Caregiver crisis: Tackling workplace violence and compassion fatigue in healthcare

This is the second blog in a five-part series on the state of the healthcare workforce. 

Blog #1: 4 immediate interventions every leader should consider; Blog #3: Creating a sense of belonging—the secret weapon for reducing first-year nursing turnover; Blog #4: 3 steps to avert physician and nurse suicide; Blog #5: How to confront challenges to coordinated care

Before the COVID-19 pandemic, social services and healthcare workers faced the highest rates of injuries caused by workplace violence of any industry, according to the U.S. Bureau of Labor Statistics, and they were five times as likely to suffer an injury from violence than workers overall. Preventing these incidents was hard enough then, but the challenge now is more complicated.  

As hospitals face a clear caregiver crisis, leadership must get innovative in how they protect their employees from verbal, emotional, and physical abuse prompted by unvaccinated patients, personal bias, and discrimination. Failing to be proactive has ripple effects across the patient experience, with 80% of emergency department physicians reporting that violence has harmed patient care. Worse, hospitals that are reactive or inattentive see a decrease in caregiver empathy and stress, and an increase in compassion fatigue and moral distress that sparks renewed anger and potential for violence among patients who consider their healthcare providers untrustworthy. 

This vicious cycle must stop. It starts with cultural transformation. 

Actively and continuously listen to your workforce

Communication barriers between leadership and employees and across departments must be removed to create lasting change. Building trust requires giving all healthcare professionals a voice—particularly the nursing workforce, which, according to studies, endures physical assaults to 21% of its registered nurses and nursing students, and in the ER, daily verbal abuse.  

Use pulse surveys to understand employee concerns, challenges, levels of engagement, and perspectives on violence prevention to identify opportunities for improvement. Creating psychological safety is key, so make these surveys confidential and follow up with focus groups, where workers can freely elaborate on situations in which they don't feel safe and activities that put them at risk. Use this input to inform shared decision-making, giving employees the chance to contribute to safety, experience, and quality policies and measurement. 

When input is negative, don't shield employees from it. Transparency, and access to leadership, is key to continued trust. Use town halls to share pain points and action plans as well as digital dashboards to show data and insights. Your workforce needs to see the full picture and understand that their leaders are committed to the denormalization of violence. 

When violent acts occur, workers also need to see accountability. Take pains to highlight the consequences for perpetrators, as well as the availability of follow-up care for victims and witnesses, including psychologist or social worker evaluation and counseling for firsthand and secondary trauma. 

Develop an action plan for prevention and risk mitigation

A comprehensive approach to making caregiving safer during the pandemic requires environmental and resource evaluations and updates, training, and policy review. Press Ganey's recommendations are: 

1. Conduct a risk assessment and execute on the results. 

Segment your data to pinpoint where threats and violent incidents frequently occur, and to classify hazards, conditions, operations, and situations that could lead to violence, including job titles and responsibilities. Independent reviewers, like safety professionals, law enforcement and security specialists, and insurance auditors, can provide an objective evaluation. Include in your assessment feedback from injury and incident reports as well as employee and patient safety culture survey items. 

A risk assessment will bring to light next steps for violence prevention, including engineering controls and workplace adaptations like a security camera and alarm audit, review of security staffing, and installation of metal detectors, panic buttons, and additional lighting. 

2. Require training on empathy and verbal de-escalation techniques. 

Behavioral health team members can be brought in to prevent total compassion fatigue by showing staff how to understand the motivations of frustrated and angry patients. Empathy training is often used to help healthcare workers identify symptoms of a mental health disease or see what factors could, for example, cause a patient to develop anorexia or post-traumatic stress disorder. It also acts as a foundation to support the learning of essential de-escalation techniques that give staff and security personnel the tools to reduce risk of a violent encounter. 

3. Establish a zero-tolerance policy for workplace violence. 

Intentional injury costs the healthcare industry $540 million per year in workers' comp claims, on top of losses from time off when workers are seriously hurt. Every organization serious about stopping workplace violence and compassion fatigue should: 

• Update your anti-violence policy to provide transparency into what zero tolerance entails 

• Clarify the reporting procedure for witnessing or being part of an incident, and share how reports are recorded, monitored, and used to drive improvement 

• Encourage staff reporting and create a culture of psychological safety to report incidents 

• Assert the consequences for patients involved in a violent act 

• Ensure support for staff involved in these incidents 

• Include the policy in Patient Rights & Responsibilities documentation 

• Reinforce the policy in signage around the hospital to notify employees and patients 

• Require annual training on the policy for all employees, with additional training for managers on worker retaliation and lawsuits 

4. Design and implement an antidiscrimination training program. 

Internal bias and its dangers have to be tackled not just to improve clinician/patient relations, but also to get ahead of potential problems between team members.  

Training on your organization's antidiscrimination policy should be part of all onboarding efforts, and refresher courses a requirement for all employees. Workers should know what constitutes discrimination, harassment, and hate crimes, as well as how to report policy violations and the repercussions of violating the policy. Ensure staff know that appropriate actions will be taken. 

Other critical education needs include:  

• Recognizing microaggressions within yourself and others, with guidance on how to have productive dialogues around them 

• Increasing cultural awareness 

• Handling requests for race and ethnicity information 

5. Prepare your staff to handle violence when it occurs. 

Personal reactions to aggressive patients vary, but intervention tactics need to be standardized to reduce the potential for harm. Practice violence prevention codes on a quarterly basis for a team-based approach to tense situations, including de-escalation techniques, and empower nurses and other high-risk employees with optional self-defense classes. Some organizations also create hospital-based violence intervention programs that provide trauma-informed care to violently injured patients, who are at risk for re-injury and continuing the cycle of violence. 

Burnout and emotional exhaustion are difficult enough for your workers to battle through. Protect their well-being by using pulse surveys and in-person forums to identify how best to address their exposure to workplace violence and lessen compassion fatigue. Use our recommendations as a jumping-off point, and schedule a demo or consult with our experts to gather the right data for your organization and act fast on findings. 

Dr. Tejal Gandhi and Alan Bennett contributed to this blog.