Understanding Workplace Violence

Jay Morrison, Senior Associate in Nursing at Vanderbilt Adult Hospital, discusses workplace violence and prevention. 

Additional Resources:

What is workplace violence? | Workplace Violence (WPV) (vumc.org)

Work/Life Connections - Employee Assistance Program | Vanderbilt Faculty & Staff Health and Wellness (vumc.org)





Adult Ambulatory Clinics – WPV SOP

Begin Transcript

Shaina Farfel:  Welcome to this edition of the Vanderbilt Health and Wellness Wellcast.  I am Shaina Farfel with Occupational Health.  Today, we are speaking with Mr. Jay Morrison, Senior Associate of Nursing at the Vanderbilt University Adult Hospital.  Thanks for being with us today, Jay.  
Jay Morrison:  Thanks for having me.
Shaina Farfel:  Today, I want to discuss the importance topic of workplace violence which is often an under recognized problem that can have major implications for individuals as well as the organizations that they work for.  Jay, can you define workplace violence for us and tell us how prevalent it is?
Jay Morrison:  It is a broad topic and we, as an organization, have been very intentional in trying to define it so that it is as inclusive as possible, so that staff and anyone else here at Vanderbilt understand what we mean.  Specifically, we would consider workplace violence to be abusive or disrespectful behavior that would be anything that is inappropriate, demeaning or otherwise offensive and would create an uncomfortable, hostile, or intimidating environment.  If it sounds like I am reading it, it is because I am because it is extremely important, and we have very well-defined policies and procedures so that we get it right.  This is really important.  Unfortunately, you talked about the prevalence.  We are seeing more and more aggression that leads to workplace violence, whether that is physical, verbal, it is pervasive unfortunately in our environment.  Specifically, working with patients, those at the front lines are our most vulnerable, but that does not mean that those that are supportive do not experience it as well.  Who is at risk?  All of us.  We need to have a good baseline understanding of what we mean by the topic and then when I identify it what do I do with that information.    
Shaina Farfel:  Have you noticed at all during the COVID pandemic, have we seen an increase in maybe some of these workplace violence encounters at all?  I know that there has been increased stressors with employees and patients, have you noticed an uptick?  
Jay Morrison:  So, we have.  It has been trending up pre-COVID.  It is not like there is this major spike all of a sudden.  We see the slope increasing, unfortunately.  We are seeing the trend increase.  We are seeing more verbal than we have before and I think that maybe more of a reflection of what you talked about, the stressors in our society and some of the rules that we have put in place that patients and visitors may not understand and certainly may not like, but for their safety we have done what we feel is appropriate for the organization and for our staff so we all stay safe.  
Shaina Farfel:  You touched on this a little bit, but what should an employee do if they experience violence in the workplace?  What is their first step, where can they go, what are the resources?
Jay Morrison:  Great question.  Important question for staff.  First and foremost is get safe.  Remove yourself from an unsafe situation first and foremost.  Second is report it to your immediate supervisor so that in the moment we can bring resources to help support staff and deal with the situation as it is happening.  We really do not want to put staff out on an island to try and understand how to deescalate a situation.  Now, we do have training available and I think we will talk a little bit about that in a bit, but we do have training so that in the moment I as a staff member may have some techniques that can help deescalate a situation, but when an event occurs, whether it is physical or verbal, we need to remove ourselves if we can and call for help,  right?  So, ask for assistance from your supervisor.  We are fortunate to have Vanderbilt University Police Department here on campus and their resources and if we need to alert them, by all means, they are experts in this and they have been great partners in this work.  If we need to reach out to our police department, we need to do that to keep us safe.  
Shaina Farfel:  So, stay safe is number one.  Is this something that an employee would complete a Veritas for, or a supervisor would Veritas?  
Jay Morrison:  Yes. I will just say, once we can exhale, right, we are now in a safe place, the environment is safe and we have deescalated the situation, we need institutional learning, right, and Veritas is our system for reporting that.  It helps provide the specifics that only someone who was involved in the event will know, so that we do not rely on someone downstream saying yeah, I think that happened in the lobby and I do not remember if that was the wife or a bystander.  So, if someone who is involved can put that information in Veritas, they are the best one to understand the situation and the environment.  A, so we know what happened.  We can understand who was involved and we can understand what resources we need to bring to bear in the future based off of the reported events.  
Shaina Farfel:  Again, we have sort of started to touch on this, but what is Vanderbilt doing to prevent some of these events of workplace violence?  
Jay Morrison:  This is the exciting point for me from an operational perspective.  We have always had our VUPD colleagues, which they are great partners.  Over the last few years, a big thanks goes to our local leaders in our entities and our executive leaders and VUMC as a whole at saying, we need to have a concerted effort instead of having a good program in this one area.  We, as an organization, need to have a standardized way to address this and specific resources to support our patients and our staff.  Our staff are unfortunately getting the brunt of this, and it is in some physical instances.  So, we need to make sure that we have the systems and structures in place to support them.  Much like I was reading the definition of workplace violence, our overarching policy is very specific in defining the types of violence and then those steps that we would ask our staff to follow up with, with the Veritas, with our supervisor support.  Each entity has created their own SOPs because each area is unique and may need to provide different resources based off of staffing, patient population, et cetera.  Speaking for the adult hospital and our SOP, we have created different algorithms to try and make it easy after the fact, say what support needs to happen?  So, we have specifics on how to support our staff because even if it is not a physical event, there is emotional trauma that happens after some of these events and we need to make sure that we are evaluating our staff and that they know the resources available for them so that they are not out on an island alone trying to deal with these issues.  Then there is the patient situation or family, right?  We do see the predominant groups involved are our patients towards our staff, but we do see events where it is visitors as well.  How do we manage those situations?  What are the resources to make sure clinically we are managing the patient appropriately and then we have the right behavioral techniques in interacting with the patient downstream as well as the environment in which care is being provided?  We have experts here, thankful to our psychiatric colleagues, and on the adult side, we have access to a behavioral intervention team, and they are experts in helping us understand the right plan of care for patients that do have dysregulation.  It is important for staff to know what their resources are and to get the primary teams involved so that this becomes a multidisciplinary review.  We do not want staff to feel like I have got to now solve this problem myself, whether that is the staff nurse or the local leader, it needs to be a team effort.  We are all in this together and we need to support one another together.  We really wanted to put processes in place to support our staff so that they can stay safe and then the patients to make sure that we can manage those situations appropriately and not have a repeat event.  

Shaina Farfel:  So, it sounds like interdisciplinary multifaceted approach.  That’s wonderful.  You mentioned emotional trauma and I just wanted to point out that there is the Employee Assistance Program that we have here that is a free service, a confidential service for employees and just wonderful staff that are there, and I will, along with this podcast, I will post some links to that service and others as well as the VUMC Workplace Violence Policy that was mentioned so folks have some resources.  Again, we do just want to remind folks that if they experience any of these acts of violence in the workplace or they have concerns please, please reach out for support and report it.  Jay, thank you so much for your time and your expertise on this.  We really appreciate it.  

Jay Morrison:  Certainly.  It is an important topic.  I am glad you are covering it.  Thanks.  

Shaina Farfel:  Yeah.  Thank you.    
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