A patient, intoxicated with alcohol, comes into the emergency department complaining of chest pain. The nurse and the ECG tech need help as the patient is yelling, flailing his arms, and trying to stand up out of bed while stumbling. The nurse puts a blood pressure cuff on his arm and a pulse oximeter probe on his finger. With his other hand, he tries to grab her, pull her toward him, attempting to hug her, and calling her “hon.” This of course is not the name with which she introduced herself. The team moves quickly to remind him of her name, to prevent physical contact, and to guide him into the bed, resting with arms by his side. Ultimately, the patient stabilizes, the team completes their evaluation, and everyone steps out of the room.
In 2021, 77 percent of health care workers reported experiencing workplace violence, including verbal and physical assaults. This is higher than for people working in other private sectors. Nurses are at more risk than doctors. Emergency departments are at more risk than other locations in a hospital. Self-study and anonymous surveys have helped to explain the causes of workplace violence in health care, and these tools will also serve as instrumental ways to create ongoing solutions.
In violent situations, it is not always obvious how to be a good team player. What we do know is that helping others is not one large skill; it’s a series of small building blocks we call microskills. Microskills build upon each other and coalesce into larger skills that help people navigate the workplace. As individuals and leaders in clinical settings, we have the agency to speak up in the moment, act in the moment, and help teammates feel psychologically safe to do their work.
Building and reinforcing psychological and physical safety can be hard, yet we do our best work when we feel safe. Knowing what to say and what to do in the moment, this is called upstanding. We prefer upstanding, an active form of engagement in real-time vs. bystanding, passively watching events unfold without intervening. We understand the temptation to keep quiet and to let things pass; however, this will not help teammates in the setting of workplace violence. Your intervention need not be complex. Simply speaking words and taking a stand is a fundamental and helpful start. Practicing phrases to say in the moment. “We don’t do that here” is one example. Or, “I am calling for help now.” Practice speaking with body language. You can simply put a hand up to signify someone to stop if they are stepping into another person’s personal space. Another upstanding act is to gather the team and debrief a violent interaction outside the room after the situation has calmed. Ask everyone, “Are you OK?” Create space and allow people to share how they feel without any expectation that they speak at all. Check-in with teammates the next day or the next time you see them. Explore how they would like to be supported in the future when similar incidents occur. Discuss as a team how best to report any system-based issues that caused the situation to occur in the first place.
Resa E. Lewiss and Adaira Landry are emergency physicians.
