Wellness - individual

Occupation violence in health care – one nurses’ story of creating change

@wrapemtweet talks with advocacy superstar and nurse Lita Olsson about the tricky and sometime harrowing topic of occupation violence in health care. Here’s her story of creating change in that space @CENAorg @acemonline @qldclinsenate

  • How did you get to where you are – the journey from ED nurse to Occupational Violence Strategy Unit clinical lead?

It was completely by accident. 

I’ve been nursing for 15 years and worked in ED for over 10. I love being part of the ED family, and I am a total mother hen. Protecting my ED family and keeping patients safe was a huge driver for me. When I was pregnant, I was assaulted. This was the catalyst for me to make change. I started challenging the way we did things: our safety culture; the way we used Security.  After a couple years of working on this locally, I was asked to present at an executive meeting on my experiences. 

This was a really intimidating thing for me – I was just a nurse in an ED, trying to keep everyone safe. After contemplating it for a few days, it became really clear that our frontline voices needed to be heard. I realised “if not me, then who?”.  

This is what catapulted my OV journey. We, as front-line workers, need to sit at the table with the decision makers. Looking back now, I can see that my aim was to use my lived experience of being assaulted as a catalyst for change, for all frontline staff.  

It certainly wasn’t a natural career progression for a nurse. On more than one occasion I was discouraged by Nursing leaders from taking a role that was so far from the traditional nursing progression. But I really couldn’t be prouder of the role I get to play. Our unit is Australia’s first dedicated unit established to respond to OV, and I’m very excited to be advocating for my frontline colleagues.

  • One of the greatest perceived and real challenge to wellness in the ED is the risk of verbal and sometimes physical violence.  What would you like to say to your colleagues about working in an area where the risk of OV is very real? 

Occupational violence is NOT just ‘part of the job’.  Don’t be afraid to respectfully set your boundaries early – both with your colleagues and your patients! 

Empower yourself with knowledge in the area of OV – seek out your local experts. Be up to date with the real-life application of local mental health and public health (eg guardianship act) legislation. Make sure you know your local escalation processes for the agitated patient. 

Familiarise yourself with your Security or response team and understand their limitations. 

The work we do can be very challenging. We are used to advocating for all our patients 24/7. We know we are seeing that patient on their worst day, perhaps in crisis. 

The majority of our patients who pose a risk of harm to staff are in crisis, which is often hard to acknowledge. Dealing with the unconscious bias we have towards these patients is difficult.  It’s not always easy to accept that the agitated, ice-fuelled addict hurling expletives in our direction is in fact a vulnerable person in crisis. Maintaining gentle compassion when you are the primary nurse for the elderly gentleman with sepsis and delirium, who keeps lashing out every time you try to do a blood pressure, is hard!

Above all, trust your gut. If you feel at risk, that risk is real.  

  • In your experience, what are the most effective individual based strategies?  

The issue of staying well when your workplace inherently exposes you to OV is both complex and multifactorial. This applies not just at the coal face, but also at the strategic planning level.  

There is no silver bullet to fix OV. At our Strategic Unit, we think of Occupational Violence in 4 pillars:

  1. Awareness
  2. Prevention
  3. During the incident 
  4. Post incident

At an individual level, we need to know our limits.  As clinicians, we think we should be able to deescalate everyone that comes through the front door of the hospital. And yes, we have to try, but often we miss the early warning signs that things are escalating. If we didn’t have high acuity workloads, noisy and high-stimulus environments, and unlimited bed capacity, things might be different. Instead, we need to engage the local experts early – whether it’s your security officers, your social worker or maybe even – if you work in a small regional place – calling the police to make your workplace safe. It’s okay to tap out and prioritise your own safety.

  • Looking ahead, what do you think should be the top organisational priorities to decrease the threat of OV at work in health care? 
  • Work together to accurately report and accept the issue:

Between July 2019 and June 2020, Queensland Health received about 12400 official reports of OV across the state. This equates to about 1033 cases a month across the state, on our Risk Man register.  Yet when we looked closer at one metropolitan hospital alone, we found a monthly rate of over 1200 security intervention. Under-reporting is a global phenomenon and there are many reasons for it. But, if we really want to make a difference, we need the data to demonstrate that we are still only at the tip of the iceberg. 

We, as leaders and advocates, need to make the space and time to prioritise recording these incidents and to seek and address the barriers to reporting. 

  • Provide the tools needed to manage OV throughout the organisation. 

We need clarity around the legislation that allows us to address the risk we face every day. For example, we need more clarity around phrases such as ‘least restrictive practice’ and ‘capacity’. More clarity around the limitations of ‘searching’ a patient. 

As clinicians, we are often scrambling to see how each patient’s clinical picture and proposed treatment plan aligns with current legislation.

  • Be Kind to each other. 

Just like after a resus, it’s not uncommon to feel emotional or to decompensate after being involved in an OV incident. In fact, it’s completely normal. So keep an eye out for your medical, nursing, allied health, security colleagues. Check in on them. After all, they are your work family.

For more information, here is a podcast that Lita recorded with the Clinical Senate. 


About Lita Olsson

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