Is Talk Cheap?

Yet, according to The Joint Commission (TJC) and 2021 US Bureau of Labor Statistics data, the incidence of violence-related healthcare worker injuries has steadily increased for at least a decade. Is our society just becoming more violent? Has respect for healthcare professionals declined? Have we lost the ability to intervene effectively when someone is upset? Is the inability to mediate escalating situations a result of overworked, understaffed healthcare facilities? Or is it a result of a generation who has learned to communicate via text and ‘snap’ methods rather than face-to-face?

A combination of these issues is likely the answer. Whatever the reason, whatever the cause, the relevant question is how can we mediate the risks associated with the growing prevalence of WPV in healthcare? What can we, as healthcare professionals, do to reduce violence in the workplace? Recommendations and protocols to mediate WPV include no-tolerance policies and behavioral response teams. These are essential and impactful interventions, but is there something more that can be done?

How to Mediate Workplace Violence

The first step in mediating violence is recognizing a situation that may escalate. If escalation can be recognized and appropriate interventions applied, the elevation of violence may be avoided. When we, as busy healthcare professionals, experience an escalating situation, do we have the knowledge, skill, and mindset to recognize risk and de-escalate a situation before a violent event occurs? Can we potentially avoid the need for physical intervention, which puts both the patient and healthcare professional at risk? TJC reported in 2019 that the utilization of physical restraints is a leading cause of staff injury. TJC continued by reporting that skilled verbal de-escalation can prevent the need to utilize physical restraint. What is needed to become effective in verbal de-escalation? Is this an attainable goal?

Staff need to be able to recognize early signs of escalation and implement de-escalation skills prior to the need for physical intervention. Staff should be trained not only in recognition but also in strong verbal de-escalation skills. We have all experienced a team of healthcare workers arriving in full force to respond to an escalating situation. This often results in the perpetrator of violence responding like a cornered cat in full attack mode. We also have experienced, skilled, smooth-talking staff who can control a situation, calm an environment, and develop an effective therapeutic relationship. How do we learn to turn the frightened hiss into a purr?

Learn How to Communicate Effectively

Communication skills are often underdeveloped and not the primary focus in healthcare education. Developing knowledge and skills for assessment, diagnosis, intervention, and treatment is fundamental in providing care for those in need. But where does the development of human skills occur? Communication skills are only effectively developed with intentionality. This is even more compounded in the digital age. The skill should be gained to listen actively and empathetically, preserve autonomy, set boundaries effectively, and communicate humanely. Some skills with effective communication can come with life experience and maturity, but much can and should be taught and learned.

Training in effective verbal de-escalation is vital. This training must be immersive and experiential. No one has ever learned to de-escalate a multiple-choice question. Training with case scenarios and role plays is needed to grow verbal de-escalation skills effectively. This skill can only be learned with experiential practice. Granted, some patients with specific disease processes or impairments may not respond appropriately with verbal intervention. Yet, the attempt to verbally de-escalate before physical intervention should always be made. It may be effective with intentional skilled intervention by those trained in verbal de-escalation. If effective, it preserves the therapeutic relationship, patient autonomy, and safety for the patient and caregiver.

(TJC) published a 2018 report on WPV, reporting that healthcare and social service employees have an increased risk of WPV five times greater than other workers. As of January 2022, TJC-accredited hospitals are required to implement and analyze WPV and WPV prevention programs annually. In addition to physical intervention techniques, healthcare facilities must provide training that includes de-escalation and non-physical intervention skill development.

What Can Be Done to Help Workplace Violence?

As violence in our world increases and communication skills remain underdeveloped, training in verbal de-escalation is vital and requires more than the didactic. It must be hands-on and immersive. Verbal de-escalation must be practiced and practiced again until it becomes a natural reaction to an escalating situation. Just as most hospitals practice ‘mock codes,’ the implementation of ‘behavioral mock codes’ should be seriously considered in healthcare settings.

According to the National Safety Council, healthcare workers and educators were the fourth most ill or injured professions in 2021. In addition, the average cost of a medical consultation for a work-related injury was $42,000 in 2021. Clearly, all these illnesses and injuries were not a result of WPV. Yet, in 2020, the Centers for Disease Control and Prevention reported that WPV increases job stress, resulting in absenteeism and staff turnover. These figures don’t include other costs, such as extended hospitalization.

Is talk cheap? I say not. The potential value of skilled verbal de-escalation is to save thousands, if not tens of thousands of dollars, preserve the patient-client relationship, retain employees, and potentially reduce the incidence of WPV.

About the Author:

Lara Thompson is the Transition to Practice Nurse Residency program coordinator at UF Health Shands Hospital. Most of her career has been in emergency nursing, holding bedside care and nursing leadership positions. Her professional works include presentations and publications on sickle cell disease, sepsis, verbal de-escalation, and the use of simulation in nursing transition to practice.

Professional works:

• “Interdisciplinary Intervention to Decrease ED Utilization by Sickle Cell Disease Super-utilizers”; Western Journal of Emergency Medicine
• “A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers”; UHC Annual Conference poster presentation
• “Improving CMS Pass/Fail Rates for Sepsis Patients in the Emergency Department”; UF Health Patient Safety and Quality Week poster presentation
• “SIMplifying Transition: From Graduate to Got It”; ANPD Annual Conference podium presentation
• “The Main Event: SBAR vs Verbal De-Escalation”; ANPD Annual Conference poster presentation

Lara is an independent contributor to CEUfast’s Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

If you want to learn more about CEUfast’s Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.