Speaking up about warning signs of violence in hospitals

At a time when hospitals are seeing more violence, health systems must staff about speaking up if patients or visitors are being aggressive or at risk of causing problems.

Violence remains a serious problem in America’s hospitals. This week, a fatal shooting in ChristianaCare’s Wilmington Hospital horrified staff and community leaders. But doctors, nurses and staff also regularly deal with the risk of assault or abusive behavior in incidents that get far less attention.

Paul Sarnese, a healthcare security consultant, says hospitals also need to do training on workplace violence, and they need to urge staff to come forward with warning signs coming from patients, family members, visitors, or even co-workers.

The founder and principal of Secured & Prepared Consulting, Sarnese talked with Chief Healthcare Executive about the importance of health systems empowering employees to come forward if staff are struggling.

“Because of the prevalence of workplace violence, all employees should have the basic training on how to identify and recognize verbal warning signs and physical warning signs that may lead to violence, and employees need to be empowered,” Sarnese says. “If I see something, I need to say something, to do something.”

“It's easier to identify that behavior, those behaviors with an employee. We spend eight hours a day with our co-workers, so we know what the baseline normal behavior is. So, if we see a change in behavior, if we see a change in appearance, if we see a change in performance, those could be indications that the person's under stress and anxiety,” he adds.

The former president of the International Association for Healthcare Security and Safety, Sarnese says it can be uncomfortable for a staff member to be raising concerns about a co-worker. Health systems should tap into the desire in healthcare workers to help.

“We always want to help people, so same thing for a co-worker. If we see a co-worker that's exhibiting some of those signs of anxiety or stress, we should either intervene and have a conversation with them and see if they're okay, or report it to a manager, and obviously,” Sarnese says.

“If somebody's threatening to do harm to themselves or others, we need to take that seriously,” he adds. “We need to do a threat assessment. We need to pull the team together, look at prior incidents, prior history, and really come up with a plan to manage that individual, if we can, or at least come up with a safety plan to keep our employees and patients safe, so it's really about recognition and reporting.”

Some employees may be reluctant to bring up concerns about a co-worker, either for fear of retaliation or potentially causing problems for a colleague who may not be violent and is simply going through a rough time.

Sarnese suggests health systems send the message that if a co-worker is struggling, employees can help them by coming forward.

“I always think of good intent, especially in healthcare,” Sarnese says. “There's always good intent. We do things because we care about people. So I think that's the message that leaders need to cascade down to the employees. We want to know because we want to take the appropriate actions to give the employee help,” Sarnese says.

“So I think the message needs to be, to employees: we care about everybody, we care about our patients, we care about our employees. If you see something that's given you cause for concerns, please report it to your leadership. Know that there's not going to be any retaliation, and that your leadership is going to intervene with the intent of helping the person through whatever stress or the anxiety they're going through,” he says.