Definition of violence

Harassment – any behavior (verbal or physical) that

demeans, embarrasses, humiliates, annoys, alarms, or

verbally abuses a person, and that is known or would be expected to be unwelcome. This includes use of offensive language, sexual innuendos, name calling, swearing, insults, use of condescending language etc., arguments, gestures, pranks, rumors, intimidation, bullying, or other inappropriate activities.

Verbal or written threats – any expression of an intent to inflict personal pain, harm, damage, and/or psychological harm, either through spoken word or in writing.

Threatening behavior – such as shaking fists, intentionally slamming doors, punching walls, destroying property, vandalism, sabotage, theft, or throwing objects.

Physical attacks or assaults – hitting, shoving, biting,

pushing or kicking. Extremes include rape, arson, and

murder. Note: ORS 654.412 to 654.423 defines assault as ‘intentionally, knowingly or recklessly causing physical injury’.

Aggravated Assault - An unlawful attack by one person

upon another for the purpose of inflicting severe or

aggravated bodily injury. This type of assault usually is

accompanied by the use of a weapon or by means likely to produce death or great bodily harm.

—OAHHS Study

Hospitals are now among the most dangerous places to work. According to a report from the Oregon Association of Hospitals Research and Education Foundation, hospitals recorded more than 24,000 workplace assaults between 2010 and 2013. In fact, in studies conducted for Emergency Department nurses, 50 to 100 percent of respondents reported experiencing verbal or physical violence on the job. Grande Ronde Hospital is working to mitigate that.

The hospital participated in a three-year pilot program with other Oregon hospitals of varying sizes to figure out how to decrease the frequency of violence against hospital staff while increasing the staffs’ feeling of being safe at work.

It’s helped, according to Elaine LaRochelle, who is the director of facilities at the hospital and who was instrumental in GRH being involved in the program that started in 2014.

LaRochelle is the safety and security officer for the hospital and oversees the other security staff. She said 18 years ago, the hospital didn’t even lock its doors.

“We were as safe with the building as we could be,” LaRochelle said. “But the (culture) in society shifted. Nurses were running into strangers in the hallways in the middle of the night.”

The majority of nurses are female, and LaRochelle said nurses at GRH reported feeling unsafe when walking to their cars at night.

“They were scared,” she said.

LaRochelle said she looked for some kind of training that was proven to make hospital staff feel more safe, but there wasn’t anything available.

Then she found out about the pilot program the Oregon Association of Hospitals and Health Systems started up. Five hospitals in Oregon — Burns, La Grande, The Dalles, Coos Bay and Portland — focused on workplace violence prevention. The goal was to create a toolkit for hospitals to use that would decrease workplace violence. LaRochelle wanted to participate to protect the staff at GRH, but also help other Oregon hospitals.

“Security was vital,” LaRochelle learned through the program of making staff more safe.

The study determined that having a trained security force on site to protect the staff was essential.

GRH now has a security team working at nights, on the weekend and during holidays when people are more likely to be taking drugs or drinking. There’s also less staff in the hospital during that time.

The bulk of violent incidents in hospitals fall under four categories, according to the study.

“Clinical related” factors are the most common contributor to violence, which includes patients with mental illness, dementia, delirium, developmental impairment or behavior issues due to intoxication and drug and alcohol abuse.

Second, social and economic risk factors that contribute to violence include financial stress and domestic violence that extends into the workplace. The availability of drugs or money at hospitals also makes staff likely robbery targets.

Third are environmental-related risk factors such as noise, crowded waiting areas and public access.

The fourth category includes staff shortages, lack of training and inconsistent procedures for to identifying and responding to undesirable behavior.

The study stated only 30 percent of nurses and 26 percent of physicians report the incidents. Bullying and other forms of verbal abuse are the most frequently underreported.

LaRochelle said the nurses felt being treated this way was just part of the job and wouldn’t report the abuse.

“They would be spit on or attacked, and it was (considered to be) normal,” she said of nurses at GRH. “(Sometimes) we would lose nurses to the industry because (of the treatment). It’s pretty scary to them.”

In addition to having a more effective security force, putting cameras and video monitors in public waiting areas was also massively successful. LaRochelle said if people can see the way they’re acting on the monitor, it often causes them to modify their behavior.

LaRochelle also said another way to curb violent incidents is for the hospital to establish a system to warn staff of patients, or their families, who have been violent in the past. The system goes beyond flagging the patient’s medical file since many of the hospital staff does not have access to it, and has been successful since it was implemented.

LaRochelle said the recommendations that came out of the study have shown “measurable results” and have gained national recognition. Violence in hospitals is happening everywhere, and she said she is getting calls every week concerning her part in the study. Hospitals want to know how to keep their staff safe.

Nurses are caregivers by nature, she said, “(but) it’s a dangerous occupation. (They) go to work to help people — not to get beat up.”

The Observer will be doing a series of stories focusing on violence against nurses and the challenges hospital staff are seeing.