By LISA EISENHAUER
When one of their own nurses was fatally shot by an ex-boyfriend outside her home last year, leaders at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., decided to step up their efforts to improve safety for their staff and patients.
Barrett
The attack came as the hospital was seeing an increase in reports of patients, their family members or visitors assaulting its team members, said Coletta Barrett, vice president of mission at Our Lady of the Lake.
Our Lady of the Lake set up the Workforce/Workplace Safety Committee at the end of last year, underscoring its determination to act quickly and decisively to keep its workers safe both in the hospital and in their personal lives.
The committee has since led efforts to rewrite safety policies, expand training programs and launch awareness initiatives intended to keep aggressive encounters from escalating to violence involving employees and to empower and protect employees facing domestic violence. All of the efforts have been undertaken in line with Our Lady of the Lake's mission to be a spiritual and healing presence, Barrett said.
Those efforts took on added urgency this spring when a nurse at nearby Baton Rouge General Medical Center died from what the coroner said were complications resulting from an assault by a patient in a behavioral health unit. Our Lady of the Lake is part of the Franciscan Missionaries of Our Lady Health System. Baton Rouge General is not part of that system.
Documented dangers
Federal statistics show the threat of workplace violence is much higher for health care workers than for other workers. In 2017, the number of nonfatal intentional occupational injuries from assaults nationwide was 18,400, according to the U.S. Bureau of Labor Statistics. Of those, 13,080 were in health care or social service settings. Those numbers have risen steadily since 2011, when the overall number was 11,690 and the number for health care or social service settings was 8,180.
Team members gather in the trauma unit at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., to pray on July 17, 2016, after a shooting in the city in which six law enforcement officers were hit by gunfire. Five of the officers were brought to the medical center for treatment. Three of the officers who were shot did not survive.
Courtesy Our Lady of the Lake Regional Medical Center
Lisa DiBlasi Moorehead, associate nurse executive at the Joint Commission, said the hospital accreditation organization has educational resources on how to respond to violence and its committees have made it a priority to do more work in this area.
"It's not an issue that's going away," Moorehead said of violence against health care workers. "We have to define it. We have to evaluate it. We have to measure it. And we have to provide staff with tools so that they can address it as it occurs."
Responding to tragedy
The safety committee that Barrett is part of at Our Lady of the Lake was formed months after nurse Gabrielle Bessix was murdered outside her home by a former boyfriend in August 2018. The man also shot and wounded a friend of Bessix' and then killed himself. Barrett said that because domestic violence attacks are affecting workers, the medical center has zeroed in on how it can do more to help team members who are facing threats at home. As part of its response, Our Lady of the Lake has posted information in staff gathering places like break rooms about how victims of domestic violence can get help. In honor of Bessix, it also set up an annual lecture series that bears her name and focuses on safety-related topics.
Safety at work
Barrett said the Workforce/Workplace Safety Committee is charged with reviewing and updating the security measures and safety protocols for the hospital and its satellite centers, and educating workers on them. The hospital's senior leadership have reviewed and supported the changes the committee has recommended and put in place.
Barrett said the ER and behavioral health unit have been the scenes of most incidents of aggression at Our Lady of the Lake and she attributes that to the higher states of stress and trauma patients and visitors in those units tend to be under. One of the committee's initiatives was to post stern warnings to patients and visitors that threatening or aggressive behavior will not be tolerated. "Incidents may result in removal from this facility and possible prosecution and imprisonment," the warnings state.
In addition, the hospital has instituted post-incident reviews, called huddles, following reported episodes of violence. Staffers, who witnessed or were involved in the occurrence, debrief with supervisors and security workers. After one of the first huddles and based on comments from a staff safety survey, Barrett said security staff were moved from behind the triage desk to the middle of the emergency department at the medical center "so people can see that there is law enforcement present."
Clear policy
The committee also has helped the hospital leadership craft a formal policy on how to deal with patients whose behavior is so disruptive that it impedes their care. To start, a team that includes an administrator, an ethics leader and clinical staffers decide if a "behavioral contract" is proper and needed. The contracts are signed agreements with patients who have remained combative, despite being coached and counseled. "It helps them to understand the consequences of continuing to act out," Barrett said of the contracts. "It could mean discharge."
If the patient doesn't follow through on the terms of the contract and acts out, the administrator on call determines if an administrative discharge unrelated to the patient's medical or mental condition is the proper course to ensure staff safety.
"Our policy now enumerates the steps that must be taken for an administrative discharge and it includes checks and balances to ensure that the action is being taken appropriately," Barrett said. She emphasized that both before and after the formal policy was put in place, behavioral contracts and administrative discharges have been rare.
A warning posted in some parts of Our Lady of the Lake Regional Medical Center.
Training and education
The hospital also has expanded on-site safety and situation de-escalation training, both to provide the training to more staff members and to include more techniques. Outside contractors train hospital staffers as instructors, and those staff members in turn train their colleagues on ways to stay physically safe in various situations. The hospital is using computer-based training to teach workers techniques to calm agitated and potentially aggressive patients.
In addition, Our Lady of the Lake now encourages staff to pursue criminal assault charges against assailants. This has included working with the local district attorney's office to educate staffers on the prosecution process as well as giving assault victims paid time off to attend any related court hearings.
Barrett said that in the past, workers seemed to assume that, since they hadn't been explicitly told the hospital would support them if they pursued charges after an assault, such incidents were to be taken in stride as part of the job. "That may have been the way it was in the past, but so much has changed and (violence) has become more prevalent," she said. "We have to be able to communicate to our teams to say, 'Should you choose … to press charges, we're here to support you.'"
As part of its collaboration with the hospital, beginning about two years ago, the district attorney's office for the parish that includes Baton Rouge assigned a violence recovery specialist to work out of the medical center's emergency department, linking violence victims with resources that could help them pursue justice and healing.
Kerry Deichmann, who holds that post, said, "I try to address all the physical, emotional and social needs that any victim of violence might face during and after the trauma after being released from the emergency department."
In recent months the hospital began tapping the expertise of the district attorney's office through Deichmann to help its employees who have been victims of domestic violence or threats. Barrett said Our Lady of the Lake wanted its team members to know what resources the district attorney's officer could provide and what their rights as victims are.
So far, Deichmann hasn't had many inquiries related to workplace incidents, but she has had several questions about how to respond to domestic situations that involve threats and violence. In those cases, she can provide referrals to domestic violence shelters and other services.
Barrett said the Workforce/Workplace Safety Committee's work is ongoing. It continues to respond to input it has gotten in surveys of staff about their safety concerns and to review recommendations from groups like the Joint Commission for ways to enhance safety at Our Lady of the Lake. "We're taking suggestions, we're taking recommendations and we're vetting it with evidence-based research," she said.