A group of leading nurse educators and policymakers are calling for more protections for nurses and staff who care for patients with psychiatric issues, including those in nursing facilities.
In a five-pronged approach published Wednesday in Health Affairs, the authors urged stakeholders to act quickly to help “prevent further injury and death to psychiatric nurses and staff.” Their comments were directed in particular at legislators, healthcare organizations and nurses at all practice levels
Workplace violence and harassment of healthcare staff became a hot button issue during the pandemic, and the call for protections comes as skilled nursing facilities are being encouraged to accept more patients with behavioral health and substance abuse problems.
Protections are needed in skilled nursing facilities, said co-author Mona Shattell, PhD, RN, FAAN, of the University of Central Florida in Orlando and editor of the Journal of Psychosocial Nursing and Mental Health Services.
“The incidence rate of non-fatal injuries in skilled nursing and residential care facilities, while lower than psychiatric and substance abuse settings, is like those in general hospital settings,” she told McKnight’s Long-Term Care News in an email Wednesday.
“Skilled nursing facilities, and in particular registered nurses and certified nurse assistants, are at heightened risk for workplace violence [WPV],” co-author Joanne Iennaco, PhD, APRN, director of Yale University School of Nursing’s clinical DNP program added. “Incidence rates for WPV are very similar between skilled nursing facilities and hospitals. …As more individuals cared for in residential and long-term settings have mental health problems, added skill is needed to effectively manage their care.”
Among the paper’s recommendations is the addition or emphasis on quality indicators related to staff harm. The authors call for the five largest accreditors of hospitals and psychiatric facilities, including the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities, to “immediately include” data-supported indicators among their accreditation standards. They also want them to create sanctions for failure to comply and penalties for allowing conditions that have been shown to increase the risk of injury to psychiatric nurses and staff.
Surveys or other tools should “absolutely” be used to track violence against nursing homes staff members, as well, the authors said.
“Violence is likely supposed to be monitored using incident reports in skilled facilities. However, it is common that use of only an incident reporting system will result in underreporting of aggression,” Iennaco told McKnight’s.
She noted a 2021 qualitative study that found that CNAs perceive violence as “part of the job” and may feel that such events are dismissed or aren’t worth reporting. The study also showed that nursing assistants lacked training to manage aggressive behavior.
Reluctant nursing corps?
The authors also urged better reporting overall, which they said may not be historically valued in a heavily female-populated industry. This can lead to implicitly reinforced silence and prevent collaboration to reduce violence, they explained.
“When nurses and nursing staff underreport acts of aggression, it sets the stage for that aggression to escalate,” they wrote. “Within a female-identified nursing culture, values such as caring and conflict avoidance can perpetuate an unhelpful silence about the nature and frequency of aggressive acts.”
In addition, the authors support the enactment of the Workplace Violence Prevention for Health Care and Social Service Workers Act, which has been introduced in each new Congress since 2019; data systems that better monitor worker exposure to violence; and the holding of educational institutions to account for teaching quality and safety standards that reduce workplace violence.
“Dangerous working conditions represent system failures, not individual failure, the authors noted. “Yet, the emphasis on individual accountability and the impulse to accept blame when something goes wrong begins in pre-licensure education.”
The problem of patient violence against healthcare staff is receiving attention at the federal level as well. The Occupational Health and Safety Administration recently proposed a workplace violence prevention rule that would likely apply to skilled nursing facilities, among other healthcare settings.
