Date of Completion

Spring 5-14-2025

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Dr. Eileen Stuart-Shor, PhD, ANP, FAAN

Practice Site Mentor

Dr. Colleen Snydeman, PhD, RN

Committee Mentor

Dr. Shawna Butler, DNP, JD, RN, CPHRM

Abstract

Abstract

Background: Healthcare workers are at increased risk of violence directed at them. Approximately three-quarters of all nonfatal injuries and illnesses related to violence were incurred by healthcare workers. Given this, the aim of this project was to decrease the frequency of workplace violence events directed at nurses and increasing the staff nurse’s perception of unit-based safety.

Local Problem: At the large academic medical center where the project was implemented, NDNQI quality data indicated a higher rate of assaults (per 1,000 care hours in a hospital with greater than 500 beds) than the national average (0.12 vs. 0.07 respectively).

Methods: A PRISMA guided systematic review of the literature was completed to determine what strategies have been shown to decrease patient/family/visitor assaults, or violence directed toward nurses in an acute care medical facility. The project was guided by the Middle-Range Theory of Nurses’ Psychological Trauma to inform a response to workplace violence in the project setting. Rapid change cycles (Plan-Do-Study-Act) along with Kotter’s Eight Step Change model were used to drive the process change at the project site.

Intervention: Over a 12-week implementation period, Police and Security were integrated into a multidisciplinary unit-based safety huddle on an adult general medicine unit. The safety huddle occurred daily, Monday through Friday, excluding holidays. Staff nurses and Police and Security received education and training related to the safety huddle structure and the process of logging completion of the unit-based safety huddle.

Evaluation: The quality improvement project was evaluated for success using a pre-and-post project implementation unit-based staff survey. Hospital NDNQI and safety reporting data was used to assess frequency of nurse assaults pre and post project implementation.

Results: Pre-post survey results indicated that six of the seven aims of the project were fully or partially met. The perception of nursing staff about the safety culture improved and staff reported increased confidence in their ability to identify patients/families/visitors at risk for workplace violence directed at nurses and were more confident in their ability to escalate concerns related to workplace violence to hospital resources.

Conclusion: This project demonstrated that an enhanced multidisciplinary safety huddle that included members of Police and Security resulted in positive change. Increased opportunities for dialogue related to workplace violence and safety, paired with further opportunities to collaborate and partner resulted in positive changes and improvement in staff nurses’ perception of unit safety. Aligning with the goals of the institution, the project provided a proactive approach to safety and workplace violence prevention and management.

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