Greetings,

See this brief article that highlights the challenges in healthcare with incivility, aggression, and violence from patients and visitors. It was shared and highlighted on LinkedIn by some of my Healthcare Security Leadership colleagues.

COVID and the associated stress (e.g., surrounding tightened visitor restrictions) have certainly added to incivility, aggression, and violence coming into our hospitals.

And yet, incivility, aggression, and violence were indeed already very present prior to COVID. And these behaviors will certainly continue to be present post-COVID (whenever that may occur!).

It is incumbent on all Team Members, and especially Nursing Team Members (who catch the brunt of all of this) to not sit idly, thinking that incivility, aggression, and violence will go away in healthcare after COVID goes away, after new legislation is final, etc.

Some actions that occur in healthcare by well-intentioned Team Members include (but are not limited to):

• If a Team Member tells a patient or visitor that “I will not tolerate this behavior,” it will make the behavior go away.
• If we erect enough large and well-worded zero-tolerance signage, this will help to stop the behaviors.
• If we tell patients or visitors that they will be escorted off campus, it will stop the behaviors.
• If we call our Healthcare Security Team, it will make the behaviors stop.

Don’t get me wrong here. There’s nothing inherently wrong with any of these responses. Indeed, let’s treat mosaically the mitigation of incivility, aggression, and violence in healthcare by including in our response plans a combination of diverse elements (that can include these items and others). The Joint Commission (TJC) will respect this approach.

However, some other elements that need to be added include the following:

• We must accept that we now have a new reality. Our society (like it or not) is now different. A great many people coming into our healthcare facilities no longer have the civility, politeness, and courtesy that perhaps characterized our society decades ago.
• Possessing a geniune sense of acceptance that people (for whatever reason) are now different, we must make training in conflict communication and crisis management a standard part of Nursing education. Not an add-on training. Not a just-in-time training. Not a nice-to-have training. And not a training that does not include continuing education (CE) hours. It must be a standard part of Nursing education.

Note (for the purposes of helping us become more awake, aware, and alert to reality as it is today): Incivility, aggression, and violence in healthcare are not going to stop. No amount of denial of reality can change this. So we’d better busy in a new way dealing with it.

What does a lack of acceptance of reality, a denial of reality, look like in daily life in a healthcare facility? It looks like a well-intentioned Team Member demanding an impolite patient or visitor to stop inappropriate behavior, expecting it to stop, and then experiencing increasing amounts of anxiety when it doesn’t stop. All of this contributes to an atmosphere wherein medical mistakes are more likely (due to emotional distress) and to further escalation of the patient or visitor.

What does training in conflict communication and crisis management that is not a standard part of Nursing education look like in daily life in a healthcare facility? It looks like widespread knowledge deficits with Nursing Team Members, since training in conflict communication and crisis management are not embedded as a standard part of education. Nurses simply are not being trained.

Do we put a Nurse in a care environment, expecting her/him to perform various competencies without training her/him? No, we don’t. Let’s get busy then and stop expecting Nurses, with no or insufficient training, to safely navigate through encounters with less-than-civil, aggressive, or violent patients/visitors.

It is time to accept reality for what it is and get busy with what we know are good (even best) practices to respond to incivility, aggression, and violence in healthcare.

Stay safe (and civil).

Farewell…