Workplace violence incidents in healthcare are seemingly on the rise. Let's take a look at why, according to these nurse leaders.

Nurses across the country are experiencing record levels of workplace violence.

According to a National Nurses United report, in 2023, eight in 10 nurses experienced at least one type of workplace violence within the past year. Additionally, 45.5% of nurses reported an increase in workplace violence on their unit in the previous year.

The nurses involved in the report cited many types of violence, with 67.8% reporting verbal threats and 38.7% reporting physical threats. Nurses experienced being pinched, scratched, punched, kicked, spat on, and groped at alarming rates. Only 18.4% of participants reported no experiences of workplace violence.

CNOs are responsible for the health and wellness of their nursing workforce, and it is imperative that they come up with innovative ways to prevent workplace violence.

Understanding the numbers

According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, it's hard to say one way or another that the incidents are rising, but it has become a more publicized issue.

"I'm not sure we have a have a good baseline to even say that [incidents are] increasing," Kingston said. "With that being said, it certainly feels as though things are increasing and we’re hearing about it more and more."

However, Kingston explained that in health systems implementing basic measures to prevent workplace violence, there have been improvements. Those measures include training and better reporting processes that can help identify where issues are, so health systems can target their approach. Health systems should also have risk and assessment processes, mobile duress technology, and behavioral health response teams.

"There's a number of basic foundational things that we can put in place to help keep all those providing care safe," Kingston said, "and not just those providing care, but everybody in the whole environment safe."

According to Gail Schuetz, associate CNO of inpatient services at the University of Kansas Health System, interim CNO at Olathe Medical Center, and HealthLeaders Exchange member, the uptick is due to more reporting and less tolerance amongst nurses.

"Historically, nurses sort of accepted that there was a certain amount of abuse that they would have to take as part of their job," Schuetz said, "so it was and is drastically under reported."

Schuetz also said that the lack of resources for people with mental health conditions might also be contributing to the issue.

"If someone has a challenging life situation that requires some type of care in a facility, those facilities are not always available," Schuetz said, "and so the hospital becomes kind of the de facto place to put the patients so that they're kept safe."

Identifying the root cause

CNOs and other leaders need to first identify the reasons workplace violence is occurring in their health systems. For Kingston, it's important to consider the patient's perspective.

"It could be fear of the unknown or a fear of diagnosis that causes them to react, or pain," Kingston said. "Sometimes it can result from frustrations in some of our processes, [such as] long wait times."

For other patients, it could be cognitive difficulties or behavioral health issues. However, Kingston emphasized that it's important not to stereotype those patients.

"This is not to say that it is patients who have behavioral health problems are the ones that cause violent incidents all the time," Kingston said, "and I think sometimes we do jump to that decision, but there are certainly circumstances."

Kingston also mentioned that recently, there has been a general lack of boundaries between patients and nurses. CNOs must work to reemphasize the role of the patient and the nurse in a healthcare environment, and reinforce those boundaries between the patient and their care team.

"So again, [there are] many, many reasons [that workplace violence occurs]," Kingston said, "which makes it difficult to have the formula to say here's what we can do in every situation to prevent or to mitigate."

Training the workforce

One of the best things CNOs and other nurse leaders can do for their nurses is prepare and train them properly. According to Schuetz, nurses need to know how to identify and assess patients that may be at risk for violence. It's critical that nurses use the proper assessment tools so that they can get the support they need.

"Coming into the hospital, you might have a patient that has not and does not appear to be violent or have violent tendencies," Schuetz said. "The added stress of being in the hospital often just brings out the worst in people that already have a propensity to act out in certain situations."

Nurses also need to be aware of their environments and know the proper procedures for when incidents do occur. De-escalation training is crucial, according to Kingston and Schuetz.

"We have yearly training around how to de-escalate patients that are escalating," Schuetz said. "Sometimes, we're inadvertently causing patients to be escalated."

"It's really about listening and trying to understand what's going on before something erupts," Kingston said. "Practicing with de-escalation, even having folks act in the patient role and being able to practice that, I think is important."

Kingston believes more advanced training is necessary for nurses who work in high-risk areas, including self-defense.

"I don't know that everyone needs that, but certainly de-escalation and more of a focus on trauma informed care," Kingston said, "understanding where that patient is at as they're coming in…so that we can try to understand [and] mitigate before it becomes very difficult."

Peer support training is also key, so that nurses know how to help each other in the workplace setting.

"That to me is so important because [in] these situations, if our response is elevated and the patent is not as elevated yet, they will rise up to meet us," Kingston said.

According to Kingston, training should start as soon as possible while the nurses are in their undergraduate degree programs. To Schuetz, it comes down to looking at the tools that are available to you, and utilizing both mandatory and optional training.

"For nursing, there's so many things that we have to teach and train," Schuetz said. "Healthcare workers are just inundated with information and so they don't always know what's available to them."

Ultimately, it comes down to communication and using a combination of methods to try and prepare the nurses for what they might face.

"I'm a firm believer that it's a million little things that make a difference," Schuetz said. "If there was one thing that could solve this, that would have happened many, many moons ago."

Part two of this piece will be published on Monday, July 8, 2024.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page. 

To inquire about attending a HealthLeaders CNO Exchange event, email us at exchange@healthleadersmedia.com. 

Nurses need to understand how AI will impact their workflows, says this CNE. 

HealthLeaders spoke to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, about how to communicate with nurses about AI and its purpose. Tune in to hear her insights.

Click here to read the accompanying article. 

Cleveland-based University Hospitals is partnering with Aidoc to help radiologists screen CT scans and make care delivery more efficient

Clinicians dread the missed spot on a CT scan or X-ray that leads to a serious health concern. Now health systems are using AI to make sure those mistakes don’t happen.

University Hospitals recently announced a partnership with AIdoc to deploy the company’s aiOS platform across all 13 hospitals and dozens of outpatient facilities in the Cleveland-based health system. The technology aims to assist clinicians by giving them another tool to analyze images.

‘[We’re] looking to see if we’re finding things that we would have otherwise not seen,” says Donna Plecha, MD, the health system’s Chair of Radiology. “We work with AI – it is not replacing our reads. And I think most studies that look at AI with a radiologist, that combination usually does better than either one by itself.”

The distinction—is AI artificial or augmented intelligence?—encapsulates both the promise and the peril of the technology, which has drawn comparisons for its effect on healthcare to both the printing press and the Terminator. Advocates say AI will work best as a tool that clinicians can use to improve their work and their workflows, rather than a replacement for a doctor or nurse.

Plecha notes the difference, saying clinicians will always be reviewing AI output for accuracy. She says the presence of false negatives and false positives in early AI results supported that position.

“I think they’re realizing how careful they have to be and not believing everything that AI is marking,” she says.

As for the potential, UH officials point to the opportunity for AI to pick up on infinitesimal aspects of a CT scan or X-ray that might bypass the naked eye. That tiny spot could be a sign of a pulmonary embolism, aortic dissection, vertebral compression fracture, or pneumothorax. Identifying those and other acute health concerns early means the patient is moved more quickly to the appropriate care provider and treated more quickly and efficiently.

“The technology identifies both expected and unexpected findings, helps physicians prioritize urgent cases, and ensures all flagged conditions are reviewed by the care team,” the health system said in a press release announcing the partnership.

Plecha says the health system will review all the data collected by the AI platform for accuracy and outcomes before expanding the platform to other departments and use cases. That review process will also help clinicians better understand how to use AI and what to look for.

Aside from improving accuracy and care team efficiency, Plecha says the tool will also help University Hospitals make the most out of its limited supply of radiologists, addressing workforce shortages that are plaguing health systems and hospitals across the country. It will, she says, enable radiologists 9and, eventually, other clinicians) to work with more confidence and at the top of their license.

The idea of using AI to improve workflows isn’t new. Texas-based CHRISTUS Health, in announcing a partnership this week with Abridge to implement a clinician conversation tool, noted the effect on “cognitive load,” or the amount of mental effort needed to complete a task.

According to CHRISTUS officials, the AI tool helped reduce physician burnout by some 78% during a pilot earlier this year. With the AI tool, they said, physicians were under less stress and were able to perform their task better and more efficiently.

“I feel much less distracted with patients since I can focus on the conversation and history without pausing to take extensive notes or re-ask questions I missed during notetaking,” Myriah Willborn, MD, a family medicine doctor at the CHRISTUS Trinity Clinic in Corpus Christi, said in a statement issued by the health system.

The concern, of course, is that clinicians become too reliant on the technology, expecting it to be perfect and catch anything they miss. That’s where continuous review comes into play, along with the understanding that clinicians always have the final say in care and are using AI only as a tool to improve their decision-making.

To that end, Plecha says she sees a future where AI not only reads an image, but combs through all other information databases, from the EHR to other tests and exams, even outside sources reflecting social determinants of health, to form a more complete picture of the patient and recommend diagnoses and other treatments.

“In the future it’s going to be impossible to be a radiologist and not use AI,” she says.

Properly measuring ROI is critical to the success of virtual nursing, say these nurse leaders. 

Executives from a dozen health systems met in Atlanta in early June for the HealthLeaders Virtual Nursing Mastermind program, in a forum to establish common goals, challenges, and successes.

The program, which included three virtual roundtables, established a number of key metrics that executives are focusing on as they evaluate their virtual nursing strategies.

Here are four key metrics CNOs need to be measuring to prove the ROI of their virtual nursing program. Click here to read the full article by HealthLeaders editor, Eric Wicklund. 

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

The founder and CEO of a medical device company has been convicted of selling an implantable medical device to providers that didn't work at all—and then creating a replacement part that was also fake.

Healthcare executives looking to embrace the latest in implantable technology for patient care need to make sure their vendor partners are trustworthy.

The U.S. Attorney’s Office in southern New York has secured a six-year prison sentence for the founder and CEO of a medical device company that sold a fake neurostimulator to healthcare providers and instructed them to bill insurers, including Medicare, for thousands of dollars in reimbursements. The device contained a plastic part that was purposefully too long, forcing providers to spend thousands of dollars to buy a replacement plastic part from the company that still didn’t work.

Laura Perryman, 55, of Delray Beach, Florida, founder and CEO of Stimwave, was sentenced to six years in prison and three years of supervised release by U.S. District Court Judge Denise L. Cote for healthcare fraud and conspiracy to commit healthcare fraud and wire fraud following a two-week trial.

“Laura Perryman callously created a dummy medical device component and told doctors to implant it into patients,” U.S. Attorney Damian Williams said in a press release. “She did this out of greed, so doctors could bill Medicare and private insurance companies approximately $18,000 for each implantation of that dummy component and so she could entice doctors to buy her device for many thousands of dollars.”

“Perryman breached the trust of the doctors who bought her medical device, and more importantly, the patients who were implanted with that piece of plastic,” Williams continued. “This prosecution and today’s sentence are part of this Office’s ongoing work in combating fraud in the healthcare system and protecting patients from being exploited for money.”

According to the press release, Stimwave created and marketed an implantable neurostimulation device called the StimQ PNS System, which was supposed to treat chronic pain by stimulating certain peripheral nerves via an electric current. The device featured a so-called Pink Stylet, which was implanted in the patient to receive the electric impulses from another part, called the Lead.

Law enforcement officials said Stimwave sold the device to providers roughly between 2017 and 2020 for about $16,000 and told them they could bill insurers through two separate reimbursement codes for as much as $24,000.

Soon after receiving the device, providers told the company the Pink Stylet was too long to be safely implanted in patients. After a while, Stimwave—which didn’t lower the price of the device or alert providers to the problem—created a White Stylet as a replacement and sold it to providers for another $16,000.

“Perryman directed that Stimwave create the White Stylet — a dummy component made entirely of plastic, but which Perryman misrepresented to doctors as a receiver alternative to the Pink Stylet,” the press release stated. “The White Stylet could be cut to size by the doctor for use in smaller anatomical spaces and was created solely so that doctors and medical providers would continue to purchase the device for use in those scenarios and continue to bill for the implantation of a receiver component.”

According to law enforcement officials, Perryman oversaw training for doctors in how to use the device and also told others in her company to vouch for its effectiveness.

The lesson learned is that healthcare providers should do due diligence on vendors offering the latest medical devices with promises of improved clinical outcomes. And remember that plastic does not conduct electric currents.

What health systems are doing is not working, says this nurse leader. 

On this episode of HL Shorts, we hear from Jennifer Croland, VP and CNO at OSF HealthCare Saint Francis Medical Center, about effective recruitment and retention strategies that CNOs can use to tackle workforce issues. Tune in to hear her insights.

Healthcare transformation is an evolving strategy. Some say a slow-but-steady approach works. Others—not so much.

Healthcare transformation is all the rage on the conference circuit these days, but are health systems and hospitals really transforming anything?

The litany of pain points within healthcare is long, from workforce shortages to soaring costs to ineffective outcomes. To address those issues, healthcare executives are looking at new technology like AI and virtual care. Some are looking for small, incremental gains, while others say the entire care delivery system has to change.

But Arthur Gianelli, MA, MBA, MPH, FACHE, chief transformation officer for New York’s Mount Sinai Health System, points out that technology may have caused just as much harm as good. For example, he says, EHRs transformed the healthcare industry “the wrong way.”

During a HealthIMPACT Forum this past week in New York City, Gianelli said the EHR is a great tool for collecting information, “but right now it has made the lives of our practitioners demonstrably worse.” Clinicians, he says, now spend as much time in front of computers as they do in front of their patients. 

As a result, the industry sees transformation as a return to the past, when patient and clinician faced each other and talked about health.

That said, technology has the potential to improve healthcare—if executives know how to use it. And that comes with practice.

“You want people to try, to experiment, to potentially fail and to try again,” he said.

What’s the fix? Call your baby ugly.

Sachin Jain, MD, MBA, FACP, thinks healthcare hasn’t done enough yet to transform—and it’ll take a lot more pain and suffering to move the industry in the right director.

Jain, president and CEO of the SCAN Group and Health Plan and a long-standing voice in the healthcare field, is critical of efforts by health systems and hospitals to enact change because, he says, they haven’t really changed anything yet.

“Why have we made changing healthcare harder than putting a man on the moon?” he asked.

In a colorful appearance by video at the HealthIMPACT Forum, Jain said the industry has “normalized the abnormal” and put the wrong people in charge of care, creating a generation of people trained not to ask the tough questions—such as, why is healthcare having such a hard time defining value-based care?

It’s a question many healthcare innovation leaders are asking as disruptors like Walmart, Walgreens, and CVS Health all struggle with their primary care strategies. The popular response to this has been “Healthcare is hard,” but why is it hard? Have years and years of pay-for-procedure and episodic healthcare clouded the playing field so much that healthcare executives can’t understand what constitutes value?

Jain argued that healthcare leaders have to get serious about change, to the point of shutting down programs that aren’t working and enduring declining revenues and job losses. But healthcare, he said, has a very hard time shutting down anything.

“You can’t change without changing,” he said. “It starts by calling our baby ugly, and that’s really, really hard to do because it’s our baby.”

Jain likens AI to the printing press in its potential to transform an industry but says healthcare leaders have to ask the tough questions now, cutting programs and positions that aren’t working.

“When people talk about workforce strategies, a lot of times it’s because you have a [horrible] workforce,” he said, using a NSFW phrase.

To Gianelli, that means moving away from the same old conversations about financial benefits and looking more closely at what healthcare should be doing: Making people healthier. AI could do that, he says, and it could also “change the types of people that we actually need in the organization.”

He described transformation as a culture, rather than a strategy, and said healthcare organizations need to enact change not in the boardroom, but on the floor. That means pulling nurses, doctors, and patients into the conversation.

“Clinicians in a hospital attach to purpose,” he said, emphasizing the idea that everyone needs to be on the same page to enact change.

Jain said that will be tough.

“We’ve eroded people’s purpose,” Jain added. “And we’ve tried to solve the problem by giving doctors tchotchkes on recognition day.”