June 4, 2019

Karen Gorby: Angel Medical Center Examines Violence toward Healthcare Workers, Adopts New Coding System

By Karen Gorby
Chief Executive Officer/Chief Nursing Officer, Angel Medical Center

Karen Gorby, Angel Medical Center President/CNO

Next time you visit Angel Medical Center (AMC), you’ll hear something different when it comes to our overhead codes, or the alerts that communicate occurrences within the hospital that every staff member should know about. In the past, these announcements, transmitted via our hospitalwide audio communication system, were color coded. You might have heard “Code Blue” to signify an adult health emergency like cardiac arrest or “Code Green” if a patient was missing.

Hospitals are now converting to what we call “plain language codes” in an effort to apprise everyone who is in the facility – staff, patients and visitors – about impending emergent situations that could affect them. These include the exceedingly rare cases of a person entering the hospital with a weapon or an environmental threat such as a chemical spill or fire. AMC is the first hospital in the system to adopt this new protocol, but the rest of our hospitals are expected to follow suit within the year.

This code update is also linked to a risk that healthcare providers face every day, but one that those outside of the profession may not be aware of: the threat of physical harm and verbal aggression in the workplace. Unfortunately, physical assault and harassment toward hospital staff has become commonplace. Verbal abuse and even physical violence are realities that, according to The Joint Commission, are affecting ever more healthcare facility workers, especially emergency department nurses. The challenges I refer to include cursing, threats, intimidation and physical assault, which constitutes everything from pushing and biting to striking or using a weapon.

Nearly 75 percent of all workplace assaults occur in healthcare settings. The American Nurses Association’s 2015 Health Risk Appraisal reported the alarming statistics that one in four nurses suffered assaults from patients or patient family members, while one-quarter of nurses endured violent incidents at their places of employment in 2016.

The following situations could precipitate a potentially dangerous event in the hospital: if the facility is busy or there are long waits, if a family domestic dispute occurs, if a patient is under the influence of drugs or alcohol, or if they are undergoing a behavioral health crisis.

Even more concerning is that this number does not reflect the many events that go unreported. I think it’s safe to say that these issues were not on the minds of our providers when they contemplated entering the profession, and I don’t want them to feel unsafe in their daily work at the hospital.

Nationwide, healthcare facilities and government agencies are examining how to alleviate workplace violence toward hospital staff. Hospitals are taking steps across the board to de-escalate it, including trainings on what constitutes abusive behavior, encouraging staff to report it, defining what administrators’ roles are when it comes to protecting workers, ensuring that hospital security staff can be powerful allies and offering violence-prevention training to all hospital departments.

If everyone in the hospital is “on the same page” regarding knowing the signs that lead up to a violent situation, alerting security and using protective tools like de-escalation techniques and medication, many instances of assault will be avoided. De-escalation strategies, for example, are ways that employees can defuse situations through verbal interaction, body language and other methods. If a patient becomes agitated or disruptive, the provider could sit down with them, speak in a calm tone and explain what procedures they need to perform before starting to treat them.

Everyone has a part to play in adopting steps that will reduce the number of violent incidents at AMC, from hospital leadership and providers to our patients. As always, our end goal is the best care for our patients and an empowered workforce. A safe hospital environment is the starting point for both.

Angel Medical Center

Karen S. Gorby, RN, MSN, MBA, CENP, FACHE, is Chief Executive Officer and Chief Nursing Officer of Angel Medical Center. Gorby is a Fellow of the American College of Healthcare Executives (ACHE). For nearly three decades, she has served hospitals and health systems in Ohio before assuming her role at Angel Medical Center. Gorby received her MSN from Saint Joseph’s College in Standish, Maine, and her MBA from Wright State University in Fairborn, Ohio.