Workplace violence in emergency situations is so common it’s often considered a part of the job. Incidents frequently go unreported due to staff’s desensitization to it and a lack of time to fill out lengthy reports. However, the cost of workplace violence impacts both the physical and emotional wellbeing of the staff, which shows up in lowered retention rates, higher absenteeism, and disastrous medical errors. Research by The Mayo Clinic shows that physician burnout has reached a rate of 54.4% nationwide.
Using techniques built for use in war zones like Bosnia and Rwanda, our team at Red Kite Project works with law enforcement, emergency responders, health care providers and others who interface with violent individuals and vulnerable populations. Here are a few of the lessons we’ve learned along the way about de-escalation and recovery from workplace trauma.
1. It Starts With Training
Just as all patients entering the ER are potentially carrying a blood-borne pathogen, all patients and their accompanying visitors are potentially violent threats when entering the ER. Acquiring basic conflict de-escalation skills is the behavioral equivalent of the PPE surgical glove. When you have acquired the skills to manage potential threats, you’re more likely to remain in a relaxed-but-alert state during patient interactions rather than in a state of hyperarousal.
2. Scene Safety
You enter the room of a patient with a shoulder knife wound. You don’t notice his friend’s narrowed stare and clenched fists when he says, “We’ve been waiting an hour. What took you so long?” After you mumble a tired response, he pushes you against the wall. You’ve been trained to take a history and physical, but have you and your colleagues been trained in scene safety? Encourage your staff to expand their observations beyond patient’s symptoms and presenting problems to recognize red flags for violence including aggressive body language, veiled verbal threats, harassment, and cornering behaviors. Observing for red flags of violence may give you information to save your own life and the life of your staff.
3. Build Empathy
Violence is more likely to occur when the perpetrator views the victim as less than human. Acknowledgment conveys empathy, which humanizes both patient and professional, while reducing the risk of attack. Acknowledge the feelings and emotions of patients, family, and friends, especially when they’re in crisis. An example of acknowledgment is “I get that this must be an overwhelming and frustrating experience for you and your family.” While you may not be able to solve the problem or complaint, you can let someone know they’ve been heard.
“My daughter is in a lot of pain, and nobody will tell us what’s wrong!” a mother screams at the resident physician. Many people begin to assume the worst-case scenario when information is scarce. Inform patients and their accompanying visitors what they can expect regarding the length of wait time, procedures, management of pain, and strategies for diagnosis. When families are in crisis, become agitated, and make threats, inform them that you are there to help but cannot do your job when you feel threatened or attacked.
4. Take Time to Recognize Traumatic Stress
In spite of the flood of media coverage on PTSD in recent years, many medical programs fail to put sufficient emphasis on the consequences of psychological trauma. Allocate one meeting every six months to addressing the impact of trauma and ways to intervene when signs of stress become apparent. This can have a positive impact on substance abuse, suicide, and quality of life among care providers.
5. Create a Safe Space for Recovery
You can’t heal from traumatic effects or burnout if you don’t have safe/healthy space to retreat to. In fact, a major reason survivors of trauma self-medicate is to quiet their hyperarousal symptoms. Create an atmosphere where the staff is allowed to show emotion and ask for help without fear they will lose their reputation as a professional, or worse, lose their job. Make addressing burnout a priority. Encourage checking in with each other when staff members are showing signs of traumatic stress. Staff that have been assaulted or threatened should be given permission to voice fear and anger, which helps them stay resilient.
6. Incorporate Mindfulness and Body-Based Practices Into Your Routine
When your competency and quality of life are jeopardized from dangerous and/or scary situations, releasing traumatic stress is probably the most important action you can take to guard against numbing or hyperarousal. Engaging in exercise helps rewrite procedural memory of feeling helpless during a traumatic event. Empowering exercises that mimic successful fight and flight are running, cycling, and martial arts. Rather than allowing the autonomic nervous system to direct decision-making, practice daily meditation and deep breathing, which can re-engage the cerebral cortex, the seat of reasoning.
