Home care nurses are particularly vulnerable to violence within the workplace

There are threats to nurses’ safety in homes and neighborhoods

According to the Department of Labor’s Occupational Safety and Health Administration, workplace violence is a recognized health care hazard that’s defined as any act or threat of physical violence, harassment, intimidation, or other disruptive behavior that happens within the workplace. For home health nurses who work in patients’ homes in sometimes unfamiliar or dangerous neighborhoods, the specter of violence is real.

Trust your individual intuition

Six months ago International Association for Health Care Safety and Security published an evidence-based health care safety research series specializing in best practices for stopping violence in the house. According to the findings, a very powerful challenge for a house health manager is to encourage employees to trust their judgment and avoid situations that feel “wrong” and for managers to respect that judgment. Jill Goldstein, MS, MA, RN, vice chairman of nursing, Mount Sinai Queens, Long Island City, New York and Robert Wood Johnson Foundation Executive Nurse Fellow, who worked for nearly 10 years on the Visiting Nurse Service in New York, agrees with this practice. “If at any time before, during, or while leaving a patient’s home, a nurse sees or hears something that is or appears to be unsafe, the nurse should immediately communicate her or his concerns to her or his immediate supervisor,” Goldstein said. VNSNY has detailed and rigorous neighborhood safety standards that include the department’s safety and security department assessing areas of concern, each pedestrians and native police stations, to find out what level of support should accompany an worker, in accordance with Goldstein. “Safe home care visits are a must for all agencies,” Goldstein said. “Some organizations, such as VNSNY, provide various levels of physician support staff, such as escorts or security personnel.” If your agency doesn’t support you in dangerous situations, you must find one other one, said Kelly Tracy, RN, case manager at Bayada Home Health Care, which has offices throughout the United States in addition to abroad. “No one should judge you if you feel that the situation is beyond your capabilities,” she added. There is cause for concern. Research results have varied widely, however the IAHSS study, which included a variety of reports, found that not less than 5% and possibly as many as 61% of home care nurses had experienced some type of violence within the workplace. Additionally, 18% to 59% said verbal aggression was probably the most pervasive. Other studies have shown that roughly 30% of home care staff have admitted to sexual harassment.

Assess and be prepared

After 25 years at Brandywine Hospital in Coatesville, Pennsylvania, after which five years at WellSpan Ephrata Community Hospital in Pennsylvania, Tracy joined Bayada. Now, as a case manager, Tracy said she makes sure the house environment is secure for the nurses she supervises. Asks specific questions when assessing an area for workers and trains employees to think about the next aspects: Is the world well lit at night? Is there parking near the client’s home? Does the nurse have appropriate equipment for the client’s needs, similar to transfer lifts? Is the world known for criminal activity? “Our nurses know that they should always have a fully charged, working cell phone, dress in scrubs so that their stethoscope is visible, only bring home what is needed, and if they feel unsafe for any reason or in any way at risk, they know to call the agency and ask for help or an escort,” Tracy said. Consistent compliance with wearing the house care organization’s uniform and prominently displaying staff identification badges are also amongst probably the most effective interventions, as are visits earlier within the day, Goldstein added. NIOSH presents 19 best practices for healthcare professionals to make use of to stop and manage violent situations.

Training is required

The Bureau of Labor and Statistics estimates that home health care employment increased 55% within the 10 years between 2006 and 2016, making it one among the fastest-growing health care sectors of the last decade. Goldstein and Kelly recognize that a growing variety of home care staff need training in environmental awareness in addition to workplace violence prevention, whether or not they are veterans or recent employees. OSHA released probably the most recent revised version of its Guidance for Preventing Workplace Violence for Health and Human Services Workers in 2015. The guidance is predicated on industry best practices and stakeholder feedback and provides recommendations for developing policies and procedures to eliminate or reduce workplace violence health care and social services settings. Through the training process, OSHA recommends that organizations create a zero-tolerance policy for workplace violence; require employees to report every incident; develop a written plan to make sure personal safety; report violence to the police; educate employees concerning the risks related to their assigned tasks and the way to assess the protection of their surroundings; and educate staff on the signs of drug use and threatening body language. According to IAHSS research, if a patient and/or family are identified as being at high risk, certain procedures should routinely be followed, similar to consultation with supervisors prior to the visit; arranging the presence of one other person; asking the client to comply with a “no damage agreement”; or providing police as an escort service, each indoors and outdoors, depending in your needs.

Use efficient resources

In addition to smartphones and all their capabilities and safety checklists, other commonly used tools help keep home health care staff secure and enable close communication between staff and the power. For example, some employees have quick access to their agency or first responder by pressing the access button on their badge. You also can add a voice activation tool to your ID. According to IAHSS, risk assessment tools are one of the vital necessary safety resources because they might help determine whether a house visit is secure. One tool uses a map that indicates the incidence of crime in a particular community using a scoring system. The map might be viewed every day, which Tracy says is especially helpful in understanding crime levels and the variety of police calls. The ‘windshield check’ also helps assess risk. By driving across the neighborhood, staff learn to differentiate between normal and strange activity or suspicious behavior. According to Goldstein, the VNSNY security team will speak with local police stations to confirm any unusual activity in the world reported by the sector RN. The team also had a plainclothes officer walk through the world “to see how safe it was,” Goldstein said. “Based on this assessment, they make recommendations to the nurse administrator to offer the nurse with an escort or higher level of support, similar to a guard. Or recommend that a nurse [makes home visits] early morning.”

Home care courses

More than 60% of RNs are employed in acute care settings. The need for home care nurses will proceed to grow because the U.S. population ages and the variety of chronic conditions older adults must manage increases, helping them avoid the necessity for intensive care facilities and reduce hospital readmissions. This continuing education activity will provide nurses with an outline of home health nurse practice and introduce them to a different profession option. This exercise will help critical care nurses understand how home care referrals can profit patients eligible for home health care services. The demand for home health care services continues to extend because the population ages and more health care services are provided outside of acute care hospital settings. In 2010 alone, 3.4 million Medicare and Medicaid beneficiaries received some sort of home health care. The demand for home health providers, especially RNs, also continues to grow. The 2013 National Workforce Survey of Registered Nurses found that 6% of nurses within the United States work in home care. Although certain legal risks for nurses translate to all settings, there are some unique situations in home care settings that nurses must be prepared for and be prepared to acknowledge and cope with.