Oncology Data Advisor: Welcome to Oncology Data Advisor. Today I'm here at ONS Congress, and I'm joined by Scott Christensen. Thanks so much for joining me.

Scott Christensen, DNP, MBA, APRN, ACNP-BC: Thank you very much. I'm happy to be here.

Oncology Data Advisor: Would you'd like to introduce yourself and share what your research focus is on?

Dr. Christensen: Sure. I work at the University of Utah Health. I am a Nurse Administrator. I'm also an Adjunct with the College of Nursing, and I'm helping to build our research program at University of Utah Health. I just defended my PhD dissertation, and my topic was on workplace violence.

Oncology Data Advisor: So, you are about to present a session titled Safety and Violence in Health Care. To give a little preview of this, what are the unique safety and violence issues that nurses face? And also, how have these worsened since the pandemic started?

Dr. Christensen: Sure. Nursing is an interesting profession. People are drawn to it because it's unique. You have the opportunity to do things in nursing that you don't do anywhere else, but it's also unique in the challenges that nursing and health care workers face. These situations in nursing are primed for workplace violence. You have people who are scared and don't understand what's going on. They're in a stressful environment. Really, all sorts of factors make it a bit hazardous to work as a nurse.

The pandemic has really been a pandemic of violence and not just a pandemic of the COVID-19 disease. Throughout the country, there have been reports of increased workplace violence, and in healthcare and in nursing, that trend holds. The rates have been unprecedented and high during the COVID-19 pandemic.

Oncology Data Advisor: In your presentation, you're going to be covering some of the legislation as well as health system responses to address this issue. What are some of the responses that you would like to see?

Dr. Christensen: When you consider health care policy about workplace violence, there seem to be two trends. One of them is for health care leaders and government bodies to make requirements for health care organizations to do more—to have employee safety programs, to do workplace violence training and prevention training, to have a zero-tolerance policy posted throughout the organization, and to have expectations for the patients. That's one legislative response.

Another legislative response that we're currently seeing more of is criminalizing patients and patient visitors who behave aggressively and inappropriately. We're seeing common state law making it a misdemeanor or a felony to attack a health care worker. We're even seeing this on the federal level. There's something called the SAVE Act that it made it through the House last year, and it kind of died and it never went anywhere. But a bipartisan group just brought it back. The SAVE Act would help to instill some standards in health care reporting standards related to workplace violence.

Even the Centers for Medicare and Medicaid Services (CMS) issued a statement about three or four months ago stating that there will be penalties for health care organizations that don't have active plans to prevent workplace violence. The CMS is the top funder of all health care, so when they lay out a standard, it usually sets the precedent that all other payers follow.

Oncology Data Advisor: Definitely. So, you mentioned prevention training. What are some actions or steps that nursing leadership can take to help promote safe working environments?

Dr. Christensen: There are several measures that that can be taken. What you typically see are things that health care leaders and administrators do to protect patients and employees, and then things that nurses can do themselves. Health care institutions can put practices in place such as a zero-tolerance program to really define what workplace violence looks like where you work, when you should report it, what's acceptable, and what's not acceptable.

Research, including the research that I have performed, suggests that nurses do report when they experience physical violence, but verbal violence and verbal abuse, nurses often do not report that it happened to them. Some of them don't even report that they have experienced physical violence. It's really important for health care organizations to clearly state what is acceptable, what's not acceptable, and when you experience it, here's what you do. Here are the resources available for you.

Some health care organizations, like where I work at the University of Utah Health, have behavioral emergency response teams. That's kind of like calling a code, where you have a group of people show up to run the cardiac arrest, but it's for inappropriate patient behaviors. You activate this call and then people show up to the room to help you de-escalate that situation. That's what we call non-violent patient de-escalation. There are also some of the more complex trainings where you're learning how to break a hold if somebody grabbed you or pulled your hair or things like that. Those are things that health care organizations do.

But on an individual level, nurses, I feel, are very altruistic. I worked as a direct clinical caregiver for a long time, and so if a nurse thinks that somebody's going to be falling out of bed when they stand up, they'll get right there, right in that person's space. If it's somebody that may act or behave violently, then they get punched for helping a patient to not fall. I have seen nursing staff stand between the door of a confused patient in the hallway because they don't want that patient to leave their room. For somebody who's not thinking clearly, that's their exit strategy, and you're standing in the way.

So, I feel that nurses need to channel their inner Jason Bourne. I always say that. But they need to walk into a patient's room and really evaluate, is this environment safe? How's the patient acting? How's the family acting? Where are my exits? What could be weaponized? You can do this as a part of your regular practice for safety to make sure that you're not taking any extra risks.

Oncology Data Advisor: Definitely, it's all really important advice. Thank you so much for sharing all this today. It was great talking with you.

Dr. Christensen: Oh, thank you. Appreciate your time.

About Dr. Christensen

Scott Christensen, DNP, MBA, APRN, ACNP-BC, is a Senior Nursing Director at the University of Utah Health and an Adjunct Assistant Professor at the University of Utah College of Nursing. He has conducted and published extensive research related to violence trends, prevention, and responses in health care.

For More Information

Centers for Medicare and Medicaid Services (2022). Workplace violence – hospitals. Available at: https://www.cms.gov/files/document/qso-23-04-hospitals.pdf

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.