The American Nurses Association reports that one in four nurses have experienced workplace violence. In the second quarter of 2022, more than 5,200 nurses were assaulted in provider settings nationwide.

Meanwhile, the Emergency Nurses Association research shows that seven out of 10 emergency room nurses report being kicked or hit on the job. This problem is exacerbated by societal and political pressures and other issues around overcrowding, long wait times, and limited staffing.

All professional nursing organizations are addressing the issue. The American Nurses Association, American Organization of Nurse Leaders, Emergency Nurses Association and The Joint Commission have laid out standards and provided tool kits for mitigating workplace violence.

"A workplace culture that values silence over safety is just another form of violence," the ANA has stated. 

Zero tolerance of workplace violence is a must, said Rhonda Collins, DNP, RN, chief nursing officer at Kontakt.io, a vendor of healthcare analytics. Collins has been a registered nurse for more than three decades, and was a hospital executive. She also was chief nursing officer at Vocera Communications, where she continued her mission to make technology conform to the real-world needs of the hospital.

Healthcare IT News spoke with Collins recently to get her thoughts on workplace violence affecting nurses, and to discuss causes and potential solutions – including the key technology can play.

Q. As a nurse and nurse practitioner, you have served both on the front lines and in leadership roles at major hospitals. How did you confront the workplace violence issue in these roles?

A. Early on in my career, the expectation was that nurses managed their patients' behavior. There was the notion that if I could not control my patient, then I was not being effective in my responsibilities. That created an environment of reluctance to report events, which led to both an increase in incidents and increase in severity of incidents.

Of course, over time we realized that enabling nurses to report, call for help, and get a response was critical to reducing injury. I think to some degree hospitals still struggle with enacting effective policies; however, we are seeing more open discussions, policies, protocols and even technologies put in place to aid healthcare workers, including nurses, to get help when needed.

Many organizations have created an assessment process to identify patients who may be inclined toward aggressive behavior. The CDC offers such assessments on their website. Identifying these patients, their triggers, environments and diagnosis is critical to keeping patients and employees safe.

Over time, evaluation of common characteristics could provide insights into what triggers aggressive behavior. There is always an opportunity to evaluate the patient experience, which includes patient wait times, time spent with the practitioner, time spent in exam rooms, and time spent waiting for the physician to round.

Poor environmental design, poor lighting, inadequate security, long wait times and poor staffing have all been identified as contributors to workplace violence events. We must gather this critical data and work to improve the patient experience throughout the process and reduce tension and opportunity for workplace violence.

The combination of assessment and intensive evaluation of people and places, based on data, of wait times and patient experience help reduce aggressive actions and outbursts by patients and families.

Q. You contend that technology can help reduce workplace violence for nurses. Let's start with Internet of Things devices, which you point to. What role do they play?

A. Robust teams, including security, leadership and frontline staff, can create policies, conduct training and include all worksite and community entities. However, the ability to call for help at the moment of need requires a technology solution.

Most hospitals provide an urgent call light or number, but the person under duress has to be able to reach it wherever it is. Frequently we see duress buttons affixed to the side of another piece of technology, available on one wall in the patient room, or otherwise inconveniently placed. This is not enough.

And it has proven time and time again that it does not protect healthcare workers or prevent incidents of workplace violence. In order for the nurse to summon help immediately, the call device must be worn.

More hospitals are using urgent call wearable devices to locate the user wherever they are with the press of a button. The user doesn't have to voice call, text or otherwise summon help. With just the touch of a discrete button, help is on the way.

Wearable duress buttons with instant alerts – that technology is here and now, and proven to be successful with the following features and capabilities:

• Lightweight and comfortable

• Be part of already established wearables (like ID badges)

• Capable of being programmed to call any entity for immediate response

• Trigger a silent alarm including a haptic response for the nurse

• Precise location tracking down to the room level

And most important, wearable duress alarms need to be consistently dependable and reliable. I can't stress this enough. For any safety solution, it's critical to ensure you're working with partners who have a proven record of success and reliability.

Q. And another technology: artificial intelligence. What role does AI play?

A. AI plays a big role in care orchestration. The data provided by inpatient journey analytics (powered by real-time indoor location data), which includes workplace violence technology, helps optimize processes and resources by revealing how patients and staff move through the health system.

AI combined with IoT and RTLS can help healthcare organizations protect their staff, optimize workflows and save money. This is the future of healthcare operations.

AI-powered analytics can ultimately be used to determine areas of vulnerability, frequency of events and individuals involved. AI can provide answers to questions about which areas to concentrate on for operational or educational improvement opportunities.

AI can combine patient assessments with technology reports to determine patients at high risk of violent events and proactively identify an at-risk patient for the healthcare team. Having the data sets the foundation to facilitate machine learning of the environment, workflows and solutions.

Using the same technology for other use cases such as asset tracking and management, patient elopement, etc., makes the data more robust, and the intelligence more insightful and actionable.

Q. Please describe a real-world example of these technologies in action and the results they achieved.

A. Northeast Georgia Health System sought a new system that would enhance staff safety. Hospital leaders noted that particularly for emergency department visits, patients present not only with their medical conditions, but they also bring their anxieties, vulnerabilities, socioeconomic issues and family problems with them.

As a result, frontline staff members sometimes felt unsafe when interacting with patients and their families.

To improve staff safety, NGHS equipped 9,000 staff members with portable duress buttons that are location-aware and integrated within existing security and nursing workflows. When staff members encounter what they believe to be dangerous situations, they can simply click the button to alert security teams that they need assistance.

Since deployment of the portable duress buttons, hospital leaders report that staff feel safer and appreciate the extra layer of protection.

Separately, NGHS uses the same technology to track patients throughout the hospital. This aspect of the platform helps ensure NGHS has the right resources in the right place at the right time to best deliver high-quality patient care.

For example, when a physician is performing rounds and a certain patient is not in the room, the technology informs the physician of the patient's absence, delivering time savings and driving greater efficiency of resource allocation.

Hospital leadership reports that employees are quite happy to wear the discrete technology that allows them to reach help when needed and stop escalation of workplace violence events. This is more than just a safety measure; it is also part of an innovative strategy to optimize care operations, cut costs, and improve how care is delivered to patients.

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Email him: bsiwicki@himss.org
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