Dealing with life’s daily crisis moments in healthcare

By Matt Phillion

A new survey by the Crisis Prevention Institute (CPI) takes a deep dive into workplace violence in healthcare, finding that 40% of the 3,155 respondents believe their staff feel comfortable addressing a workplace violence crisis.

To address the findings in the survey, CPI has offered its Workplace Violence Prevention Training Index, which enables healthcare workers to get a score related to their workplace violence prevention training at their organization and see how the organization compares to others in the industry.

Other notable findings from the survey include:

• 40% of respondents believe that they are below average as a leading safe workplace; 9% feel they are lagging behind
• 17% believe their staff feel very or mostly unsafe
• Less than half (43%) believe their policies against workplace violence are effective or very effective

“It was pretty much what we expected in terms of feedback,” says Tony Jace, CEO of CPI. “We had hope, post-pandemic, that the industry would unite around standards and measurement.” Clearly, though, there’s still more work to be done.

Workplace violence in healthcare isn’t exclusive to the U.S., Jace notes, as his organization has seen related challenges across the globe. “This acute and increased level of what we call life’s daily crisis moments have been building,” says Jace. “It’s more acute than ever.”
The tenure and seniority of the respondents gave weight to their answers, he says, noting that respondents had an average of 11 years spent in the industry. “These are people who have lived it, seen it pre-COVID,” he says. “They’re really leaning in and saying, ‘Listen, we want to understand.’ ”

CPI works with a train-the-trainer model, teaching not just nurses but professionals across many industries how to take training back to their organizations to help others with crisis prevention. CPI has also seen those professionals express increased interest in how their organization compares to others. “They want to get a feel for what is normal,” Jace says. “These are things you can’t necessarily talk to your spouse about, and the trainers were really flocking to each other to discuss their experiences.”

The ability to level-set was very important to them, he notes. “There is a concern that, they say, [the organization is] at best average with this stuff, and their confidence is way down,” says Jace. “You learn how to manage patient EHR, draw blood, but you’re not taught in school or even in your introductory training how to manage that workplace violence, how to play that role you have to play to de-escalate or minimize crisis moments.”

But the keys to promote success are out there. “There are strategies and tools, techniques that leaders can deploy in their organizations that can meaningfully and impactfully address this issue full on,” says Jace. And there is absolutely a need for those techniques. “This is the worst I’ve seen it in my 14 years in this business,” he adds. “Private or national health systems, U.S. or international, everyone is facing these issues.”

A societal issue

Healthcare is uniquely in need of help in solving the violence problem. “Healthcare has been at the epicenter for workplace violence for decades,” says Jace. “There’s more violence, more aggression, pointed at healthcare workers than any other industry.”

These crisis moments are manifesting in all parts of society, Jace notes, but “unfortunately, healthcare organizations are the final mile for a lot of vulnerable, distressed people,” he says. Mental health, substance use, generalized stress, the list of reasons people may be moved to violence are numerous—but many of them lead toward interacting with healthcare.

“I think there’s a better recognition that every person is carrying a backpack of trauma around with them and some cope with it OK, while others can’t. And the amount of those who can’t has increased, as has the opportunity for that backpack to be opened up,” Jace says.

Trust between workers and their organizations has eroded as well. Staffing cuts and shortages occurring side by side with growing workplace crises has broken down the bond between frontline workers and their administrators, Jace says. “They’re coming to work in a more transactional way than vocational now,” he observes. “It’s almost a perfect cauldron for issues to manifest themselves. And then add in the factors patients bring with them into the healthcare setting and it’s brought to a boil.”

So how do we bring that temperature back down? “Hospital systems and boards of directors are seeing the bottom line. They’re losing millions of dollars a year. There are hard costs to a high churn of staffing. The cost to get a new nurse up and going is expensive,” says Jace. And there are other costs leaders need to pay attention to related to crises: worker’s compensation, medical insurance costs, and other preventable costs incurred through workplace violence.

Safer, better-trained environments can foster improvements in recruiting and retention, he notes. “But you need to have the tools to fulfill your vocation,” he says. “You have to go to the golf course that’ll rent you clubs, not a Little League bat.”

Healthcare systems are meant to be environments of healing and care, Jace says. “We need to focus more on delivering care and getting rid of the crisis moment. Training like ours can reduce the number of crisis moments, as well as reduce the severity of those that do occur. This allows staff to get time back to spend with patients.”

Caregivers, not selfless warriors

The industry has been coming up short in training and education for crisis prevention.

“We’re not training these selfless warriors. They’re out there delivering care because they want to give back to society, and we’re not giving them the tools they need,” Jace says. “They want to care for their patients and they’re either getting harmed themselves, or accidentally harming people in these crisis moments.”

The right training can empower decision-making capabilities during a crisis and offer a more serene way to deal with whatever is occurring in that moment.

“A nurse is a nurse, whether they’re in Dubai or Rochester,” Jace says. “They’re just great people, and this is why we’ve let them down by not giving them the skills to manage their work environment.”

The first step is to give them those tools. There’s a clear path from average to leader in the industry when it comes to handling daily crises with the right training. The other component is data: tracking and measuring incidents to better understand what’s happening in the field.

“A lot of times it’s just making the first move,” says Jace. “Organizations may overthink things, try to build out a full committee, etc., but try additional training in a hospital or two and see what happens.”

Leadership needs to acknowledge the status of workplace violence, as well. “There’s this issue where they don’t know it’s an issue, and they just don’t know how to move,” says Jace. “Start small. Add awareness training. Build a common language on how to respond to an incident. You can’t just leave it to a security guard—in fact, the way different people perceive the security apparatus can be misconstrued and felt as an aggression that can inflame the anxiety someone is feeling or the trauma they carry. And sometimes that can create an incident that begins with a receptionist or nurse. There’s a care aspect and safety aspect, and they go together, so you need everyone to share a common language of how to manage a crisis moment.”

Healthcare, and society in general, is in a vulnerable spot, Jace says. “We can’t continue to be the last stop for the most vulnerable in society,” he says. “We need to reconnect and have a new compact between the community and care providers, and only then will we be able to re-nurture these roles.”

These crisis moments aren’t just the terrifying moments we see in the news, either—there’s an opportunity every day to deal with smaller moments that bubble up in the workplace.

“We need to get rid of all the Band-Aids and get to the core of the issue,” says Jace. “It’s about prevention and early awareness of what it takes to create a safer environment for healthcare workers, patients, and their families.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.