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episode 7

Current Issues in Nursing

Safe staff ratios

Violence in the workplace

Lack of self care

Safe Staff Ratios

From the ANA website

Usually 3 different approaches depending on the state:

- Requires hospitals to have nurse driven staffing committees

- Legislators to mandate specific nurse to patient ratios

- Requires facilities to disclose staffing levels to the public

Nurse driven staffing committees- they take input regarding the population their organization serves and matches it with the level of experience and skills of the staff.

  • 7 States currently require this- CT, IL, NV, OH, OR, TX, and WA.

  • MN Requires a CNO to create a staffing plan with input from staff/nurses etc. This requirement is similar to Joint Commission standards.

Specific ratios:

  • Only 1 state so far has this for ALL nursing units: California

  • Minnesota has this specific to ICU: 1:1 or 1:2 depending on patient acuity.

  • Last year Massachusetts had the opportunity to pass a similar law however was met with a resounding “NO”. Surprisingly, the ANA did NOT support this law because it was not flexible enough to allow nurses’ autonomy and ability to staff the needs of their own unit. They felt it was too strict and did not take into account issues like patient acuity. They were successful however in bringing the conversation forward and I look forward to a revision of this law and hope for it’s success in the future.

Disclosing to the public:

  • Only required by these 5 states: IL, NJ, NY, RI, and VT.

What can I do as a nurse?

First, know your laws for your state. Find out what your rights are as a nurse and join one of the organizations for nurses. I personally joined ANA and GNA (Being that I’m in GA) and they offer discounts to students and/or newer nurses (usually within 5 years). This is the organization which will help you stay informed regarding legislation in your state and how it affects the nursing profession.

2. VOTE!! Go out and inform yourself of those who are running and what their stances are regarding safe patient ratios! Engage with them, ask questions, and educate others! It’s amazing how easy it can really be to contact your representative.

Get in touch with ANAs Political Action committee here

3. Get involved at work! Join a committee or nursing governance so that you can be more aware of the specific nursing and staffing issues affecting your organization. This will help link you into nurses within the organization, not just your specific area and if you are educated in politics affecting nursing in your state and local areas you can bring that education to others to effect change.

Violence in the Workplace

Another hot topic: Violence from patients, violence from family members, workplace bullying (other nurses, care techs, and providers).

Workplace violence consists of physically and psychologically damaging actions that occur in the workplace or while on duty (National Institute for Occupational Safety and Health [NIOSH], 2002). The Bureau of Labor Statistics releases an annual report about injuries and illnesses resulting in time away from work in the United States.

In the health care and social assistance sectors, 13% of days away from work were the result of violence in 2013, and this rate has increased in recent years (U.S. Department of Labor [DOL], Bureau of Labor Statistics, 2014).  

Examples of workplace violence include direct physical assaults (with or without weapons), written or verbal threats, physical or verbal harassment, and homicide (Occupational Safety and Health Administration OSHA, 2015).

Violence in the workplace- National Nurses United:

  • 3 times higher for registered nurses than any other industry

  • Healthcare workers 5-12 times more likely to experience nonfatal injuries than average workers

  • Under reported by hospital employees- 88% do not document incident reports

  • Associated with decreased productivity and increased employee turnover

  • Reduces quality of patient care

The Federal Health Care Workplace Violence Prevention Act- HR 5223

To prevent and reduce the frequency and severity of violent incidents in healthcare settings, a comprehensive federal workplace violence prevention standard must:

  • Broadly define workplace violence to include threats and physical acts of violence, including incidents involving firearms or dangerous weapons.

  • Require employers to develop unit-specific and facility-specific assessment and prevention methods rather than one-size-fits-all plans.7

  • Actively involve employees in developing, implementing and reviewing the plan, and provide detailed and interactive training programs for employees.8

  • Ensures that employers assess hazards and provide correction procedures, including sufficient patient care staffing to prevent workplace violence, trained security personnel who are available to respond immediately to workplace violence incidents, alarm systems, and job and facility design to prevent workplace violence.

  • Require that employers establish policies for reporting of workplace violence incidents and concerns without fear of retaliation; systems for communicating among coworkers, shifts, emergency services, and law enforcement about risks for violence and violent incidents; procedures for incident response and investigation; and methods for correcting hazards.9

  • Requires employers to maintain Violent Incident Logs and must adhere to reporting requirements, both of which are critical to the effectiveness of annual evaluations of workplace violence prevention plans and hazard correction.

What to do?

If you experience threats or unsafe conditions in the work-place immediately remove yourself from the situation. Get the appropriate people involved- Security officers are trained just for that, you are not paid to be a security officer.

REPORT the incident using your organization’s incident reporting system so that there is a documented paper trail of what happened. REPORT to police if necessary. (All threats of violence I would report personally).

This applies to anyone who makes you feel threatened>> not just patients or family members but coworkers and even physicians. Go to HR if cannot be resolved on your unit.

Know the culture of your workplace! If it is not intolerant of harassment, bullying, or hostility you will observe that rather quickly. If things do not change get yourself out of that situation.

Workplace bullying- Not all hospitals allow this!!!

How to combat if you see someone else being bullied--- focus attention on the victim, not the bully themselves.

  • Offer help, acts of kindness.

  • Team building in your department

  • Mentoring programs, assistance to the new graduates/nurse residents.

What if it is a nurse-tech/ tech-nurse?

  • Focus on the person being bullied and offer to help them

  • Do not engage with the bully

  • Report to manager if continues

  • IF it’s the manager, report up the chain of command.

  • ANY employer worth your time will take action against bullies in the workplace.

Lack of Self Care

Nurses and health care workers in general will give all of themselves with nothing in return--- leads to burnout and health issues including mental health.

Compassion Fatigue




What are you doing every day to fill up your cup?

Reading, exercise, art, music, spa, nails, hair, time with friends, time with family, time off in general (don’t have to go anywhere), volunteer!!!

Support groups,  therapy, debrief in the moment of a difficult situation at work…

I throw myself into art, music, therapy, and volunteering time for others. Helps keep me grounded. What about you?


  1. Bureau of Labor Statistics. U.S. Department of Labor. “Occupational Injuries and Illnesses and Fatal Injuries Profiles,” available at Non-fatal injury rate for RNs in the private sector due to violence was 12.7 per 10,000 full-time workers. Non-fatal injury rate for all private industry was 3.8 per 10,000 workers.

  2. Ibid

  3. Arnetz, J. et al. Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents. Workplace Health and Safety. Vol. 63, 2015

  4. Gates, D. et al. Violence Against Nurses and its Impact on Stress and Productivity. Nursing Economic$. Vol. 29:2, 2011, pp. 59-67.

  5. Sofield L, Salmond SW. Workplace violence: a focus on verbal abuse and intent to leave the organization. Orthop Nurs. 2003;22:274–283.

  6. Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med. 2001;52:417–427.

  7. A 2017 study found that rates of violent incidents were 60 percent lower in hospital units with unit-specific, comprehensive intervention plans compared to units that did not have such plans. Arnetz, J. et al. Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention. J. of Occup. and Environ. Med. Vol. 59:1, 2017, pp. 18-27.

  8. A 2002 study found that interactive, hands-on workplace violence recognition and intervention training can be effective in reducing violence incident rates and, importantly, that refresher trainings are needed to maintain those effects. Fernandes, C. et al. The Effect of an Education Program on Violence in the Emergency Department. Annals of Emerg. Med. Vol. 39:1, 2002, pp. 47-55

  9. A 2009 study showed that one inpatient psychiatric Veteran’s Affairs Medical Center reduced rates of violence on the day shift — by 89 percent during treatment and 57 percent from pre-treatment to post-treatment — after real-time incident recording tools and regular twice weekly meetings on violence prevention were implemented. In the night shift where continuous involvement of staff in risk assessment and prevention was not implemented, rates of violence did not show significant change.
    Lanza, M. et al. Reducing Violence Against Nurses: The Violence Prevention Community Meeting.
    Issues in Mental Health Nursing. Vol. 30, 2009, pp. 745-50