Protect nurses from violence so they can best care for patients

More than two-thirds of health workers are victims of assault so we must protect them against violence.

RNAO today is releasing Preventing Violence, Harassment and Bullying Against Health Workers (second edition) best practice guideline (BPG) to combat a surge in violence that in 2015 made health workers twice as likely as police and correctional officers combined to be injured badly enough to miss time from work.

This evidence-based BPG recommends that health service organizations screen all patients to assess who is more at risk of acting violently, choosing screening tools that have been shown to work and teaching frontline staff how to use them. Those recommendations are among 15 made by an RNAO panel of experts that consulted widely and reviewed evidence from 56 studies.

“Workplace violence and harassment are significant hazards that threaten the safety of health-care workers and the quality of patient care. These threats can be combated by prevention efforts grounded in evidence and shown to be successful. This document presents that evidence so health service organizations can decide how best to intervene,” said Henrietta Van hulle, the RN who co-chaired the expert panel.

A 2017 report by the Ontario Council of Hospital Unions found that of nearly 2,000 health workers surveyed, 68 per cent had been assaulted in the previous 12 months, 86 per cent had been abused verbally, and 42 per cent sexually assaulted or harassed. The rate of violence has been growing: From 2006 to 2015, the number of injuries that led to missed time at work increased 66 per cent.

“Violence continues to compromise health-care organizations and those who provide direct care, particularly nurses on the frontlines,” said Althea Stewart-Pyne, an RN and program manager for RNAO’s best practice guidelines program. “We must continue to promote respect for each other and those we care for. This guideline provides easy access to evidenced-based resources that support nurses and others to create a workplace that promotes health and safety, while providing optimum care for patients.”

Like all RNAO BPGs, Preventing Violence, Harassment and Bullying Against Health Workers (second edition) is based on a review of the most current and relevant evidence by an expert panel, which includes nurses, other health and people with lived experiences. Among its recommendations is that health service organizations:

•  Document incidents of violence and share that record so that future caregivers are aware of the risk
• Teach health workers to de-escalate patients who seem at imminent risk of being violent and teach workers how to breakaway safely when violence is attempted 
• Develop a plan to reduce bullying and harassment by workers against co-workers by choosing proven tools that track such incidents

The guideline also recommends health services organizations and academic institutions monitor harassment and bullying, create policies that prevent such behaviour, and when such conduct occurs, respond quickly and appropriately.

The recommendations can reduce violence not only in Canada but around the world, says panel co-chair Dr. Gordon Gillespie, the deputy director of the Graduate Occupational Health Nursing Program at the University of Cincinnati. “Workplace violence has become an international plague to all sectors of health care. This best practice guideline has the potential to provide the needed guidance across health sectors for the prevention and management of workplace violence,” he says, noting the BPG will be translated into several languages.

“The guideline is critical if we want to reverse the surge of violence,” says Dr. Doris Grinspun, RNAO’s CEO and founder of the BPG program. “Health-care workers and patients deserve a safe work environment, free from violence, harassment and bullying. If the guideline’s recommendations are adopted, nurses and their colleagues can better focus their expertise and compassion on optimizing care and outcomes for patients.”

RNAO’s Best Practice Guidelines Program is funded by the Ministry of Health and Long-Term Care. It was conceived in 1998 and launched in 1999 to provide the best available evidence for patient care across a wide range of health settings. The 54 guidelines developed to date represent a substantial contribution towards building excellence in Ontario’s health system. Health-care facilities that successfully implement multiple guidelines receive special recognition from RNAO as Best Practice Spotlight Organizations (BPSO).

RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and influenced decisions that affect nurses and the public they serve.

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