar contract language. This nurse also received excellent support and follow-up care, including psychosocial intervention. These guidelines are noted in the contract. The nurse returned to work after a period of time, with specific accommodations that were followed and today is working comfortably in the same position as prior to the tragic event.
Joint labor/management committees formed for the purpose of addressing workplace violence, can provide valuable insight and develop workable interventions, while stressing compassion and respect for injured workers.
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