Practicum at St. John Hospital with a Focus on Workplace Violence By: Amy Toman, BSN, RN June 10, 2013

St. John Hospital and Medical Center and 2 East St. John Hospital is a 772 bed teaching facility in Detroit Level 2 Trauma Center Centers of Excellence: Cardiology, Oncology, Neuroscience, and Bariatric Treatments 2 East is a 20 bed unit that specializes in the care of the trauma patient. Specializes in the treatment of all traumatic injuries including blunt and penetrating traumas, motor vehicle accidents, falls, bone fractures, and head injuries

Site Supervisor Susan Mooney Smith MBA, BSN, HNB-C Director of Medical Surgical Nursing at St John Hospital and Medical Center

Practicum Overview 200 hours of directed study at St. John Hospital and Medical Center Partnered with site supervisor to identify leadership learning opportunities within the organization Due to escalation of violence on the unit level, Workplace Violence has been identified as an area of opportunity for 2 East due to increasing threats made to staff, multiple entrances into the unit, and an awareness in the community that 2 East is where all the trauma patients are cared for. Develop and Implement a practicum project that will address this need.

Practicum Objectives Identify ways to decrease incidence of workplace violence by increasing safety measures on the unit. Review policies and procedures for workplace violence. Identify ways to educate, support, and communicate changes to the staff. Identify process improvement opportunities as it relates to safety. Look at cost of implementation of increase safety measures for the unit.

Current Status Initial work began for this practicum on 1/3/2013 with 217 hours completed. Most of these hours have been in meeting time, process improvements on the unit, mentoring opportunities with staff (includes real time coaching, discussion of real/potential safety risks on a daily basis) and site supervisor, and research. A system team has been established to address workplace violence Approval has been granted at a hospital level to lock down the 2 East unit Measurements and costs have been reviewed for the project Currently working with staff to establish visitor guidelines A security binder has been developed and will be presented to the staff to record any incidence of workplace violence in order to have better tracking As part of safety huddles in the morning we address security issues and plan security measures for the day if needed Started to meet daily with security to review high risk patients and establish plan

Clocked Hours January 16 8 10 42 February 3 11 5 4 23 March 15.5 27.5 Summary/Proposal Meeting Planning Research Mentoring Implement Education Total January 16 8 10 42 February 3 11 5 4 23 March 15.5 27.5 April 13.5 2.5 21 May 15 12 2 32 June 17.5 48.5 July Totals: 100.5 38 14 42.5 217

Lessons Learned Workplace violence is a serious topic that effects many different people and areas in the hospital Using theories from organizational culture, research, and finance has helped guide the process of this practicum Creating a culture change is a long and difficult process

Next Steps Awaiting approval from the state and fire marshal for work to begin on 2 East Implement policies related to workplace violence such as visitor guidelines as work starts on the lockdown process Continue to provide support, coaching, and mentoring for the staff to continue to change the way workplace violence is viewed along with encouragement to report all incidences of workplace violence. Look into the possibility for more staff to go through Nonviolent Crisis Intervention (CPI) training. Continue work with the system workplace violence team to develop and implement strategies in handing these situations Continue to strive for excellence as it relates to improvement of security measures by conducting debriefings and continuing to look at process improvements

References OSHA Trade News Release (2011): OSHA issues compliance directive to address workplace violence. Sears, M. (2006). Humanizing health care with nonviolent communication. iUniverse, Lincoln NE. CPI (2005). Nonviolent crisis intervention a CPI specialized offering. www.crisisprevention.com. St. John Providence Website: www.stjohn.org