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Protecting Our Nurses: Preventing Workplace Violence in Healthcare

The word "EMERGENCY" is spelled out in red letters above the entrance to a hospital ER

Axon invited several experts on workplace violence in healthcare to share their knowledge and experience at Axon Accelerate 2023. Watch the panel here or read the summary below.

Healthcare professionals do noble work, especially in a hospital environment, but the nature of that work often puts them at risk of bodily harm. A hospital’s emergency department can often take in patients with substance abuse problems, behavioral issues, or violent tendencies. The high ambient stress level in these departments can sometimes prompt problematic, and even dangerous, behaviors to surface, contributing to workplace violence in healthcare occurring at quintuple the rate of the average U.S. workplace

Many facilities have invested in technology to better protect hospital staff, so Axon invited several leaders in the space to share their insights on a panel at Axon Accelerate 2023. Read on to learn the hidden cost of workplace violence in healthcare, what tools the experts recommend, strategies for their deployment, and advice on winning the necessary budget.

How common is workplace violence in healthcare?

According to a survey Axon conducted, though healthcare and social assistance professionals feel safer at work than they have in previous years, incidents of violence remain common and costly. That result aligns with the experience of Gloria Graham, System Director for Public Safety, Emergency Management, and PBX Operations at Lee Health System in Florida. Graham said she saw around 260 days of injury-based PTO go out alongside just under $180,000 in medical claims for staffers. Beyond the numbers, she said, “We can’t measure the psychological impact those things had on our team members.”

Mark Wilhelm, Senior Director of Public Safety for Jefferson Health and Einstein Health, echoed those challenges. Security officers at Einstein Medical Center in North Philadelphia were physically ejecting 870-1,000 people from the site each year. “Biting, punching, kicking, scratching – you name it, we were experiencing it,” he said. That had an ongoing impact on staff morale and widened a rift in the therapeutic relationship between nurses and their patients.

The cost of workplace violence in healthcare

Bill Marcisz, President and Chief Consultant at Strategic Security Management Consulting, said his years as the head of security at AdventHealth taught him the financial burden of workplace violence. “You’ve got to investigate it. You’ve got to send people in to do some resourcing to do that. You have to piece it together through CCTV,” he said. “It was a long, drawn-out affair. And then you have to put the entire staff on administrative leave, so you have to pay them and then you have to backfill them, and sometimes that costs overtime. All these things add up.”

Violence at work also leads to turnover. Graham cited a report by NSI Nursing Solutions showing each nurse departure costs a health organization $52,350 on average, while each travel nurse hired in their stead costs $157,000 per year. Marcisz added that the American Health Association estimated the total cost of workplace violence in healthcare at $2.7B in 2016.

“We didn’t have good reporting back then,” he said, “so I’d venture to say it’s about five times higher than that [today].”

What strategies are preventing workplace violence in healthcare?

In talking to nurses, Axon found that investing in tools and technology can lead to significant improvements in feelings of workplace safety. At facilities that hadn’t invested in security solutions, close to two-thirds (64.55%) of respondents reported feeling stressed or anxious about their safety. On the other hand, only around one-third (35.5%) of respondents at facilities that had made such investments reported safety concerns. Furthermore, nearly seven in 10 respondents (69.7%) believed safety investments directly improved employee retention.

So which tools are making the most impact?

TASER devices

Several of the panelists at Axon Accelerate had overseen the rollout of TASER devices at their facilities. Axon’s technology provides several advantages to healthcare security. Its bright, pulsing light and loud alert sound emit whenever its Warning Alert is initiated, which can help de-escalate fraught situations without the need to deploy cartridges. It also integrates with Axon Evidence, making it easy for organizations to manage weapons activity, event logs, and firing logs.

Wilhelm said when Einstein Medical Center first introduced TASER devices for security, staff experienced some trepidation. They feared deploying it would lead to legal ramifications, or even cost them their jobs. But as they grew more comfortable with the technology, they found its deterring capabilities saved them from having to go hands-on with potentially dangerous individuals. “Very impressive program, very impressive tool,” he said. “And our nurses are seeing that. Because our community knows what we do and how we protect that environment.” In its first year with TASER 7, Einstein Medical saw 21 draws and 12 deployments.

At Lee Health System, Graham says she predicted resistance from leadership when suggesting TASER devices. Rather than walk into that meeting empty-handed, she decided to build the business case. She emphasized the number of working days lost to injuries and the cost of medical claims in 2021. She also emphasized a commitment to transparency: "I said, 'I will continue to measure and see if this has the impact I think it's going to have, and I will report that out to you. And if it's not having an impact, I'll be the first to tell you.'"

That helped her win approval from the C-suite, and once TASER devices were in the field, the results were clear. Lee Health went from 61 days off and $37,000 in medical claims in the first quarter of 2022 to 31 days off and around $91,000 over the rest of the year. That period saw TASER devices drawn 16 times and deployed 10 times. In Q1 2023? “We’ve had zero days off, and I think we had a $28 claim,” Graham said. The hospital had effected a 99.92% year-over-year reduction in medical claims.

Body-worn cameras

Body-worn cameras (BWCs), such as the Axon Body Workforce, also play a crucial part in improving workplace safety. For one, people tend to treat employees with more respect when they know they are being recorded.

Another benefit - cameras provide an objective record of interactions. As Marcisz said, “The body camera is a source of truth.” The buffer feature can help ensure the camera was recording - even before pressing the record button. This additional context can show what happened 30-120 seconds before the incident. Bryan Warren, president of War-Sec Security and former director of security for what’s now known as Advocate Health, says that’s critical when protecting security personnel from erroneous misconduct cases, each of which can cost an average of $17,500. 

hospital security officer enters hospital while wearing an Axon Body-Worn CameraHealthcare providers sometimes balk at incorporating BWC because of privacy concerns around the Health Insurance Portability and Accountability Act (HIPAA). But Warren noted there are exceptions to HIPAA for law enforcement and security (he highlighted section 164.512). Marcisz pointed out that the Axon Evidence system proved even more secure than the one his facility had in place, while Carr emphasized that the Joint Commission has a familiarity with Axon and knows that it treats protected health information (PHI) with sufficient security. Per Marcisz, incorporating these solutions is more straightforward than people perceive. “The technology works to your benefit,” he said.

Earning C-Suite buy-in

As many of the Axon Accelerate panelists can attest, leadership at healthcare centers don’t always jump on board when it comes to security solutions. As a result, you must frame the challenges of workplace violence in terms to which leadership can relate. Warren recommends heading into budgeting meetings with answers to what he calls the Three Big Questions:

  • What’s everybody else doing?

  • Who says you have to do it?

  • What happens if we don’t?

Administrators rarely want to be the first to introduce an untested solution. They’re also reluctant to incorporate solutions without impetus from a regulatory or accreditation body. Finally, their preference can often skew toward the status quo if it doesn’t appear sufficiently deleterious not to.

Fortunately for security professionals, many of these answers are within easy reach. There are a growing number of facilities using TASER devices and BWCs to great effect. Although no regulators require these solutions, they have proven track records of receiving approval from those bodies. And growing data shows the hidden costs that can accrue without their use. This is where security leadership can start building the business case. "We're moving much more into metrics, and key performance indicators, and numbers and ROI than we've ever had to before in public safety, security, and law enforcement,” Warren said. “That's because that's the language the leadership speaks now."

Panelists across the board advised presenting the C-suite with the cost savings these solutions generate – in employee retention, fewer injury payouts, less labor lost to injury, compliance violations avoided, reduced complaints against officers, and staff safety. And as Warren said, no administrator wants to be the one to turn down staff safety improvements for budgetary reasons.

Lean on Axon

Axon has provider safety at its heart, but it understands the reality of healthcare budgeting. That’s why it compiled a list of resources demonstrating the effectiveness and cost-efficiency of TASER devices and Axon Body cameras. Healthcare security professionals can use these resources to secure leadership buy-in, making their hospitals safer without breaking the bank. From case studies to tools to statistics, find what you need to better protect your hospital staff at the website for Axon’s National Healthcare Security Initiative.