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RNAO releases best practice guideline to combat violence

Screening all patients recommended
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The RNAO has released a best practice guide to combat violence and bullying against health-care workers. Shutterstock

The Registered Nurses Association of Ontario (RNAO) has released Preventing Violence, Harassment and Bullying Against Health Workers (second edition) best practice guideline to combat a surge in violence that in 2015 made health workers twice as likely as police and correctional officers combined to be injured badly enough to miss time from work, according to a press release from the RNAO.

The best practice guideline (BPG) recommends that health service organizations screen all patients to assess who is more at risk of acting violently, choosing screening tools that have been shown to work and teaching frontline staff how to use them. Those recommendations are among 15 made by an RNAO panel of experts that consulted widely and reviewed evidence from 56 studies.

"Workplace violence and harassment are significant hazards that threaten the safety of health-care workers and the quality of patient care. These threats can be combated by prevention efforts grounded in evidence and shown to be successful. This document presents that evidence so health service organizations can decide how best to intervene," said Henrietta Van hulle, the RN who co-chaired the expert panel, according to the press release.

A 2017 report by the Ontario Council of Hospital Unions found that of nearly 2,000 health workers surveyed, 68 per cent had been assaulted in the previous 12 months, 86 per cent had been abused verbally and 42 per cent sexually assaulted or harassed, according to the release, which added that the number of injuries that led to missed time at work increased 66 per cent from 2006 to 2015.

"Violence continues to compromise health-care organizations and those who provide direct care, particularly nurses on the frontlines," said Althea Stewart-Pyne, an RN and program manager for RNAO's best practice guidelines program, according to the press release. "We must continue to promote respect for each other and those we care for. This guideline provides easy access to evidenced-based resources that support nurses and others to create a workplace that promotes health and safety, while providing optimum care for patients."

The guide’s recommendations include that health service organizations: Document incidents of violence and share that record so that future caregivers are aware of the risk; teach health workers to de-escalate patients who seem at imminent risk of being violent and teach workers how to break away safely when violence is attempted; and develop a plan to reduce bullying and harassment by workers against co-workers by choosing proven tools that track such incidents.

The guideline also recommends health services organizations and academic institutions monitor harassment and bullying, create policies that prevent such behaviour and respond quickly and appropriately when such conduct occurs.

"The guideline is critical if we want to reverse the surge of violence," says Dr. Doris Grinspun, RNAO's CEO and founder of the BPG program, in the press release. "Health-care workers and patients deserve a safe work environment, free from violence, harassment and bullying.

“If the guideline's recommendations are adopted, nurses and their colleagues can better focus their expertise and compassion on optimizing care and outcomes for patients."

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