Step Two: Evaluating your Emergency Department’s Present Status

Now that you have become well informed of the scope of emergency department workplace violence through the informational resources made available to you in Step One of this toolkit, you can begin to structure your own workplace violence project first by finding out how your department including your staff, your physical environment and workplace policies compare to the data that was presented.

For a project such as this to be efficient, useful and have high impact for your situation, it must be tailored to the priority problems and needs that present themselves in your emergency department’s daily workflow. The task now is to investigate and analyze your current situation.

How to Assess your Emergency Department Creating a Summary Toolkit Resources Summary and Next Steps

 

Assessing your Emergency Department

This step is focused on directing an initiative to obtain a comprehensive evaluation of the current status of workplace violence in YOUR emergency department. This toolkit will provide you with the resources to conduct a multifaceted assessment that documents objective data (observations and facts) and subjective information acquired from your staff (bias and beliefs). As part of this process you will analyze the data that you collect and try to summarize the deficiencies that, in the context of the ENA assessment tool and the ENA Emergency Department Violence Surveillance Study, might indicate that your department is at higher risk for violence occurrences and their consequences.

If your emergency department has incident reporting tools in place for violent occurrences, it would be helpful to get access to the reports that have been filed over time to evaluate the types of occurrences that are prevalent in your emergency department. Sometimes, a simple retrospective review can reveal significant areas for improvement when reviewed as a group. You may need to meet with Human Resources or Risk Management to gain access or these reports may not be available to you at all. While a valuable contribution, if you are unable to review past reports, you can still proceed with a comprehensive assessment that will define your initiative going forward.

The primary tool used in this step of the process is the Emergency Department Assessment Tool which is used to do a comprehensive audit and review of your work environment, administrative policies and procedures and staff preparation. In addition, the Staff Assessment Survey is used to collect information about your staff's perception about workplace violence.

Although workplace violence is generally defined as any physical assault or emotional or verbal abuse (or threatening, harassing or coercive behavior) in the work setting potentially causing physical or emotional harm, many nurses still do not characterize verbal abuse by patients and visitors as violent behavior, and consider such abuse "just part of the job". Although all employers have a legal responsibility to provide a workplace that this free from hazards that can cause physical harm, they also have an ethical responsibility to provide a safe, non-violent workplace that fosters a climate of trust and respect.


Tips for Using the ENA Worklace Violence Assessment Tools

First, download the assessment tool using the links above and get familiar with the metrics used to evaluate the status of your own emergency department relative to a workplace violence prevention program, response plan and reporting mechanism. As you will see on the Emergency Department Assessment Tool, there is a list of evaluative metrics that help you take a focused look at the practices in your own department and analyze whether the elements that can help achieve each metric are truly important in your own situation. Remember that this tool is not a score sheet but a descriptor of your presence situation. You can work with this information when it is complete to decide what is an important priority for your emergency department to work on. Let's look at an example to further emphasize this distinction:

 

EXAMPLE: Two project managers are both completing the assessment for his or her emergency department. Both indicate under the metric "the hospital security guidelines in place support an initiative of safety in the Emergency Department" that they do not have 24/7 presence of a security guard in the emergency department. One project leader works in trauma center located in an urban, high crime area and the other works in a small community hospital in a rural area, low crime area and low volume emergency department traffic. Review of occurrence reports show that at the urban hospital, a significant number of the violent incidents occurred because perpetrators were able to gain entrance from the outside into the triage area of the emergency department, undeterred. At the smaller, rural hospital, upon review of the occurrence reports, it was found that many of the violent incidents occurred in the treatment area and were related to high risk patients going unidentified. The urban hospital later placed the need for security personnel present in the entrance and accessible common areas as a high priority, the rural hospital did not. Neither had this security measure in place but it was significant to the future plan in only one of the specific emergency department environments.

Before using this tool to evaluate your own department, you may want to review some of the OSHA recommendations related to evaluation of the present status of your emergency department. OSHA recommends a "workplace analysis" that involves taking a common sense look at the work environment to find existing or potential hazards for workplace violence. The broad analysis suggested by OSHA is supported by the tools supplied to you in this toolkit to conduct a departmental evaluation as part of a workplace violence prevention initiative. To review the suggestions made by OSHA for evaluation of your department, view the document listed below.

To use the Emergency Department Assessment Tool, the project leader or designate will need to do a comprehensive review, answering all the questions included with each metric on the form. Use the comments box liberally to note information that may have a bearing on your analysis including observations, history, opinions from key people and other related interventions. See the following link for a sample completed assessment form to guide your utilization of this tool.

The next assessment tool provided by this toolkit is the Staff Assessment Survey. This survey includes a comprehensive list of questions that allow your staff to express their experiences and perceptions of safety in the department, their own experience with violence in the workplace and how prepared they are to deal with it. The Staff Assessment survey is not a tool for objective collection of data but an exercise for the staff to articulate their feelings about the safety of their job and department and a chance for the project team to assess the culture and attitudes of staff regarding violent occurences and response. This is an important step in identifying the staff's readiness for change, if change is required to promote a safer workplace.

The Staff Assessment Survey is a comprehensive document that provides the project team with questions related to violent occurences, staff perception of security and safety, staff perception of training and readiness, and their beliefs regarding the support they receive in promoting safety in the workplace. It is important to remember that every question in this survey may not be applicable to all departments so the list is designed for easy modification; simply cut and paste to develop a customized survey to meet your assessment needs. Some other considerations related to conducting a staff assessment:

  • Staff assessments should be voluntary, confidential and anonymous so that the staff feels comfortable sharing their answers
  • Be sure to meet with the staff to explain the role of the survey and answer any questions related to this data collection BEFORE the survey is distributed; gaining their support in this project is imperative and it is important for the staff to know that their opinions and experience will help drive the project plan and direct efforts for improvement
  • Consider assigning a time period for data collection so that numbers can be assessed within a timebound framework (for example, word your survey so the staff knows that they are answering questions based on set time period--last month, last year, etc.)
  • Make it clear to staff what you intend to do with the data collected and gain their approval, that is, are you going to summarize it and present it back to them with the proposed solutions? Who else will see the results of the survey? How will their responses help shape the direction of this safety improvement initiative? Make sure the staff understands that there would not be a punitive response to their participation in the survey

Many of the questions available on the Staff Assessment Survey are comparable to the questions used for the 2009 research study conducted by ENA assessing violence against nurses in the emergency department. You can view this study below and compare your findings with the findings and conclusions described in this study.


The final challenge of this step is to summarize your findings in order to determine where to direct your first efforts. The assessment tools, when used properly, should begin to focus in on the areas that are in need for improvement. Usually, it is clear what actions would improve the priority issues identified in your department. It is harder to figure out how to prioritize your efforts and resources than the actual glaring problems. You will find it harder still to work with changing ideas and opinions, than to add tangible policies and procedures, training or physical or environmental changes.

Creating a Summary

The summary of your assessment findings is crucial since it will help you steer the efforts of this initiative towards improvements that count. The summary of the assessment can be documented to get administrative support for this project targeted at workplace violence and creating a safer emergency department. These observations can also be presented to staff to help elicit support and collaboration when executing the action plan. When reviewing your findings, make sure you ask important questions about why certain incidents occur but be careful not to draw conclusions or cause and effect without sufficient evidence.

The ENA Workplace Violence team has developed a data collection form to help you compile the results of your surveys and assessments. They have also created a sample communication letter that can help you to create your own letter to your administration to solicit support for the initiative. When reviewing your findings, it is important to highlight any events that you see as emergent or urgent, for instance, those that are threatening the safety of the staff on a daily basis, and make those a priority or present those to the appropriate adminsitrative personnel for immediate action. Engage nursing leadership, risk management and human resources as needed to endorse the efforts of this project as a positive step towards creating a safer work environment.

The following is a list of toolkit resources and references used in Step Two: Analyze your Emergency Department's Present Status:

This second step of the toolkit has defined the importance of departmental assessment and given you the tools to evaluate your own emergency department from many perspectives. The tasks to complete in this step are to:

  1. Conduct a thorough assessment of the physical environment of your emergency department.
  2. Survey the staff and collect information about the staff attitudes towards the current status of the department relative to personal and patient safety, their perception of what constitutes a "violent behavior" and their habits related to reporting violent occurrences.
  3. Collect information about the institutional policies that are in place to prevent, respond to and report violence; consult with human resources and administration to assess what policies are in effect in the emergency department.
  4. Review the reports from previous occurrences of violence, if possible, and collect information about the details of the incidents, the frequency of occurrences and similar features that may display a pattern that can help point you to an area in need for improvement.
  5. Compile the information you have collect and consult with your team to draw conclusions regarding areas of deficiency, staff perceptions and adminstrative and human resources initiatives and constraints. Remember to draw conclusions based on facts and not assumptions or conjecture.

In the next step, the team will use the data collected in this assessment phase to draft a list of desired outcomes as the first step to your Workplace Violence project plan, the cornerstone of an ongoing quality improvement initiative.


Describing desired outcomes