Curbing ED Dangers Requires Strong Leadership

Last week, I wrote about the importance of making sure student nurses stay safe at work, and a reader wrote the following comment:

"[The] Culture of safety in my hospital certainly does not apply to nurses when they are sometimes attacked by intoxicated patients who come to our ER. Apparently, intoxication is an excusable "medical condition" that is somehow acceptable without consequences for this behavior. I wonder how acceptable it would be if the same intoxicated person attacked or punched an innocent bystander in a public place outside of the hospital setting. Certainly more needs to be done to protect medical staff."

Most people in most professions don't feel threatened when they go to work every day. But for nurses, especially those in the ED, the threat of danger at work is real and acute. Nurses get kicked, slapped, pushed, spit on, and yelled at every day at EDs across the country.

EDs are unpredictable places where anyone, in any condition, can enter. But nurses have the right to a safe working environment, which means hospitals and nurse leaders have the obligation to educate their staff about crisis prevention and intervention and offer resources to deal with crises when they occur.

According to Teri Johnson-Kelley, MSN, RN, CEN, the director of nursing for the ED at Banner Estrella Medical Center in Phoenix, her hospital started requiring crisis prevention intervention courses for staff working in areas identified as high risk for potential combative patients in January 2011. Johnson-Kelley (who is speaking on a HealthLeaders webcast on April 30) says the training helps nurses learn when to call a "Code Gray" for a combative patient.