Safety Culture & Virtue 4: Security

Nurses are on the frontline of violence. And patients, already vulnerable from disease and disability, are at particular risk to the volatile environment of a healthcare organization. The current attention given to reducing and mitigating violence in healthcare and preventing patient and staff assault is completely warranted. This nurse’s week, I would ask to see security take priority in the board room of healthcare facilities.

I’ll never forget the the night a patient directly threatened me. He asked which entrance I used when I came and left work. He tried to guess which car I drove, what time did I usually come in to work, and what days did I work. When he discharged a few hours before my shift ended, he was free to go where he wanted, and he told me he planned to see me again. My charge nurse told me to be careful because he might be waiting for me to exit the building.

I determined that I would call for a security escort to my car. There was no lighting in the lot, the hospital was in a shady part of town, it was late at night, and there were no emergency alarms to call for help if something went wrong. But when I called to ask for an escort to my car, the security guard chuckled at me and implied that I was being over-dramatic. I was floored. The guard grudgingly walked me halfway, but from that point on, my husband drove me to work and picked me up every day.

No healthcare organization should ever become comfortable with a baseline threat of violence. Staff should not risk their lives just to go to work. And while we can’t control everything, we can work to manage obvious threats. Certainly, we cannot change the entire community around us, but we can learn to deliver care in imperfect circumstances (because dangerous places need healthcare too).

And I’m not just talking about staff. Did you know that The Joint Commission’s 2023 annual report highlighted how acts of violence had risen dramatically, representing 8% of the approximately 1,400 patient sentinel events in 2023?[1] The risk is increasing; so should our attention to mitigating that risk.

But what can be done to protect people in a place that is fraught with tense emotions? Forbes published an article describing practical security methods to keep everyone in the hospital safe, including metal detectors, cameras, panic buttons, safety badges, improved lighting, and limiting traffic.[2] They talked about scheduling and virtual visits and the role that telehealth can play in reducing the potential for violence in healthcare. These are great ideas because they are practical, system interventions with evidence to support their use.

Personally, I can say that I saw a difference at my workplace when we hired an off-duty police officer to remain in the ER at all times. There was a measurable reduction in the incidence of violence, and any escalations were quickly de-escalated. We also had active shooter training, and we were taught negotiation tactics in case we answered the phone when a bomb threat was called in. These practical interventions not only increased our physical safety awareness and prepared us for difficult situations, but it also demonstrated that the organization valued our safety and was willing to invest in it.

So today’s safety culture assessment is to call security and ask for an escort to your car. If a security guard shows up promptly with a professional attitude and asks about any perceived threats, then give your facility 1 point. If they make you wait more than 15 minutes, fail to ask why you requested additional safety measures, or otherwise act unprofessional, it’s time to elevate your institution’s security at the administrative level. Update your policies for various threats and do a thorough review of security items like lighting, traffic, incident response, and video surveillance. Ask staff if they know about safety measures and set aside time for some security-related drills. Show your staff that safety is a priority.

[1] The Joint Commission (May 15, 2024). 2023 Sentinel Event Data Annual Report. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/joint-commission-online/may-15-2024/now-available-2023-sentinel-event-data-annual-report.

[2] Markovitz, S.; Grimes, C. (Sept. 1, 2022). Violence Against Healthcare Workers Is At An All-Time High: Here’s How Workplaces Can Keep Them Safe. Forbes. https://www.forbes.com/sites/coronavirusfrontlines/2022/09/01/violence-against-healthcare-workers-is-at-an-all-time-high-heres-how-workplaces-can-keep-them-safe/.