By Carol Boston-Fleischhauer, CNO and Managing Director

With Covid-19 cases now on a slow, but steady decline, hospitals and health care systems are continuing efforts to rebuild the health care workforce, in particular, stemming the alarming exodus of RNs. Ensuring safe staffing, avoiding bed closures, and maintaining full capacity is at risk across the country, and organizations are implementing myriad efforts to combat root cause of increased turnover, including factors permanently driving RNs from inpatient employment altogether.  

Infographic: Strategies to stop workplace violence before it occurs

An unanticipated challenge facing hospital leaders as they try to confront the shortage is an increase in verbal and physical violence directed at health care workers by patients, families, and community members, largely triggered by the political discourse surrounding Covid-19. As provider organizations continue to take local stands on mandatory employee vaccinations to ensure safety, organizations must take an even stronger stand on employee safety as well. Health care employees deserve nothing less. Employees are in the middle of a crossfire, not of their making. If left unaddressed, unacceptable acts of harassment will further compound the already untenable exodus of clinicians from inpatient employment.

Current safety strategies aren't enough to protect staff today—here's why

Many organizations have been working for years to effectively respond to point-of-care threats—for example, by educating clinicians on de-escalation techniques, increasing security personnel, or equipping staff with panic buttons. While these efforts remain important, they are insufficient to protect staff from the abuse levelled at them today, for three reasons.

• Staff are experiencing violence both in and outside the four walls of the health system. While facility-centric strategies such as improving hospital security and de-escalating disruptive behaviors remain important to keeping staff safe, it won't protect them in mobile clinics or even in the community at large, like grocery stores;
• Navigating difficult conversations with patients and families remains a core responsibility of clinical staff, including nursing. However, RNs may be ill prepared or uncomfortable with supporting controversial dialogue around Covid-19treatment options, patient preferences, and end of life care decisions that can rapidly escalate, depending upon the consumer's personal/political beliefs; and,
• Public silence from organizational leaders may signal to staff that the health system places political neutrality and patient satisfaction above basic employee safety.

In addition to doubling down on security protocols, executive teams need to publicly take a stand on the violence impacting their staff and the misinformation fueling that violence. Doing so may feel counter to the personal beliefs of some leaders. But allowing for differences of personal leader opinion does not have to mean tolerating physical and verbal abuse of employees who remain committed to the system's mission of providing high quality care to all, regardless of ideology. It is the job of executives to make that clear to our communities.

Four key ways to protect frontline workers

1. Revisit and update health system policy on point-of-care violence as needed.
   
   6 proven ways to handle disruptive patient behavior

   While not a comprehensive solution, leaders should do what they can to bolster security within the walls of the system, in all sites of care. This includes recommitting to a zero-tolerance policy of abusive behavior from patients, families, and employees, and publicly communicating that commitment. This review must include point-of-care violence detection and mitigation strategies for all sites of care; in particular, ambulatory clinics, urgent care centers, and care sites located in outlying areas. Use our workplace violence resource library as a starting point.

2. Publicly set expectations with patients, families, and community members that violence of any kind will not be tolerated.

   If you haven't already, update the system's Consumer Code of Conduct with specific language around verbal abuse, assault, and other unacceptable behaviors—and be transparent about the consequences if those standards are not met. Arm your frontline leaders with talking points about the steps staff should take to report violence, and consistently reinforce those messages in key forums.

3. Leverage the C-suite and Board to advocate for better treatment of frontline staff.

   Executives and health system board members aren't just leaders of their organizations—they're community leaders. Work with local and regional media outlets to highlight the gravity of the situation and the steps your system is prepared to take. Deploy internal marketing expertise to implement an external communication strategy, including executives and Board members as community spokespeople to local organizations with influence in the community.

4. Arm staff with the tools, processes, and reporting mechanisms to manage difficult conversations with patients and families.

5. Covid-19-related conversations concerning treatment alternatives and patient preferences may be especially challenging and emotionally charged—they can rapidly escalate if not handled effectively. Frontline staff need to be coached on how to engage in these difficult conversations while being equipped with options for immediate assistance if escalation occurs.

Parting thoughts

In 2020, health care workers were applauded as heroes. In 2021, these same workers are now being attacked in record numbers by the very consumers that they are committed to caring for. As organizations work to stabilize the clinical workforce, mitigating the harassment of health care workers is a non-negotiable action—a moral leadership imperative. While arming staff with panic buttons and increasing the number of security guards near care settings is helpful, this moment in time calls for an all-hands-on-deck approach from executive teams and boards. It is time to publicly advocate for the safety of health care employees.

Lauren Rewers and Andrew Mohama contributed to this article