Table of Contents
The changing stage requires the organization and its employees to take time to understand the action plan, acknowledge the new way of operation, and proactively contribute in the transition period. Regarding nurse Gail’s incident, the change focuses on people, communication, workplace environment, and workforce management.
Targeted Change: People
There is no wrong response; staff response depends on their personality, culture, perception of the risk to their personal safety, and available choices at the time of the incident (California Hospital Association, 2018). In order to prevent workplace violence, all employees first must understand that aggressive behaviors and violent acts are unacceptable (OSHA, 2016). They will also embrace the idea that reporting all violent incidents can give the organization and all employees a chance to improve their security plan and safety skills (OSHA, 2016). They must be alert and ready to take action when dealing with patients or visitors, who may be under stress or tense, and potentially perform verbal or physical violence (TJC, 2018).
All employees must receive training in de-escalation and self-defense skills, as well as understand organizational policies and procedures related to emergency code response (TJC, 2018). Studies show that violence prevention training has positive impact on nurses: it enhances their self-respect, increases confidence in managing aggression, develops de-escalation knowledge, and improves performance of skills (Heckemann et al., 2015). When well-equipped, staff can initiate de-escalation techniques as quickly as possible when threatening language, agitation, or potential physical violence is identified (TJC, 2018). Staff will also actively contribute to the evaluation of the violence prevention program by providing feedback and concerns about shortcomings in the system (ANA, 2015).
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Targeted Change: Communication
All staff, as well as patients, family members, and visitors will be reminded that any intentional or non-intentional violence in health care settings will not be acceptable or tolerated (Public Services Health and Safety Association [PSHSA], 2018). This important message can be delivered via posters or placards placed at the facility entrance or lobby. The organization will create a violence prevention brochure affirming that everyone in the hospital is responsible for keeping it safe. The brochure will be handed to patients on admission or to visitors at the front desk (PSHSA, 2018).
When staffing is adequate, a call to the operator for initiating a code can be immediately made in an emergent situation. However, if the shortage of staff is unable to be solved as needed, bedside nurses will be equipped with panic buttons that connect to a real time locating system (RTLS). According to Maged and Geoff (2012), RTLS is location engine software that receives and reads wireless signals from tags, which will be attached on all employees’ identification badges. In the case of staff shortage, staff will carry a panic button along with tags on their badges. When a staff member presses the panic button, the RTLS software will identify the exact location of the staff and send help as needed (Maged & Geoff, 2012). In this specific sentinel event, when Templeton started to get agitated, if the facility had installed RTLS, nurse Nicky could press the panic button and summon the security personnel immediately.
Targeted Change: Workplace Environment
The organization will maintain the adequacy of staffing in order to reduce safety-related risks (TJC, 2011). Short-term understaffing can be solved by hiring temporary nurses from staffing agencies, because this helps the organization meet the desired nurse-to-patient ratio and improve patient care (Seo & Spetz, 2013). In addition, staff working in emergency departments or walk-in clinics will be reminded to use a buddy system and avoid working alone with agitated patients (OSHA, 2016). Administrators, or managers, will review staff satisfaction about work schedules and shifts, in order to identify fatigue-related risks (TJC, 2011).
All employees will receive education about the importance of sleep, the effects of fatigue on work performance, and methods of promoting sleep hygiene (TJC, 2011). TJC (2018) also recommends several changes to the workplace environment, including visible security presence, regular security rounds, and metal detectors. As metal detectors facilitate the confiscation of concealed weapons, the installation and regular maintenance of metal detectors helps discourage attempts to enter with weapons and reduce the unnecessary presence of weapons in the hospital (Malka, Chisholm, Doehring, & Chisholm, 2015). In addition, all visitors will sign in at the front desk and receive a visitor badge (OSHA, 2016).
Targeted Change: Workforce Management
The violence prevention program will include management commitment, worksite analysis, employee training, and program evaluation (OSHA, 2016). The organizational administrators start the program by committing to provide appropriate policies and sufficient resources including access to personnel training, tools, and equipment. Next, the organization will conduct workplace analysis to identify contributing factors and prioritize interventions.
Workplace analysis will include the risk assessment on worksite conditions, review of previous workplace violence, and feedbacks from employee, patients, and visitors. The organization will enforce its culture of safety by requiring all employees to participate in safety and health training annually. Supervisors and managers will obtain training in identify potential hazards, encourage staff training participating, and make changes in staffing policy and procedures to reduce risks. Education and training for all workers help raise their knowledge and awareness regarding workplace violence and equip them with essential tools to address potential problems and protect themselves and others (OSHA, 2016).
Training topics will focus on policies and procedures for addressing emergency codes and de-escalation and self-defense techniques (OSHA, 2016). Effective teaching methods involve drills, simulations, and role-playing (OSHA, 2016). Practice drills will extensively cover response plans to all violent situations, ranging from verbal abuse to active shooting (TJC, 2018). Through hands-on drills, the organization can evaluate the effectiveness of the entire security plan, identify possible deficiencies in policies, and test safety equipment (CDC, 2017). The effectiveness of trainings will be assessed by testing staff’s knowledge about aggression management and observing their de-escalating performances (OSHA, 2016). In addition, the coordinator of the workplace violence prevention program will review its content, teaching methods, and frequency of training annually (OSHA, 2016).
In addition, all employees will have equal access to receive an efficient work schedule (Miller, 2010). Several factors will be considered when making schedules: staff adequacy, shift length of eight- or twelve- hours, 24-hour time off after each night shift, and no more than three consecutive night shifts. The good-quality work schedule allows security personnel to maintain their vigilance throughout the night shift to recognize possible risks and effectively respond to emergent situations (Miller, 2010).
Refreezing
The refreezing stage occurs when the changes are in place and well-accepted by the organization (Mind Tools Content Team, n.d.). The refreezing stage succeeds when the organization and its employees achieve the sense of stability and confidence when implementing new ways of operation (Mind Tools Content Team, n.d.). The organization will accurately document all incidents, regularly review reported incidents, and analyze trends in incidents comparing to baseline rates (TJC, 2018). After implementing action plan, it is expected that the rate of workplace violence incidents will be decreased by 40 to 50% over two years.
In addition, after the installation of metal detectors at entrances, the numbers of deadly weapons discovered in the medical center will be decreased by 80 to 90%. The organization will survey employees to determine the effectiveness of new changes and support any recommendations for change (OSHA, 2016). Supervisors and managers will listen to their staff and encourage them to report any incident related to workplace violence (OSHA, 2016). In addition, staff will be actively involved in implementing the action plan and work towards organizational goals.
The organization will also reinforce the partnership with local law enforcements in order to improve strategic plans in emergent situations, as needed (TJC, 2018). For example, the organization will plan the internal security resource more efficiently by regularly evaluating the response time of law enforcement (TJC, 2018).
Conclusion
The tragic event that happened at Good Shepherd Medical Center not only took lives of innocent people like Gail and Harry, but also accentuated the sentinel event alert on workplace violence. The RCA disclosed factors contributing to this specific workplace violence incident, including understaffing, lack of staff training, worker fatigue, and inadequacy of the security system. Optimistically, the implementation of an action plan targeting people, communication, workplace environment, and workforce management, can help prevent workplace violence and reduce the possibility of future similar incidents.
