equity is of vital concern to nurses, whose daily work as patient educators and
healthcare practitioners is influenced by interrelated factors such as:
Social Determinants of Health
With the help of Drs. Janice Phillips (PhD, RN, FAAN) and Margaret Moss (PhD, RN, JN, FAAN), editors of the upcoming book Health Equity and Nursing, DailyNurse is looking at these basic concepts and exploring the role of health equity considerations in the day-to-day work of nursing.
“Health disparities” refers to the inequalities in health and health care between different population groups. There are widespread inequalities that impinge upon public and individual health and well-being. Among the patients most directly affected are members of ethnic minorities, immigrant and low-income families, and people living in areas far from accessible care. According to a 2018 study, the US spends an estimated $93 billion in excess medical costs per year due to racial disparities alone.
nurses help to overcome health disparities that affect their patients?
Phillips: “It’s been over a decade since nurse leader Dr. Gloria Smith wrote a
commentary “Health Disparities: What Can Nursing Do?’ In her commentary, Dr.
Smith encouraged nurses to promote nurse managed primary care and focus on
changing local, state and national policies to help address health disparities.
years however, we have expanded our efforts to reduce health disparities to
include an emphasis on achieving health equity. Healthy People 2020 defines health
disparities as a type of particular difference in health status that is closely
linked with economic, social, or environmental disadvantages. Populations that
experience greater social and economic hardships are more likely to experience
health equity is a principle that underscores a commitment to reducing and
ultimately eliminating health disparities. Health equity occurs when all
populations (especially vulnerable, less advantaged socioeconomic populations)
experience their highest level of health. Efforts to achieve health equity are
intertwined with our ability to effectively eradicate health disparities. In
our daily practice, nurses can be mindful to assess for these and other
conditions that may adversely impact health outcomes and make appropriate
referrals to members of the health care team such as social workers and case
managers who are skillful in addressing identified social needs and can make
appropriate referrals for additional services.
On a higher level of intervention, nurses must become skillful in advocating for social policies that can positively impact the myriad of social and economic conditions (inadequate housing, lack of employment and education opportunities) that adversely impact the health and well-being of those we serve.”
Health Equity and Social Determinants of Health (SDOH)
of health (SDOHs) are factors apart from medical care and genetics that
account for roughly 80 percent of overall individual health outcomes, according
to the National
Academy of Medicine. SDOHs are factors such as socio-economic status,
availability of nutritious food, air and water quality, housing, education,
transportation, racial segregation, and exposure to racism and violence. SDOHs can
include a patient’s neighborhood and environment, access to health care
(including insurance); social, cultural, and community context; level of education;
and economic stability—all of which play a role in a nurse’s assessment of a patient’s
wellbeing and risks to the same.
DN: In what ways can a nurse incorporate SDOH considerations into treatment?
Janice Phillips: “As they are working on the frontlines providing direct care to patients, it is important for nurses to be mindful of the many social and economic factors that may impact the health and well-being of patients and communities at large. In recent years hospitals have started screening patients for social needs that may have some bearing on a patient’s health and health outcomes. Factors such as access to stable housing, primary care, nutritious foods and transportation have emerged as significant factors impacting health status and health outcomes. Thus nurses are pivotal to integrating these factors when conducting patient assessments and making referrals that can help address the identified social needs. Other factors such as structural racism, income, education, poverty also impact health status and outcomes.
advocates, nurses are well positioned to relay important information to social
workers, case managers and other members of the interprofessional health care
team who have the expertise to refer patients to needed resources. Nurses are
valued collaborators in this regard and are encouraged to familiarize
themselves with how their respective hospitals and health care systems are
assessing and addressing the identified needs of patients. According to the
American Hospital Association, by 2023, 48% of health care organizations will
have a standardized means for collecting data on the social determinants of
health, making this an important opportunity for nursing practice. Knowing
where one’s organization stands with these efforts is an important first step.
Public policies that address the root causes of poor health status and longevity are central to any effort devoted to addressing the social determinants of health. Nurses are encouraged to get involved with their professional organizations, home institutions or other stakeholders who can work together to advance a policy agenda aimed at addressing the myriad of social and economic factors that impact health.”
Dr Jasmin Whitfield (RN, MSN, MPH, DNP), “culturally competent care is not just acquiring information on
a particular group of people but rather developing a respect for and
understanding that the beliefs, attitudes, behaviors, language, and rituals of
that group all play a role.” The epidemiology, manifestation of disease, and
effects of medications vary among different ethnic and cultural minorities, so
nurses need to make themselves aware of matters such as ethnicity and culture, sexual
preferences, and other points of identity as part of their patient dialogue, as
all of these matters have specific health connotations.
DN: How can a nurse deal with topics such as patients’ ethnicity, language, culture, sexual orientation, and gender identity in a sensitive, yet direct manner?
Margaret Moss: “It may be of help for the practicing
nurse to know of other care modalities recognizing a cultural component. There
is Cultural Safety, defined by Williams (1999), “as an environment that
is spiritually, socially and emotionally safe, as well as physically safe for
people”. This includes being safe to tell your nurse how you identify, relay
your spiritual and other needs without fear of retribution etc. Especially when
there is patient-provider racial, gender or ethnic discordance, there can be a
tentativeness on either side to communicate effectively and fully.
There is Cultural Humility and Cultural Respect as well. So, a big tip is just ask…very simple. With humility, state you are unaware of any special needs or care they may have and ask. Ask, how do you identify? Instead of guessing and then go from there. Whereas Cultural Competency can be seen as useful for the dominant culture caring for the ‘other’. As an Indigenous nurse, no one offered me a Cultural Competency course or workshop as I cared for dominant culture patients. However, safety, humility and respect always serve to increase a patient’s comfort and optimize results.”
DN: In your view, what role do today’s nurses have in working towards social justice?
Margaret Moss: “Social Justice (from the Oxford Dictionary at Lexico) is justice in terms of the distribution of wealth, opportunities, and privileges within a society. It is well known, published, proved, that minorities in the US suffer, daily and out of proportion to non-minority peoples, at the lower end of these distributions. Other groups such as the poor, working poor, chronically ill and disabled, and LGBTQQ2+ suffer as well. To help even out these disparities in the health realm, nurses must advocate. At times, they are the only thing standing between a patient and health or death.
Similarly, nurses are and must be advocates beyond the
individual. Nursing programs at the bachelor’s level and above incorporate
Community Health, Population Health, Leadership and often Health Policy into
the curriculum. I sought a law degree after my PhD in nursing, as both have at
their base-advocacy. I have worked my career in advocating for more just
American Indian Health. Social Justice Issues face every nurse every day and
they are deep and wide. They hit ethics; policy and procedures that may be seen
as detrimental but are, “always done that way”; unpotable water such as in Flint,
MI; or Uranium on American Indian reservations; lack of available medicines;
unfunded programing, and the massive leading edge of aging care; autism; and a
host of other issues.”
DN: Finally, what actions can nurses take to further social justice and health equity in healthcare?
Margaret Moss: “Nurses at 3 million strong have the collective and individual power to help change these imbalances, by showing up (legislatures); speaking up (comment on proposed rules); and participating (in practice and advocacy associations).”
Health Equity and Nursing
Featuring contributions by nurse educators, leaders, and scholars, this groundbreaking new text focuses on the power of nursing to make substantive contributions to improving the health of all populations. In clear, accessible language, this work traces the evolution of thinking from eliminating health disparities to achieving health equity, and examines population-based and population-specific inequities in health status and outcomes.
It is well-known that people with Substance Use Disorder
(SUD) and Opioid Use Disorder (OUD) face a heavy stigma in society at large. For
instance, in Victoria, BC, while exceptional caregivers such as Corey Ranger, the
nurse are saving addicts’ lives, hostile bystanders often offer disdainful
suggestions such as “Oh, why bother? Just let them die!”
Indeed, it is not uncommon for the general public to regard SUD and OUD as examples of societal weakness and personal failure, rather than viewing the condition as a medical condition that is frequently combined with other chronic disorders. In many cases, those suffering from addiction are also subjected to negative attitudes from nurses, doctors, and other healthcare practitioners. As a nurse in one study says of SUD patients, “[they create] a cycle of problems,” where “the staff perceives them to be annoying or obnoxious…” Another nurse in the same study notes, “staff attitudes are obvious, you can’t really hide them that well.” It is acknowledged that “Stigmatizing attitudes among health professionals have been shown to be widespread, which has detrimental consequences for connecting persons with OUD to treatment.”
Nurses, Doctors and SUD; Nurses and Doctors with SUD
However, doctors’ tendency to protect colleagues with SUD, and the policy of theNCSBN that promotes a nonjudgmental, stigma-free approach to treatment of nurses with SUD (approximately 70% of nurses who seek treatment successfully return to practice) coexists with strong evidence that a substantial number of doctors and nurses have a negative attitude toward addicted patients. The consequences are as grave as they are incongruous; as a study in Canadian Nurse.com remarked, “perceived discrimination on the part of health-care staff was a major barrier to [patients’] seeking medical help, both for their substance abuse and for treatment of general and chronic conditions.”
Doctors and OUD: A Static System
“Fresh out of medical school, you can prescribe for pain relief any of the opioid medications that can lead to addiction, but you have to get a special waiver to treat addiction, a disease process. That just doesn’t make sense…”
–Dr. Sandeep Kapoor, director of the Screening, Brief Intervention and Referral to Treatment (SBIRT) program at Northwell Health
The situation of doctors is particularly unfortunate with regard to patients with OUD. The reaction of one doctor, when asked about the sparse availability of buprenorphine treatment, was a flat comment that “Most doctors don’t want to treat OUD or SUD patients.” A Statnews editorial on this topic concludes that a pervasive problem is that a) many doctors do not see addiction “as a brain disorder requiring treatment, but as a personal failing,” and b) “some physicians believe that medication-assisted therapy is little more than switching one addiction for another.”+
Even among those doctors who are willing to treat OUD patients, the problem is compounded by the fact that even now—in the midst of an opiate crisis—treating addicted patients with medications such as buprenorphine is highly regulated, requiring strict state and federal registration. To be permitted to prescribe, regulations require that doctors take eight hours of training (for NPs and PAs the requirement is 24 hours of training), after which they are required to register for a DEA waiver.
A further deterrent to the propagation of buprenorphine treatment is the inspection of office records by DEA agents (see within link, “What to Expect When the DEA Comes to Your Office”). An independent-minded physician—who may already be unenthusiastic about treating “addicts”—is unlikely to readily tolerate this sort of heavy-handed government interference in his or her practice. As it is, at present, despite the generally acknowledged opiate crisis, fewer than 7% of US physicians currently have DEA waivers for the prescription of one of the safest and most effective methods of treatment for opiate addiction.
Ties that Bind
This means that while the opiate crisis is raging, the hands of the practitioners who ought to be on the front lines of the fight are bound—both self-bound and bound by regulations. Doctors Kevin Fiscella and Sarah Wakeman ask in another StatNews editorial, “Would deregulation work?” They go on to note that “after France instituted this approach in 1995, deaths from opioid overdoses dropped nearly 80 percent.” Until attitudes among caregivers become more advanced, and until a proper deregulation movement for the prescription of buprenorphine gains national attention, attempts to stem the crisis are little more than a grand display of running in place.
Border detention facilities that house immigrants have been in the news recently because of their policy of not providing influenza vaccinations to their detainees, sparking high-profile protests. Why would an immigration detention facility, tasked among other things with providing comprehensive medical care to its detainees, refuse to provide them with flu vaccines?
To answer this question, it might be instructive to ask how influenza vaccinations are handled at other prisons and jails in the U.S. It depends on what type of facility you are in and how long you will be there. All prison systems I know of offer influenza vaccinations to their inmates. On the other hand, most jails (short-term detention facilities) do not have a routine flu vaccination program, though there are exceptions.
Vaccinations in Prisons
Inmates are sentenced to prison for a minimum of one year and usually longer. As a result, prison populations are stable. Almost all of the inmates in a particular prison now will still be there next year. Also, prisons are tasked with providing comprehensive medical care to their inmates. This includes influenza vaccinations, but also other recommended vaccinations and boosters. Of course, just like in the community at large, not all inmates want to be vaccinated. The percentage of prison inmates who get vaccinated depends on how vigorously the prison pushes the program.
If a prison advertises the availability of the flu vaccine and actively encourages its inmates to be vaccinated, the acceptance rate can be greater than 50% (compared to about 33% of adults in the community who get vaccinated). Most prisons have a “big push” campaign to encourage flu vaccines once a year in the fall. However, if a prison does not advertise the availability of the flu vaccine, the percentage of inmates vaccinated can be very low. It makes economic sense for prisons to actively encourage their inmates to be vaccinated. Every dollar spent on influenza vaccinations will save more than a dollar down the road trying to deal with influenza outbreaks.
Vaccinations in Jail
Influenza programs in jails are
different for several reasons. The first issue is that the inmate population in
a jail is not stable. The average length of stay in the average jail in the
U.S. is around 2-3 weeks and many are released within days. If a jail offers
influenza vaccinations in October, most of the inmates vaccinated will be gone
by November. The jail will now be filled with new, unvaccinated inmates. If you
vaccinate the November inmates, most (again) will be gone by December. So, to
be effective, influenza programs in a jail must last the length of the
influenza season — making jail influenza programs more difficult and expensive
to administer than a prison program.
As an example, remember that one
must order influenza vaccines well in advance. In order to have influenza
vaccines ready in the fall, a prison or a jail has to order them at least six
months earlier. A prison will know how many influenza doses it will need based
on its population and previous acceptance rate. But how many doses will a jail
need with inmates coming and going over the course of an entire flu season?
That can be hard to get right in a jail! It is expensive and maddening to order
too many vaccines only to throw the unused doses away at the end of the flu season.
Also, jails vary greatly by size and
sophistication of the medical services they provide. There are many small jails
in the U.S. (think 10 beds) where no medical personnel ever come to the jail
for routine medical care. If their inmates need medical attention, the deputies
have to load them into a van and take them to a clinic or ER in the community.
Such a jail is unlikely to offer influenza vaccinations to their inmates. On
the other hand, bigger jails (say, more than 1,000 beds) with a full-time medical
staff may indeed have an influenza vaccination program.
“Kicking the Can Down the Road”
The most successful jail influenza
programs that I have seen are done in cooperation with the local health
department. The health department is tasked with providing vaccinations to the
community at large, which includes jail inmates. When asked, health departments
often will come to the local jail once a month to provide influenza
vaccinations to any inmate who requests one. (This is also a good way to
provide screening for sexually transmitted diseases in asymptomatic inmates.)
Even small jails can approach their local health department about providing
immunizations to inmates, though few do.
Customs and Border Patrol reportedly
defended its policy of not providing influenza vaccinations during border detention
by saying that immigrants are only there for a few days and are expected to get
the flu vaccine later, when they are moved to a long-term facility. Where I
grew up, this was called “kicking the can down the road.” To my mind,
deferring vaccinations until later makes little medical or financial sense.
Since none of these detainees is going to be released, and since you are going
to vaccinate them later anyway (as reported), why not do it as part of their
initial medical screening?
Jeffrey E. Keller, MD, FACEP, is a
board-certified emergency physician with 25 years of experience before moving
full time into his “true calling” of correctional medicine. He now
works exclusively in jails and prisons, and blogs about correctional medicine
This post was originally published in MedPage Today.
Four physicians and two others protesting their inability to vaccinate migrant detainees at the U.S. Customs and Border Protection (CBP) headquarters here were arrested last Tuesday for failing to comply with federal orders to disperse.
They were held for about an hour, according to some of those who were arrested.
The two groups of protesters — about 60 people in total — had gathered in two driveways leading to CBP headquarters for about an hour when one of the groups received a warning from federal officials that if they stayed in the driveway, they would be arrested, said Marie DeLuca, MD, an emergency room physician from New York who was one of those arrested. Some of the members had blocked the driveway by laying down across the road while others chanted, “No more death.”
“We stayed peacefully in the driveway entrances of their building and said that if they weren’t going to let us in to vaccinate against the flu, we were going to remain. They didn’t let us. Instead they chose to arrest members in one of the two groups,” DeLuca said.
She said her hands were secured behind her back with zip ties by officials from the Department of Homeland Security (DHS) as she and the other protesters were led into a conference room and told to wait. After about an hour following the protest, they were issued tickets with a court date for “failure to comply with the lawful direction of federal police officers or other authorized individuals,” and then released, she said.
A San Diego Union-Tribune reporter posted a video of some of those doctors being arrested.
At about 2 p.m. Tuesday, DHS’s press secretary tweeted a picture of the protesters
and said, “Of course Border Patrol isn’t going to let a random group of
radical political activists show up and start injecting people with
Other doctors arrested, who were part of the group Doctors For Camp Closure, included Mario Mendoza, MD, a former anesthesiologist who now lives in New York City and runs the organization Lifeundocumented.org; Hannah Janeway, MD, an emergency room physician in Los Angeles who helps run the Refugee Health Alliance; and Mathieu De Schutter, a pediatric hospitalist from San Luis Obispo, California. The non-physicians arrested were Rebecca Wollner of Jewish Action San Diego and Matthew Hom, a graduate student from Cerritos, California, who works with the group Never Again Action.
On Monday, the physicians began their three-day vigil and protest of federal immunization policies at the gate of the detention center in San Ysidro at about 11:30 a.m. They stayed until about 4:30 p.m. with no response despite repeated requests. Tuesday’s action took place nearby at the Chula Vista CBP headquarters.
DeLuca said the doctors and their supporters planned to return Wednesday to try one more time to administer the 120 influenza vaccines they brought with them for the detainees. They say it’s important for public health, not just to protect these detainees, but also everyone else they come in contact with.
Members of the groups chanted slogans and carried banners and signs
calling on federal officials to let them administer the vaccinations to
those inside. The vaccines were purchased with financial donations.
As trusted professionals in the eyes of the public, health providers are considered stewards of public health and safety.
Health providers are ethically bound to advance health holistically, and with climate change, this means translating information into advocacy. The effects of climate change call for the many roles that medical providers take on: first responder to disaster, risk educator of patients and public, and — in an almost exact reenactment of Florence Nightingale’s work — defender of clean water, nutritious food, and sanitation.
The scope of climate-related effects on human health is simultaneously as broad as global drought and as specific as increased incidence of skin cancers. Health providers are uniquely positioned to address the health implications of climate change, providing education within the context of direct patient care and speaking with authority on policy decisions that affect public health.
Climate Change and Human Harm
Scientists are still working to understand the full impact of climate change on human health; however, there are existing studies that show severe effects on human health as a result of environmental hazards. According to the National Institutes of Health, there are several key areas of concern regarding climate and health, and many opportunities for health providers to offer prevention and education.
THREATS TO RESPIRATORY HEALTH
Implications: Lung disease, allergies, and asthma will be worsened by longer allergy seasons and deteriorating air quality.
Health Provider Recommendations: Support staying inside on poor air quality days and remind vulnerable populations to adhere to medical treatment plans and medication.
Implications: Ticks and mosquitoes will be more active for longer and range farther.
Health Provider Recommendations: Encourage people to use bug repellent when outdoors or in any areas with insects. Monitor and record reports of disease outbreaks. Inform others about signs and symptoms of diseases and when to call a health care provider.
WEATHER-RELATED ILLNESS AND INJURY
Implications: Extreme temperature fluctuations affect outdoor laborers, children, pregnant women, and older adults and can cause pulmonary and cardiovascular problems and dehydration. In addition, increased particulate matter, ozone concentrations, and extreme weather events may trigger stress and respiratory issues that lead to heart disease.
Health Provider Recommendations: Educate about the risks of heat exposure. Ensure access to air conditioning for vulnerable or older adults and homeless populations. Also, encourage people to drink enough water throughout the day and not just when they feel thirsty.
MENTAL HEALTH AND STRESS DISORDERS
Implications: Extreme weather can be destructive to property and quality of life, often resulting in the loss of homes, belongings, and loved ones. Prolonged exposure to these stressful experiences can manifest psychologically as people try to navigate grief and loss with interrupted access to care.
Health Provider Recommendations: Encourage others to speak openly about their grief to reduce stigma. Identify gaps in mental health literacy and teach patients about signs and symptoms of mental health risks. In addition to educating, refer at-risk patients to a mental health provider as soon as possible.
Spreading the Word About Disaster Preparedness and Dangers
In a 2018 World Health Organization report on climate change and health, experts state that “globally, the number of reported weather-related natural disasters has more than tripled since the 1960s.” For this reason, it’s essential that health providers inform their communities about disaster preparedness and dangers. The best time to get involved is before a disaster; therefore, it’s critical for providers to leverage any one-on-one time with patients to address holistic health and emergency concerns. Special attention should be paid to those who may be vulnerable in the wake of disasters. For example, this could include people with chronic conditions, physical disabilities, or respiratory diseases; infants and children; pregnant women; and older adults.
Thin Ice: The Life-Threatening Effects of Climate Change
Air Temperature Change
Increase in heat exhaustion
Spread of disease vectors among animals, insects, and people
Increased movement of airborne allergens and diseases
Higher risk of respiratory illness
Loss of loved ones and pets
Water Temperature Change
Changes to coastal ecosystem health that will affect food supply and erosion
Increased likelihood of extreme precipitation, drought, or flooding
Water contamination due to harmful chemicals and pathogens
Malnutrition, especially for prenatal or early childhood development
A Rising Tide Lifts All Boats: Advocacy for Climate-Related Health Policy
Climate change may be politically polarizing, but illness and injuries seen by first responders and health providers are concrete outcomes and can translate into loss of life on a global scale.
In a 2018 report on climate change and health that accounted for continued economic growth and medical progress, the World Health Organization stated that “climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050.” These fatalities are projected to come from the following climate-related health complications:
— 38,000 due to heat exposure in older adults
— 48,000 due to diarrhea
— 60,000 due to malaria
— 95,000 due to childhood undernutrition
Health providers can draw awareness to this dire need for attention at the policy and community levels. They can also share firsthand experience and research. This is an ethical duty that can result in widespread support of strong public health programs and climate justice.
How to Get Involved in Climate and Health Policy
In addition to in-person education with patients, health providers can do a variety of things to spread awareness about climate and health policy in their communities:
Leverage social media. Share articles with verified, evidence-based information on social channels. Use hashtags related to climate and health that make your posts easier to find. For example, #ActOnClimate, #Go100Percent, #Renewables, #SaveThePlanet, and #ClimateChange.
Continue your education. Request or attend an educational presentation from a trained professional, then collaborate with community organizations to educate people in your area. Volunteer with climate- or policy-focused organizations to gain perspective.
Participate in civic engagement. Call your representatives to let them know whether you support specific legislation. And always, vote in local and national elections.
Organizations for Further Reading or Involvement
If you are a health care provider
looking to learn more about climate and health policy, you may wish to visit
the websites of these organizations.
On November 21, the US House of Representatives passed the Workplace Violence (WPV) Prevention for Health Care and Social Services Act of 2019 (the bill now moves to the Senate). Strongly supported by the Emergency Nurses Association, the bill now moves to the Senate for consideration.
In the U.S., the prevalence of workplace violence (WPV) in the healthcare industry is four times higher than in other private industries. According to surveys by the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), some 70 percent of emergency department (ED) nurses have been hit or kicked while at work. Because of ease of public access, crowding, long wait times, presence of weapons, and other factors, the emergency department is a highly vulnerable area, especially where triage occurs.
ED Health Providers Literally on the “Front Lines” for WPV
The shocking statistics on WPV in emergency departments are behind ACEP and ENA’s campaign, “No Silence on ED Violence.” This joint effort aims to educate, empower and protect doctors and nurses working in emergency departments. By raising awareness of the serious WPV dangers emergency health providers face every day, and promoting action among stakeholders and policymakers, the campaign seeks to ensure a violence-free workplace for emergency nurses and physicians.
Acts of workplace violence (WPV) can cause physical and/or
psychological harm to emergency nurses. WPV can lead to job dissatisfaction,
emotional exhaustion, burnout, secondary trauma stress, PTSD, absenteeism, and
intentions to leave the job or nursing profession, all of which have potential
impacts on patient care.
Workplace Violence Affects Majority of ED Doctors and Nurses
ACEP President William Jaquis, MD, FACEP, said, “If you asked the majority of our nurses and our physicians, they have all been impacted directly by violence—as have I. It goes everywhere from verbal violence, which happens frequently, to physical violence. Ultimately, we hope that in sharing our stories we will gain insight and share resources on how to prevent future harm to our medical teams and our patients.”
The “No Silence on ED Violence” website includes a variety of workplace violence resources for emergency healthcare providers, including guidelines for safety in and around the Emergency Department, and lists of warning signs indicative of potential violent events.
Inspired by the Raise Your Hand movement—which first encouraged emergency nurses in 2018 to share their workplace violence experiences — ACEP and ENA have collaborated on this effort to minimize the frequency of attacks, protect emergency department professionals and build a new level of awareness about this crisis.
Some Tips on Staying Safe
To increase program effectiveness, it is recommended that a workplace violence prevention program include education and training; formal incident reporting procedures; and administrative, environmental and consumer risk assessment, physical design, and security components to address all types of WPV.
Trust your feelings if you feel uncomfortable
around a patient.
Don’t isolate yourself.
Have security around.
Call security when you first become aware of a
Maintain safe distance.
Keep an open path for potential exit.
Present a calm, caring attitude.
Don’t match the threats.
Don’t give orders.
Acknowledge the person’s feelings.
Avoid any behavior that may be interpreted as
Limit eye contact.
Further, if you do become a victim of workplace violence, report it! Underreporting is a documented barrier to effective identification and mitigation of workplace violence. Although many nurses do report WPV incidents using both informal (e.g., telling a supervisor or colleague) and formal channels, the latter is only likely when an injury is sustained. Organizational commitment including workplace policies such as zero tolerance and the role of nursing leadership for establishing a just culture that discourages bullying and retaliation—is essential to mitigating all types and forms of WPV in emergency nursing and other healthcare environments.
Passed in the House, Now Advocate for the Bill With Your Senator
Among other features, the “Advocacy” page on StopEDViolence.org focuses on S. 851, the Workplace Violence Prevention for Health Care and Social Service Workers Act. Resources include an easy form for writing your Senator to support the act. In its current form, S.851 will require health care and social service employers to develop and implement comprehensive workplace violence prevention plans. These plans must include procedures to identify and respond to the common risks that make health care settings so vulnerable to WPV incidents. In addition, the bill is designed to help ensure that employees are appropriately trained in mitigating dangerous situations. For examples of action taken in State legislatures, see this PDF.