"Having a zero tolerance policy is the most important thing a hospital can do," Papa says. "And that means not just having a policy in writing, but really live and learn the policy, and every time there is an act of violence, do a root cause analysis and work to fix it."
Despite the successes, Papa does not see the issue going away. Today, hospital patients are sicker and more stressed out, she says, and they are more demanding of an immediate response from healthcare workers. Acts of violence are gravitating from emergency and trauma settings even to inpatient and intensive care units. Lateral violence—actual physical abuse and verbal intimidation between healthcare workers—is an increasing problem as well.
Those two issues are next on Papa's agenda, and more surveys are planned.
Papa says that the past three years have been very rewarding because she feels she's empowering other ED nurses to speak out, and that has made a big difference. "Yes, we're here to care for patients, but we also have to care for each other," she says.