Texas Nursing 2023 Issue 1

TEXAS

ISSUE 1, 2023

Volume 97, Number 1

EDITOR IN CHIEF: Serena Bumpus

MANAGING EDITOR: Lisa Maxwell

COPY EDITORS: Gabi Nintunze, Natalie Hill

4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444

P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648

tna@texasnurses.org | texasnurses.org

MISSION

Empowering Texas Nurses to advance the profession

VISION

Nurses transforming health

TEXAS NURSING (ISSN 0095-36X) is published quarterly—

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POSTMASTER

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Copyright 2023 © Texas Nurses Association

BOARD OF DIRECTORS

OFFICERS:

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN, President jbatcheller7@yahoo.com

Colleen Marzilli, PhD, DNP, RN, CNE, NEA-BC, Secretary cmarzilli@uttyler.edu

Gloria Lorea, DNP, RN, NEA-BC, Treasurer glorialoeradnp@gmail.com

Tamara “Tammy” Eades, DNP, MSN, RN, Past President eades@uta.edu

DIRECTORS:

Patricia Freier, MSN, RN-BC, CPHQ patricia.freier@sbcglobal.net

Lucindra Campbell-Law, PhD, ANP, APRN, PMHNP, BC campbel1@stthom.edu

Edtrina Moss, PhD, RN-BC edtrina@comcast.net

Brandon “Kit” Bredimus, DNP, RN, CEN, CPEN, CNML, NE-BC, CENP, NEA-BC kit.bredimus@midlandhealth.org

Mary Vitullo, MBA, MSN, RN-BC, PCCN, NE-BC, CLSBB vitullo.mary@yahoo.com

CHIEF EXECUTIVE OFFICER: Serena Bumpus, DNP, RN, NEA-BC, sbumpus@texasnurses.org

TNA DISTRICT PRESIDENTS

Dist. 1: Jackeline Biddle Richard, DNP, JD, RN, CNE, jackie.richard1@icloud.com

Dist. 3: K. Renee’ Yarbrough-Yale, DNP, APRN, ACCNS-AG, CDCES, tnad3president@gmail.com; District office: Jamie R. Rivera, JamieRivera@texashealth.org

Dist. 4: Robert Castillo, MSN, RN, CCRN, NE-BC, 817-229-6478, robert.castillo@utsouthwestern.edu; tnad4.nursingnetwork.com; District Secretary Lori Batchelor, batchelorb@prodigy.net

Dist. 5: Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, bclipper1@gmail.com, tna5.org

Dist. 7: Connie Barker, APRN. PhD. FNP-C, crbarker1@yahoo.com, tnadistrict7@gmail.com

Dist. 8: Donna R. Wallis, MBA, MSN, RN, 210-486-3089 dwallis3@alamo.edu, tna8.org

Dist. 9: Nancy Yuill, PhD, RN, nyuill@yahoo.com District office: Melanie Truong, RN, Executive Secretary, tna9@tnadistrict9.com, tnadistrict9.com

Dist. 17: Mari Cuellar, NEA-BC, MSN, RN, mari.cuellar@christushealth.org

Dist. 18: Belinda Gallegos, belinda.gallegos@ttuhsc.edu

Dist. 19: Dixie R. Rose, RN, dixiegtc@gmail.com

Dist. 35: Karen Koerber-Timmons, PhD, RN, CLNC, CNE, NEA-BC, CCRN, RN-BC  mkkoerbertimmons@gmail.com

At-Large: Contact TNA, 800-862-2022, ext. 129, brichey@texasnurses.org

President’s

Notes

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN

THE TNA LEGACY: MOVING ONWARD We Need You to Strengthen Our Voice

TNA HAS A WELL-ESTABLISHED HISTORY of advocating for change for nurses on key issues. To better understand what the current issues at the forefront of our members’ concerns are, a series of listening sessions have started. CEO Dr. Serena Bumpus, Director of Gov. Affairs Jack Frazee, Director of Membership Belinda Richey and I plan to visit with nurses of various backgrounds and disciplines in different parts of the state. We have already been to Austin, San Antonio, Galveston, and Houston and have plans to visit other parts of the state in the upcoming months. TNA staff is working with district leadership to plan these events. Both members and nonmembers are welcome.

The main goal has been to listen and better understand the challenges nurses are facing and practices they are implementing throughout the continuum of care. This dialogue is helping TNA prioritize what is most important to nurses as the new strategic plan is created. Discussions thus far have centered on the need for safer work environments, safe staffing, better transitions to practice, the need to increase enrollment in nursing schools, and enhanced access to care. Nurse well-being and the need to support staff are additional priorities being shared. Additionally, we have seen great examples of innovative work nurses are leading.

The board completed a strategic planning session at the end of January. More details about the new strategic plan will be shared in early spring.

We are hearing a lot of great ideas and there is excitement around the many ways TNA can continue to be the voice

of nurses in Texas. Engagement of current members and recruiting additional members to strengthen the voice of nursing is essential. And here is how you can start:

ƒ Join me by becoming involved in this important work.

ƒ Attend one of the dialogue sessions when we come to your area.

ƒ Engage with your local district, and

ƒ Attend the TNA Annual Conference in June to learn more about what

we’re doing and build a network of colleagues passionate about moving Texas nursing forward.

I hope to see you in person soon.

P.S. I know how busy you may be raising families, caring for parents, working long hours and fulfilling multiple roles—so if you want to share a story or express a concern, please email me at: TNAPresident@TexasNurses.org. i

Central Texas nurses gathered in Round Rock to speak with Joyce Batcheller, Serena Bumpus and Jack Frazee about the issues and challenges they face.

TNA MEMBER NEWS

SPOTLIGHT ON YOU

KUDOS

Valerie Kiper, DNP, MSN, RN received Texas Tech University Health Sciences Center’s 2021-2022 Presidential Distinguished Alumni Award. This is the highest honor bestowed by the university, recognizing and honoring alumni who have made significant contributions to the health care profession.

Kathleen Kearney, JD, MSN, RN was promoted to Associate Professor for the RN to BSN program at Texas Tech University Health Sciences Center and elected Secretary of the American Association of Nurse Attorneys Foundation board of Trustees.

Susan McBride and Mari Tietze’s textbook Nursing Informatics for the Advanced Practice Nurse, Third Edition was named AJN’s book of the year.

The following organizations received ANCC’s Magnet designation:

ƒ Houston Methodist The Woodlands

And redesignation:

ƒ Hermann Greater Heights Hospital , Houston

ƒ Memorial Hermann Southwest Hospital

ƒ CHRISTUS Trinity Mother Frances , Tyler

JPS Health Network in Fort Worth achieved ANCC’s Pathway to Excellence redesignation, one of only 204 organizations globally.

A nursing student from TTUHSC’s satellite campus in Mansfield receives his degree at the School of Nursing commencement ceremony on Saturday, Dec. 17, 2022

Congratulations to TNA’s newly elected leadership. Sarah Williams , PhD, DNP, RN-BC, ANE, Leadership Succession Committee Chair, has announced the results of TNA’s 2023 ballot and the winners are:

President-Elect/President/Immediate Past President, 4-year term, 2023-2027

ƒ Amy McCarthy, DNP, RNC-MNN, NEBC – Dallas

Secretary, 2-year term, 2023-2025

ƒ Missam Merchant, MBA, BSN, RN, CENP, CCRN-K, PCCN, CV-BC, GERO-BC, MEDSURG-BC, NE-BCSan Antonio

Board Member At-Large, 2-year term 2023-2025

ƒ Jose Alejandro, PhD, RN, NEA-BC, MBA, CNE, FACHE, FAAN- Dallas

Board Member At-Large, (Small District) 2-year term 2023-2025

ƒ Patricia Francis-Johnson DNP, RN, CDP – Lubbock

ANA Membership Assembly

Representative – 1-year term, 2023-2024

ƒ Nelson Tuazon , DNP, DBA, RN, NEABC, CENP, CPHQ, CPPS, CPXP, FNAP, FACHE, FAAN - San Antonio

ƒ Leslie Morris , DNP, RN, AMB-BC, NPD-BC- Houston

ƒ Christopher Vestal , BSN, RN - Plano

ƒ Gayle Dasher, PhD, RN, ANP-BCSan Antonio

ƒ Edtrina Moss , PhD, RN, AMB-BC, NEBC, CLSSGB - Missouri City

ƒ Deidre Palmer, BSN, RN - Cypress

ƒ Anne Hulzing , RN, MSLC, BSN, HACP - Austin

Leadership Succession Committee

Member 2-year term, 2023-2025

ƒ TaCharra Laury, MSN, APRN, ACNPBC, AOCNP- Houston

ƒ Ebony Mitchell , MSN, RN, BSHHouston

Brittney Majefski joined the Texas Peer Assistance Program for Nurses (TPAPN) as program director. She holds a Bachelors Degree, Summa Cum Laude, and master’s degree in nursing education from The University of Texas at Arlington. Her background includes roles as director of nursing at Meridell Achievement Center and as a clinical instructor at the University of Texas at Austin. In her new role at TPAPN, she hopes to support nursing by helping promote open conversations to all nurses, hospital administrators and legislators regarding mental health needs, and to assist with the improvement and allocation of available resources to help keep all nurses healthy and trauma informed; not only for their patients but also their peers and themselves. i

If you are a TNA member and you’ve, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Please send submissions to editor@texasnurses.org.

TNA NEWS

WHAT'S NEW AND NEXT

TNA REPRESENTS YOU

ƒ ANA

› ANA Executive Enterprise Conference

› Nurse Staffing C/SNA Advisory Group

› State-Based Innovation Incubators

› C/SNA Pres-ED calls

› Lobbyist Meeting

ƒ Board of Nursing

› BON Quarterly Meeting

› Testify Senate Finance CommitteeBON LAR support

ƒ State Legislature

› House Public Health Committee, Interim Charge Hearing

› Senate Health and Human Services Committee, Interim Charge Hearing

› House Public Health Committee, HB 112 Hearing

› Senate Health and Human Services Committee, SB 240 Hearing

ƒ DSHS/HHS

› TCNWS Advisory Committee Meeting

› Quarterly Quality Provider Meeting

ƒ Media

› KXAN, Austin

› Dallas Observer

› Fort Worth Report

› KVUE, Austin

› ABC13, Houston

› KTRK, Houston

› Waco Tribune-Herald

› KWTX, Waco

› CBS Austin

› CBS Dallas

› Univision

› VIN News Service

› Spectrum News

ƒ Other

› San Antonio Indian Nurses Association Annual Gala

› Tau Epsilon Chapter of Sigma

› Greater Houston Partnership Health Care Advisory Committee

› Memorial Hermann CNOs

› Coalitions formed by TNA or on which TNA is represented:

› Nursing Legislative Agenda Coalition

› Nursing Shortage Reduction Coalition

› Workplace Violence Prevention Coalition

› Texas Public Health Coalition

› The Immunization Partnership

› UTMB School of Nursing

› Texas Tech DNP Program

› UT Health Houston Cizik School of Nursing, Policy Class

› UT Health San Antonio School of Nursing, Health Economics and Policy Class i

GET SUPPORT AND SAFEGUARD PATIENTS

Nurses Helping Nurses

If you, a coworker, or a family member need help with a substance use or mental health issue, call the Texas Peer Assistance Program for Nurses. TPAPN case managers provide guidance, support, and monitoring to help nurses recover and maintain their licenses. And TPAPN peer advocates provide an empathetic listening ear. You and those you care about are not alone!

New Guidelines for Opioid Prescriptions and Equitable Use of Prescription Monitoring Program

The Centers for Disease Control and Prevention (CDC) recently released updated clinical guidelines for prescribing opioids for pain. The new publication updates guidance from 2016 that was issued to help improve appropriate opioid prescribing while minimizing opioid-related negative health outcomes.

The updated guidelines include comprehensive recommendations to help Prescription Monitoring Program (PMP) providers improve the equitable use of PMP through enhanced individualized care, risk management, and attention to health disparities.

CDC makes the following key recommendations:

• Review PMP data before every opioid prescription for acute, subacute, or chronic pain.

• During long-term opioid therapy, review PMP data at a minimum before an initial opioid prescription and then every three months or more frequently. However, because PMP information can be most helpful when results are unexpected, providers should apply this recommendation when feasible to every patient and not differentially based on assumptions about what they may learn about a specific patient.

• Use specific PMP information about medications prescribed to their patient in the context of other clinical information, including the patient’s history, physical findings, and other relevant testing, to help communicate with and protect their patient.

• Do not dismiss a patient from their practice based on PMP information alone. Doing so could adversely affect patient safety and result in missed opportunities to provide life-saving information (e.g., about risks of prescription opioids and overdose prevention) and interventions (e.g., safer prescriptions, non-opioid pain treatment, naloxone, and effective treatment for a substance use disorder).

• Screen for substance use and discuss concerns with the patient in a nonjudgmental manner.

These evidence-based recommendations establish clear standards for effective and equitable use of the PMP.

Texas Health and Human Services urges all providers prescribing opioids to review the other recommendations in CDC’s new guidelines and align their practices with the most recent evidence.

For additional support incorporating these recommendations and to access resources and continuing education courses, visit txpmp.org

Sign on before you sign off.

CRISIS POINT

Nurses Face Increasing Numbers of On-the-job Assaults. Merely Going to Work Shouldn't Endanger Your Life

By: Lisa Maxwell, TNA Director of Communications

I DIDN’T KNOW WHAT I EXPECTED TO SEE when I watched the security camera footage of the murder of two healthcare workers at Methodist Dallas Medical Center last fall, but the brutal truth was so much worse. The murders of Jacqueline Ama Pokuaa, 45, and Katie Annette Flowers, 63, a caseworker and nurse, happened in just a few seconds. The video is shocking and upsetting. Fortunately, a police officer happened to be nearby and intervened, preventing further harm.

As a non-nurse, I was struck by the knowledge that the nurses working in that hospital had to give medical attention to the gunman, who had just killed their colleagues, as well as continue to

work in the unit where it happened. The babies didn’t stop being born.

In a September 2022 report, Press Ganey found that more than two nursing personnel were assaulted every hour in the second quarter of that year. That equates to roughly 57 assaults per day. To nurses, this likely comes as no surprise. In recent years, healthcare settings have seen a disturbing increase in incidents of workplace violence. Workers are facing an increasing risk of physical and verbal assault from patients, their families, and even their own colleagues.

According to the Occupational Safety and Health Administration (OSHA), healthcare workers are nearly five times

more likely to experience workplace violence than workers in other industries.

Serena Tobar, MSN, RN-BC, CVRN-BC, shared her story of walking across a skyway at her hospital with just one other person coming in the opposite direction. The woman appeared to be talking to herself and as Tobar approached,

In an industry already facing a workforce shortage, implementing workplace violence prevention programs is critical to not only retaining staff, but also to protecting their very lives.

it became clear that she was angry with someone else in the hospital. The woman then suddenly pulled a knife out of her pocket and threatened Tobar.

“I realized I was alone with this woman in the skyway and no way to call for help,” said Tobar. “I felt totally vulnerable.” Fortunately, Tobar was not injured. The impact of workplace violence is significant. It can lead to physical injuries, emotional trauma, and even long-term health problems. Nurses who experience violence may also feel a sense of helplessness and disillusionment, which can lead to burnout and high turnover rates. In an industry already facing a workforce shortage, implementing workplace-violence prevention programs is critical to not only retaining staff, but also to protecting their very lives.

WORKPLACE VIOLENCE PREVENTION STRATEGIES USED BY HEALTHCARE FACILITIES

In her August 2022 webinar in the Nurse Talks Empowerment Series, “Making Workplace Violence a Never Event,” Lisa W. Thomas, DNP, RN, ACNS-BC, introduced this definition of workplace violence from the National Institute of Occupational Safety and Health (NIOSH): a “physically and/or psychologically damaging actions that occur in the workplace or while on duty.” She noted that this definition is important because it makes clear that workplace violence can also be psychological in nature. All too often, nurses have been asked to overlook these incidents and told that it is “just part of the job” when no one should expect to tolerate physical or psychological injury.

One nurse wrote, “The expectation in health care and nursing is patient satisfaction: Treat patients with respect and care they deserve. I’ve seen in a hospital (situations) where patients could hit a nurse or state false accusations against a staff member…and (the nurse would) be immediately placed under investigation and have their job threatened. Just because it is a patient doesn’t mean

All too often, nurses have been asked to overlook these incidents and told that it is “just part of the job” when no one should expect to tolerate physical or psychological injury.

Courtesy Texas Center for Nursing Workforce Studies.

WORKPLACE ACTS OF VIOLENCE

TNA SURVEYED NURSES RECEIVING EYE-OPENING RESPONSES

“A spouse who was more than seven feet tall picked up a clipboard and threw it at me, hitting me in the forehead.”

“I saw a patient grab a nurse by her ponytail and throw her to the ground, striking her head on the floor.”

“During COVID, I was verbally abused by a man who was angry because we didn’t allow visitors during the Delta surge. He was wearing a no COVID shirt and

rebel flag hat. He called me every name in the book, threatened me, screamed at the top of his lungs telling me there is no such thing as COVID as patients were dying every hour in our hospital.”

“I’m a home healthcare nurse and encountered a patient with a loaded gun on his coffee table.”

“Sexual comments are made to staff and patients expose themselves.”

If an organization does not prohibit workplace violence, there is no mechanism for stopping it. The first step in preventing workplace violence is to create an organizational policy which defines roles and responsibilities and clearly articulates the organization’s position, which may be on a scale of “maintaining a culture of respect” to “zero tolerance.”

you have to be subjected to abuse, especially by allowing it and not reporting it. Our job is to make sure a patient feels safe, but we should feel safe in the workplace too.”

If an organization does not prohibit workplace violence, there is no mechanism for stopping it. The first step in preventing workplace violence then, according to Thomas, is to create an organizational policy which defines roles and responsibilities and clearly articulates the organization’s position, which may be on a scale of “maintaining a culture of respect” to “zero tolerance.” From there, the next steps are developing training programs that educate workers on how to spot signs of violence and how to de-escalate tense situations and creating a reporting process that leads to results. Evaluating the physical environment for security risks and involving law enforcement are additional ways that organizations can begin to improve the work environment.

In a 2022 survey, the Texas Center for Nursing Workforce Studies asked Texas healthcare facilities about their workplaceviolence prevention strategies. The study found that of the responding hospitals, those indicating that they had implemented a workplace-violence prevention

WORKPLACE-VIOLENCE PREVENTION STRATEGIES FOUND TO BE MOST SUCCESSFUL

Courtesy Texas Center for Nursing Workforce Studies.

policy increased prevention from 77.8% to 90.9% since 2018.

SPEAK UP FOR CHANGE!

The Texas legislature can play a role in achieving this by passing legislation that requires healthcare organizations to implement these types of programs — but only if they are aware of how desperately they are needed. While many nurses are unfortunately all too familiar with onthe-job assaults, the general public is not. Your lawmakers must understand the importance of enacting change. Follow the bills discussed in this magazine and make sure your voice is heard.

The facilities reported that staff training was the most effective single strategy to preventing workplace violence, followed by restricting access to certain areas, adding static and rounding security personnel, and involving law enforcement.

There are many resources available for organizations wishing to develop workplace-violence prevention programs. The Joint Commission has a compendium of resources, www. jointcommission.org/resources/patientsafety-topics/workplace-violenceprevention/compendium-of-resources/, for a start.

A Reputation for Excellence!

Educating Nurses since 1890, UTMB SON offers undergraduate, graduate and doctoral degree tracks, designed to meet the unique needs of each nursing professional. Our graduates are skilled in providing patient-centered care and are developed to become leaders in health care.

UTMB SON’s teaching innovations have resulted in consistently high national rankings and alumni who have distinguished themselves as leaders throughout Texas and the United States. Today, informed by tradition, our vision continues to be our mission—to be the best in nursing education, research and practice in order to improve health for people around the world.

Implementing workplace-violence prevention programs is part of a bigger need to support nurses and other healthcare workers by improving their working environment. Other components include adopting a Just Culture policy, having adequate staff, providing for mental health and well-being and bringing in new tools and care models that free nurses up from non-productive tasks and allow them to do what they do best: provide excellent patient care. i

REFERENCES

www.pressganey.com/news/on-average-twonurses-are-assaulted-every-hour-new-press-ganeyanalysis-finds/ www.osha.gov/healthcare/workplace-violence

Programs Offered

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• Neonatal Nurse Practitioner

• Clinical Nurse Leader

• Executive Nurse Leader

• Nurse Educator (also offered as postBSN or post-MSN certificate)

DOCTOR OF NURSING PRACTICE (ONLINE)

• BSN to DNP

▪ Family Nurse Practitioner

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DOCTOR OF PHILOSOPHY IN NURSING (ONLINE)

• BSN to PhD

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To learn more about our programs, visit: https://nursing.utmb.edu

Evaluating the physical environment for security risks and involving law enforcement are additional ways that organizations can begin to improve the work environment.

Implementing workplaceviolence prevention programs is part of a bigger need to support nurses and other healthcare workers by improving their working environment.

THE UNIVERSITY OF TEXAS MEDICAL BRANCH

FIND YOUR STATE LEGISLATORS HERE: https://wrm.capitol.texas.gov/home

ERASING

WORKPLACE

PREVENTION THROUGH POLICY CHANGE

By Jack Frazee, J.D., TNA Director of Government Affairs

WORKPLACE VIOLENCE AGAINST NURSES has been a problem for decades, but data shows the problem only accelerated during the COVID-19 pandemic. TNA is working to address workplace violence this legislative session along with the Nursing Legislative Agenda Coalition and the Texas Hospital Association.

THE DATA DOESN’T LIE

The Texas Legislature commissioned studies on workplace violence against nurses from the Texas Center for Nursing Workforce Studies in the 84th legislative session. The Center published the results of their research in two reports in 2016 and 2018. The data shows nurses are subjected to physical assault and verbal abuse at shockingly high rates, with 49.8% of all Texas nurses enduring physical assault during their careers and 81.8% of all Texas nurses enduring verbal abuse during their careers.

Most violent events against nurses go unreported. When asked whether they had reported the most recent episode of physical assault against them, only 40.5% of Texas nurses said they had. The main reason Texas nurses gave for not reporting physical assault against them was that workplace violence “was an accepted/expected part of the job,” or they “did not expect anything to change.” The Center’s research provided policy

ENDING "ACCEPTED AND EXPECTED"

Most violent events against nurses go unreported. When asked whether they had reported the most recent episode of physical assault against them, only 40.5% of Texas nurses said they had. The main reason Texas nurses gave for not reporting physical assault against them was that workplace violence “was an accepted/expected part of the job,” or they “did not expect anything to change.”

recommendations for the Legislature’s consideration, and TNA is working to implement those recommendations this session.

WE CAN MITIGATE THIS PROBLEM

Two legislators have stepped up to lead on this issue: Representative Howard, a nurse, and Senator Campbell, a physician who practiced as a nurse before obtaining her license as a physician. Both leaders know the seriousness of the issue from their own work experience, and they have both filed bills to address the issue: HB 112 and SB 240.

These bills are key to empowering nurses to call out workplace violence and have it addressed without fear of retaliation. The bills require facilities to set workplace violence prevention policies, and require that a nurse be part of the committee that develops the policies. They also require facilities to set up plans of action for how to respond to violent incidents, and create anti-retaliation protections for nurses who report incidents of workplace violence to management and law enforcement.

HB 112 AND SB 240

If these bills are enacted into law, nurses will have a greater role in preventing violent events, reporting them as they occur, and prosecuting violent acts if the nurse chooses to report the incident to law enforcement and press charges.

If these bills are enacted into law, nurses will have a greater role in preventing violent events, reporting them as they occur, and prosecuting violent acts if the nurse chooses to report the incident to law enforcement and press charges. These legal tools are vital for protecting nurses and changing the culture that has permitted this rising violence.

THE ROAD TO REFORM

It is not enough to say workplace violence is part of the job— it’s not. Nurses sign up to heal others, not to endure abuse. TNA, in coordination with its coalition partners, is calling for meaningful reform, and you can join us. You can call your state representative and senator and request that they support these reforms too. Every nurse’s voice matters in this important policy discussion. Join us in calling for passage of HB 112 and SB 240 and help put a stop to these abuses. Find your state legislators here: https://wrm.capitol.texas.gov/home. i

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WHILE NURSES GET TO WITNESS some truly beautiful things, we are also faced with a variety of events that could increase the risk of mental distress or Post Traumatic Stress Disorder (PTSD). One very serious consequence of the rise in workplace violence in health care settings is the prevalence of PTSD. As many companies turn a focus inward to help promote wellness in employees, PTSD is something that is important for health -

IN THE AFTERMATH

Supporting Nurses After a Workplace Violence Incident

By Brittney Majefski, MSN, RN

While the public promoted the well-meaning idea of “healthcare heroes,” this label dehumanized the lived experiences of nurses and made them even more prone to ignore warning signs of PTSD.

care professionals and hospital administrators to understand, be able to identify, and be ready to put policies and protocols in place to assist with prevention of the causes of PTSD and treatment of this diagnosis.

Nurses as a group are vulnerable to PTSD due to the likelihood that in their professional career, they will be subjected to both primary and secondary forms of trauma. In one day’s work you may: run to resuscitate a patient; have an acutely

MANAGING PTSD IN THE WORKPLACE

› Promote discussions and education on mental health and substance use from onboarding orientation and throughout all employee training.

› Encourage the use of time-off and self-care.

› Have engaged leaders who

listen and support their staff.

› Encourage reporting and nondisciplinary approaches .

› Have meaningful debriefings after traumatic events (Check out code lavender).

› Promote therapeutic services for staff.

› Implement supportive policy around workplace violence prevention.

› Foster a culture that talks about these things with supportive language and resources.

› We believe nurses are heroes, but we are also human. Recognizing symptoms in

One thing that experts agree on is ensuring that nurses are promoting overall balance. This includes such things as appropriate work hours, setting good boundaries, having hobbies outside of work, engaging in social activities, having support networks and, arguably the most important thing, seeking professional help early and often.

psychotic patient threaten to assault you; hold the hand of a family member as they learn about a terminal diagnosis; help stop the bleeding of a new mother; and get yelled at by a patient or family member. The pandemic, of course, did little to help this situation.

While the public promoted the wellmeaning idea of “healthcare heroes,” this label dehumanized the lived experiences of nurses and made them even more prone to ignore warning signs of PTSD. Many may have felt as though they had to push through to be that “hero” and help others at the cost of their own mental health.

Nurses are in a unique position to educate themselves and one another to keep a watchful eye for signs and symptoms of this illness in their peers or themselves. As with most medical diagnosis the first step is prevention. But how does one prevent PTSD especially when the chances of experiencing multiple traumas in your day-to-day life are high?

One thing that experts agree on is ensuring that nurses are promoting overall balance. This includes such things as appropriate work hours, setting good boundaries, having hobbies outside of

work, engaging in social activities, having support networks and, arguably the most important thing, seeking professional help early and often. However, studies have shown that even nurses with more perceived resilience skills such as these listed above are still showing signs of PTSD (Leng et al., 2020).

So how can healthcare systems and facilities help support initiatives to help prevent long-term problems associated with PTSD among their teams? Destigmatizing mental health and substance use issues is a huge start. We must start having open and candid conversations with our teams from day one. Ensuring our nurses feel both supported and informed on how to identify signs of substance use or mental health concerns such as PTSD in themselves and others is imperative. Having policies or protocols that promote support rather than punitive discipline regarding these areas can be a step towards improving burnout. Promoting frequent use of benefits such as employee assistance programs and wellness initiatives can help create an environment that is employee-centered and compassionate.

ƒ Recognize Common Signs of PTSD

ƒ Hypervigilance

ƒ Behavior Changes (ex. Once calm and steady nurse becomes easily angered or defensive)

ƒ Increased Anxiety/Depression

ƒ Insomnia and/or nightmares

ƒ Avoidance of specific tasks or assignments

ƒ Intrusive thoughts and/or difficulty concentrating

ƒ Panic attacks including physical symptoms

ƒ Verbal or physical signs of using or misusing substances (Draze,2022).

When healthcare leaders view PTSD as a consequence of workplace violence, it allows decision-makers the opportunity to have critical conversations around prevention and implementation of supportive changes when formulating work-

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oneself or your peers can help you move towards acceptance and prompt treatment, and can reduce negative outcomes for nurses and foster a culture of patient safety. PTSD, like many mental health diagnoses, is treatable, and we can help those affected lead healthy lives.

place violence prevention programs. With the nursing shortage crisis, it is vital that nursing leadership be the frontrunner in developing supportive resources within their facilities for nurses to utilize when an identified concern arises. Ensuring that we are taking a holistic approach to identifying, preventing, and treating PTSD in nurses can help have a lasting impact on efforts to decrease the stigma. By decreasing stigma, we can hope to improve the health and vitality of our nursing workforce.

For more information on how to get help with mental health or substanceuse issues, please visit tpapn.org or contact us at 1-800-288-5528 or tpapn@ texasnurses.org

We are happy to come to your workplace to discuss TPAPN and our role in providing supportive care to nurses, as well as how your facility can as well. i

Brittney Majefski, MSN, RN, has worked in the mental health field for more than seven years. She recently joined TPAPN as Program Director.

REFERENCES

Draze, L. (2022). Covid-19 and PTSD in frontline nurses. American Nurse. www.myamericannurse.com/covid19-and-ptsd-in-frontline-nurses/

Leng, M., Wei, L., Shi, X., Cao, G., Wei, Y., Xu, H., Zhang, X.,...Wei, H. (2020). Mental distress and influencing factors in nurses caring for patients with Covid-19. Nursing in Critical Care, 26(2), 94-101. https://doi.org/10.1111/ nicc.12528

Pirani, F. (2021). Many nurses suffer from PTSD. What can be done to help? The Atlanta Journal Constitution. www.ajc.com/news/health-medfit-science/many-nurses-experience-ptsdsome-point-their-careers-what-can-donehelp/5fJk45IPQKzgoH0Zi1S5rM/

Post-traumatic stress disorder (n.d.) retrieved from www.mayoclinic.org/diseases-conditions/posttraumatic-stress-disorder/symptoms-causes/syc20355967

Stone, S. (2018). Code lavender: A tool for staff support. Nursing 2018. 48 (4), 15-17. DOI-10.1097/01.NURSE.0000531022.93707.08

Ensuring that we are taking a holistic approach to identifying, preventing, and treating PTSD in nurses can help have a lasting impact on efforts to decrease the stigma. By decreasing stigma, we can hope to improve the health and vitality of our nursing workforce.

ALLMAN & ASSOCIATES, INC. CERTIFIED PUBLIC ACCOUNTANTS

INDEPENDENT AUDITORS' REPORT

OPINION: In our opinion, the financial statements referred to [in the audit] present fairly, in all material respects, the financial position of the Texas Nurses Association, Inc., as of June 30, 2022, and the changes in its net assets and cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America.

Current members can log in to view the audit at texasnurses.org/aboutus.