Physical and verbal abuse against healthcare workers appears to be on the rise in America. Keeping clinical staff safe is a key component of keeping nurses in the profession. At the end of 2022, Press Ganey’s National Database of Nursing Quality Indicators reported more than two nursing personnel were assaulted every hour (American Association of Critical Care Nurses (AACN), 2019). In addition, the United States Occupational Safety and Health Administration reports that from 2002 to 2013, serious workplace violence was, on average, four times more common in healthcare settings compared to private industry (AACN, 2019). Although it has been reported nurses who work in psychiatric departments, emergency rooms, and geriatric departments may be at the highest risk, raising awareness and preventing violence against healthcare workers in all areas of patient care is paramount. So much so, the American Association of Critical Care Nurses (AACN) states, ‘Healthcare facilities are responsible for ensuring the safety and security of staff, patients, and visitors’ (AACN, 2019).

Here are 4 things a new graduate nurse should know:

1. De-escalation Techniques
   • Nursing school education touches upon aspects of non verbal communication and the importance of how healthcare providers approach patients, but spend some time discussing additional techniques that can help de-escalate a patient or their family member, should the need arise. Consider including verbal approaches to de-escalation and encourage the new graduate nurse to role-play various situations with you. If your organization offers a formalized de-escalation class, enroll the new grad and ensure they can attend.
2. What to do if those de-escalation techniques are not working
   • As experienced nurses, we likely understand that de-escalation techniques are not always effective. The new graduate nurse may not recognize when the situation is escalating, not what to do if that occurs. Spend some time reviewing what these situations might look like and how the new graduate should escalate for help. If a behavioral health emergency team is available, discuss who is expected to arrive. If panic buttons are available, discuss how they are activated and what occurs after activation. If the unit is locked, discuss how that may impact a patient or visitor who is escalated.  
3. Policies and procedures for lateral violence
   • Violence and aggression towards nurses doesn’t only come from our patients and/or their families, but also our peers. Research has shown lateral violence in the nursing profession has steadily increased over the past 10 years and prevalence by nurses has been reported to be as high as 85% in the United States. New graduate nurses are a targeted population due to their lack of confidence and/or skills (Goodard & Mason, 2023). This high rate of lateral violence could have a negative effect on the retention of staff, be correlated with increased rates of burnout, and ultimately negatively impact patient care (Goodard & Mason, 2023). Take a few minutes to review what lateral violence is with your new graduate nurse. If your organization has a policy or procedure for lateral violence, be sure to discuss that too. Encourage a conversation regarding the impacts of lateral violence and how the new graduate nurse should escalate their experiences.
4. Importance of reporting events
   • Without reporting events of physical or verbal abuse, by patients, their families, or other members of the healthcare team, it is impossible to take action and create change. Review how safety events are reported with the new graduate nurses while encouraging a culture of no fear and no retaliation to reporting events. Encourage leadership to track and trend reports to create an organization where lateral violence is not tolerated and staff have the education and skills to keep themselves safe against escalated patients and visitors.

Bringing awareness to the potential need for de-escalation and subsequent safety events is an important aspect of clinical nursing care. Take the time to have a discussion with your new graduate nurses not only during their onboarding period but in subsequent interactions. Through education and discussion on this important topic, leaders can impact the retention and wellbeing of new grads.

Jessica Ociepka, MSN, RN-BC

Program Coordinator, Iowa Online Nurse Residency Program

jessica-ociepka@uiowa.edu

References

American Association of Critical Care Nurses. (2019). AACN Position Statement: Preventing Violence Against Healthcare Workers. https://www.aacn.org/policy-and-advocacy/aacn-position-statement-preventing-violence

Goodard, D., & Mason, H. (2023). Lateral violence in the nursing profession. Gastroenterology Nursing, 46(3), 259-262. doi: 10.1097/SGA.0000000000000734