By Peter J. Papadakos, MD, FCCM, FAARC
The last number of months has brought the issue of violence and sexual harassment into the news cycle. Employers and universities have rolled out programs to address discrimination and sexual harassment in the workplace. Health professionals and support staff are not immune from this issue. Media are full of reports of highly trained and educated healthcare workers assaulting each other, rising reports of sexual harassment and gender issues and assaults by patients and families on their health providers. The reasons for this increase in reporting are multifactorial and varied. Of course, the #MeToo movement has played a positive role in allowing individuals to report issues, but societal norms have also played a role to generate a zero tolerance to violence and discrimination.
The data for workplace violence in healthcare is sobering. The Occupational Safety and Health Administration (OSHA) has reported that the ratio for assaults on nurses was 25/10,000, whereas for other private sector industries, the ratio was 2/10,000 employees. The numbers may be even higher in that many healthcare workplace assaults are not reported and believed to be part of the job, and victims do not report them or may fear retribution. Everyone is at risk, from physicians, nurses, pharmacists, students, support staff and housekeepers. By far, nurses are at the highest risk, with 43.4 percent of reported assaults in healthcare with physicians at 13.8 percent.
Reports of sexual harassment in the workplace can easily decay the morale of staff and lead to poor patient care. We must have a zero tolerance to fellow healthcare providers making sexual advances, crude and demining jokes, provocative gestures and lack of respect to each other. We should expect an environment that is safe and respective of the individual as they practice their profession. Units and hospitals should be at the forefront of providing this environment of mutual respect. Staff should feel comfortable reporting such issues early so that they can be acted on prior to any escalation.
How can the neurocritical care practitioner affect change and improve our workplace to decrease sexual harassment and workplace violence? First and foremost, we most address stress, tension, burnout and other factors that affect all levels of our team and patients. Many studies have confirmed that workplace stress, especially in healthcare, have led to poor performance, lasing out, burnout and even suicide. This horrific rise in healthcare provider suicide is especially depressing and needs to be addressed by each one of us. Each unit needs to have policies and programs to recognize employees at risk. ICUs are highly stress-filled environments where life and death are addressed each day. How many of us can state we have programs to discuss and provide support in a regular basis to not only our staffs but to patients and families?
We propose that ICUs provide such programs that deal with these issues. Weekly or daily debriefing meetings where stresses within the unit are discussed in an open forum — where staff feels comfortable and provides mutual support. Employees should also be exposed to education on how to deal with stress, harassment issues and workplace violence on a regular basis. Unit leadership should be proactive and act as a role model to rapidly address unprofessional behaviors such as sexual harassment, staff bullying, racism and ethnic slurs. Such behaviors have no place in healthcare or any other place in our lives. Employees should respect their leadership knowing that it is a safe haven to report issues in their professional and personal lives. Families and patients also need a robust system to defuse issues. Critical illness is a great stressor and may lead to lashing out at staff if not proactively addressed. Many units have weekly family council meetings where such issues are addressed. Staff should also work to identify families at risk and refer them to unit based social workers and support programs before issues arise. I can state without reservation that such programs have worked at my facility.
We must also be aware that our hospitals, universities and facilities also are mandated to have human resource support services to address workplace issues. New staff should be oriented to such programs and feel comfortable reporting issues in a confidential and supportive environment. There are also many agencies in healthcare that both track and enforce behavior in hospitals such as the The Joint Commission, state professional boards and the Council on Surgical and Perioperative Safety. They all have mechanisms of reporting and analyzing such issues. Of course, the final agency to report violence and sexual assault is law enforcement.
These are important issues that not only impact on our lives as healthcare providers but also impact on society as a whole. We must act as a role model to the rest of society on how to address these issues. Our society should evolve to prevent violence, injustice and sexual harassment in all aspects of our lives.
#NCSRoundup #Advocacy #PeterJ.Papadakos #December2018