According to the U.S. Bureau of Labor Statistics, health care workers are five times more likely to experience workplace violence than employees in all other industries. Recently the Josiah Macy Jr. Foundation awarded a $25,000 President's Grant to Texas Tech University Health Sciences Center El Paso, which will support the training of Hunt School of Nursing students in the prevention of workplace violence. Scott Brocato spoke with Dr. Ivonne Espinosa, a psychiatric nurse practitioner with TTUHSC El Paso and assistant professor at the Hunt School of Nursing, about the training program, and how it addresses workplace violence against health care workers.
SCOTT BROCATO:
Let's talk about the prevalence of violence against healthcare workers in the workplace. According to the survey company Press Gainey, in the second quarter of 2022, more than 5,200 nursing personnel in the US experienced assaults, translating to an average of two nurses attacked every hour, or approximately 57 assaults per day. The analysis revealed that the majority of the aggressors were patients. So what do these assaults from patients consist of, first of all?
DR. IVONNE ESPINOSA:
Well, you know, the assaults can range from anything from verbal aggression to physical, actual violence. And what is important to remember is that it can happen in any setting. We often think of mental health, you know, being the riskiest setting. But really it can happen anywhere. It can happen in the emergency department. It could happen in Pediatrics. And it also happens in long term facilities or nursing homes.
I think we're seeing patients in their worst moments, right? They're coming in, they're not feeling well, whether they're stressed because they're ill or their family member is ill and...You've been a patient before, I'm sure. You know, there's long waits and often we have to go without food because we're waiting on the procedure.
So we're out of our element. Sometimes, you know, depending on our distress tolerance, we may become angry. And if we don't know how to manage our anger, we'll take it out on whoever is available. Oftentimes it's a healthcare worker. More often than not, it's a nurse.
SCOTT BROCATO:
Tell us about the recent $25,000 grant that was given to support the training of the Hunt School of Nursing students and the prevention of workplace violence. In what ways will the grant help with the training?
DR. IVONNE ESPINOSA:
So what we know is that when nurses and other healthcare providers, physicians for example, experience workplace violence, it can cause trauma, right? Because it’s a traumatic experience to be verbally assaulted, physically assaulted, which many of us have been. Over time, that creates psychological trauma, which then turns to burnout. Then, when a provider, a physician, a nurse, is burned out, they're going to be, you know, complacent, just not motivated to do optimal work. Which we really need to be on our A-game as healthcare workers.
And then worst case scenario is that they leave the profession. We know that there is an attrition rate for nurses of about five years. Many nurses are leading the profession after five years, and workplace violence is one of the reasons given.
There was a recent article about a nurse who committed suicide because of her workplace violence. And I believe in her case it was lateral violence, meaning maybe some bullying going on as well as patients who were...less than nice, I suppose.
SCOTT BROCATO:
The training program is underway now?
DR. IVONNE ESPINOSA:
Yes. So we are in our second semester of the training program. And what we're trying to accomplish through this grant is to prepare these nursing students to identify when a patient is becoming emotionally dysregulated, becoming upset and aggressive. And hopefully through this training, they're able to identify this behavior, be able to verbally de-escalate the situation and/or get themselves to a safe area, whether that is calling a provider to collaborate--which is part of the objectives of the grant, is to collaborate with a healthcare provider, which is usually a physician and nurse practitioner--to help with the de-escalation of this patient. And we want to be able to approach these situations collaboratively, and this is one of the objectives of the Josiah Macy (President’s) grant, which we got.
SCOTT BROCATO:
And the training, there are simulations involved?
DR. IVONNE ESPINOSA:
Correct. So the simulations involve a standardized patient who is acting the part of an aggressive patient. The simulation entails that the patient is becoming angry because he's been waiting in the emergency department for three hours. To add to the simulation, the background is that he is going on a hunting trip, and his father is downstairs waiting for him in the vehicle. And since they're going hunting, there's the potential of having weapons involved. So the students are keyed into that, and need to act accordingly, whether that is to report it to a supervisor, a physician, or even the police.
SCOTT BROCATO:
Beyond the immediate impact on health care professionals, what message does the training send to health care students, potential healthcare students?
DR. IVONNE ESPINOSA:
Right. So we all go into healthcare because we want to help, right? We want to be able to help others. So it does come as a surprise when patients are mean or rude or aggressive, because we're supposed to be there with our best intentions to help others, right? So it creates a little bit of a cognitive dissonance the first time that we're approached with verbal aggression or hostility. So this training, hopefully, is going to prepare the future nurse, the future doctor, to encounter these situations, be psychologically safe themselves, and identify these patients who may become aggressive. And again, get themselves safe. And realize that as nurses as healthcare providers, we're not there to take aggression from other colleagues or from patients or patients’ families. You know, that's not part of our job.
When I started my career about 18 years ago, it was just something that, you know, “it came with the job”. It came with the territory to put up with these types of behaviors. But now we know that it's leading to burnout. And we've got to prevent this as much as possible.
