Joey Wahler (Host): April is Workplace Violence Awareness Month. So, we're discussing how that's addressed. Our guests, Linda Sistrunk, she's Director of Behavioral Health, and Andria Rexroad, she is Human Resources Supervisor and Employee Relations Specialist.

This is a podcast today with Memorial Health System. Thanks so much for joining us. I'm Joey Wahler. Hi, Linda, Andria. Welcome.

Linda Sistrunk: Thank you.

Andria Rexroad: Hello.

Host: So first for you, Andria, what would you say is the most important significance of Workplace Violence Awareness Week? And are there any related statistics you can share to help illustrate that?

Andria Rexroad: Well, this week is really an opportunity for us to increase understanding, really to encourage prevention. That's our priority, is to prevent. We want to maintain a safe work environment for everyone and bring attention to maybe some of the unspoken things or some of the ways to handle situations that people aren't really familiar with. We want to make sure that staff and leadership can be proactive rather than reactive.

Some of the statistics that I have found is healthcare workers, unfortunately, are experiencing a significantly higher rate than most other industries of workplace violence incidents. So, according to the US Bureau of Labor Statistics, according to their two-year period study from 2021 to 2022, it showed that there were 41,260 non-fatal incidents that occurred within the workplace. And of those 72.8% would've been healthcare within the healthcare sector. So, those are what's reported.

Unfortunately, we find that there are a lot of things that are unreported. Really according to the Journal of Emergency Nursing, it shows that nurses face daily, physical and verbal issues that they continually don't report because it takes a lot of time, it takes a lot of energy. So, that's really what this is about for our Workplace Violence Week, is to look into those things and see what do we do to protect ourselves and what do we do to protect our community?

Host: And speaking of which, Linda, what exactly does workplace violence look like in healthcare? Is it only patients being violent towards staff? What's going on here actually?

Linda Sistrunk: Yeah. So, workplace violence has become a hot topic over the past several years. In regards to internal and then regulatory standards, workplace violence encompasses not only patients, visitors, staff, it encompasses our entire environment and how people conduct themselves safely within our environment. And so, our workplace violence initiatives often incorporate staff, visitors, and patients.

Host: And so, how does each of your roles tie into this week's recognition of violence here? Let's start with you, Linda.

Linda Sistrunk: So, my role as the Director of Behavioral Health Services, our primary goal is to engage with patients. who come into our system, who are struggling with emotional crisis. Our main goal is to work with them in a trauma-informed way that decreases the potential for them to escalate and possibly have harmful interactions with our staff members.

It is to create a modeling behavior where we model how to interact appropriately with patients in order to decrease the possibility of escalation. It is an opportunity to advocate for the rights of all people in our community to come to our healthcare system and receive excellent clinical care, while at the same time decreasing their escalation related to how uncomfortable, how anxious, how depressed, or how nervous they are about the situation.

So, my role is to employ staff who provides support across the entire healthcare system to work with patients, work with staff in order to integrate conversation and communication in a healthy way.

Host: And Andria, how about your role here?

Andria Rexroad: Human resource's role, our critical role is fostering a staff-centered approach for workplace violence. We want to provide safety and we have resources that we try to utilize, and that would be developing and enforcing the policies to make sure we have those in place.

So, the public responding and coming in knows exactly how they respond, what they can do, what they can bring with them; the staff, the same, you know, what do they do in a crisis? What do they do if there's an emergency situation? Who to call? We have policies that need to show a really A, B, C, D textbook-follow-this. Because sometimes in a crisis, that's what our go-to is. We aren't responding quickly if we haven't had a lot of training on it. And sometimes we don't, we could be a brand new employee. So, it's good to have references to be able to take a look at that.

We also support any of the reporting that is done. Any incident report, any workplace violence that would result in a worker's compensation, HR is going to handle that and help an employee walk through any of that type of process. We also partner with leadership for training and education. We utilize our educational services team. They provide a lot of modules that we do on an annual basis to make sure people keep those skills up, they understand the policies. We also promote a culture where our safety concerns are taken seriously and they're addressed promptly. If there is a harassment, which can be a workplace violence type of incident between employees or things that happen within units, human resources are going to investigate that and take a firm stand on it.

Host: And indeed, when we talk about each of your respective philosophies regarding staff and patient safety in the workplace, Andria, just to follow-up, the importance of having these policies and these go-to practices in place is obviously crucial here, like anything else that a particular job would require within a hospital, because workers need to know in a split second how to handle these things before the fact, right? Because sometimes there's no time to ask or to think, you've just got to react. It could be the difference between things being nipped in the bud and getting out of hand, right?

Andria Rexroad: Yes. And I think that's one of the opportunities that we're taking within this week, is we want individuals to put these in practice. We really want the focus to be going over different topics every single day and taking a look at, "What do I do in this situation?" You know, we've got our ALICE training, we've got our Fight or Flight. We want to challenge everyone to take up to five minutes, 15 minutes, or whatever time they can spare to actually do a drill in absolutely every location we have. Because when you practice something, you get better at it. And it becomes muscle memory and you know how to react. Because in those types of workplace violence situations, you probably aren't going to have time to stop and think about it, and you may not have time to stop and print a copy of the policy out. So, we want to make sure people have that experience and can practice that. So, it's really important that they focus on some of these things this week. And feel free to ask questions. Raise your hand if we don't have something that's covered in policy. It may be something we haven't thought about. So, we want people to make those suggestions.

Host: And then, Linda, how about from a patient standpoint, philosophically speaking, what's the most important thing here?

Linda Sistrunk: Philosophically speaking, we want everybody to have a safe environment. From a patient safety standpoint, in order to understand the needs of a patient, you have to systematically work in a way that tries to understand their clinical need and their emotional need. And so, this is something that we've worked on for numerous years to try to change the understanding of a healthcare environment in a trauma-informed lens, meaning that when people come into our system, patients come into our system and they are struggling clinically or emotionally, that we want them to feel that this is a safe space for them to honor their needs, how we care for them, and how we speak to them.

On the flip side of that, we also are a zero tolerance campus, meaning we have zero tolerance for verbal, physical threats or any type of, I would say, unsafe social interactions with our staff. And so, patient safety also has to contend with us explaining to patients about the deep connection we have to keeping our staff safe also. And so, when we speak to patients, we remind them that you have a right to a safe experience, and we also have a right to the same safe experience. And so, it's a communication expectation. It's how we engage, how we speak, how we care for people. And our patients deserve a dignified experience when they come into our healthcare system.

Andria Rexroad: If I could add, we also want our staff to have that same experience. And one of the things that can be confusing is what happens if this is your coworker that is behaving in a volatile manner or they may be having a mental health crisis that you identify something's happening. But when it's our coworker, we don't think sometimes to call security or to go through those same steps we would if it is a visitor that has come in or a patient that is becoming violent. And what we want all of our employees to know is we want them to be safe. And we want them to follow those same practices as you would with anyone to make sure you're safe. Whether it's a coworker, whether it's a family member that you know that's coming off the street, as well as with patients and guests, we want all of our individuals to have that power to be able to make those decisions and make sure they're safe.

Host: And speaking of which, in terms of the vital role that HR obviously plays in these situations, how about the resources and supports that are available for staff regarding promoting a safe working environment? It sounds to me like one thing you're saying here is it's so important just to let staff know again before the fact that you have their back, right? That it's okay to report these things, even if it involves a fellow employee. How important is just knowing that?

Andria Rexroad: Extremely important to know it. Again, we want to be proactive. We don't want to be reactive. If we can do things and prevent things from happening before they escalate, that's in everybody's best interest. So, HR's role is to do an investigation. We keep things confidential. We also even have a hotline number that individuals could call to keep things completely anonymous.

It's extremely important from an HR perspective that you speak up. Especially if you have individuals that are making statements about violence, if you see that they're escalating within their department for an event, we want to know that information so we can get those involved, that can help deescalate it like Linda's behavioral health team.

Host: A couple of other things for you. How about examples of how staff can respond to patients who have potential for volatility if in fact you're able to see it before it happens and kind of head it off at the pass, so to speak?

Linda Sistrunk: Right. So, I think the important thing is consistency. And when we talk about how we speak to people who have the potential to escalate, I always encourage our staff to be consistent in their verbiage. What we want is for patients to feel comfortable being emotional. So, we want to remind patients they have every right to be emotional when they're experiencing a healthcare crisis.

What we don't necessarily want is for them to escalate and be unsafe. So, the word safe is really a key indicator to our consistent language. If a patient is escalating, just a quick reminder that you are speaking safely to them and you would like for them to speak safely to you. If they are not able to speak safely, if they're escalating in their tone, the verbiage they use, if they're using foul language, they're using any sexually explicit language, then the expectation is to disengage from that patient and remind them that you will return and engage with them when they are able to be safe with you.

And we do that so that we can keep the language clear. And we don't escalate ourselves with verbiage that sounds unprofessional, sounds inconsistent, and sounds like we are not in control of our own emotions when we say it, so, "I'm being safe with you. I need for you to be safe with me." And then, disengaging with that patient until they're able to be safe with you.

Host: And in summary here, what's the most important single thing to kind of put a bow on this, that staff and patients respectively should keep in mind in these situations? How about you, Andria?

Andria Rexroad: We want them always, of course, to work together. We want everyone to be aware of what is going on. we want to keep communication at every level open. We want individuals to be able to report. We want them to feel safe when they're reporting. We want them to understand that we do have other programs that are available for EAP programs. We have Nivati, which is an online program if they need some additional wellness help. We also have counseling and wellness, that would be a local program here that they can utilize along with Employee Connect. Some of those are within our wellness hub that they can find on our My Memorial site. So, those are just some things that they can do. But you know, it's communication, it's recognition. If you see things that are a problem or an issue, we want it reported.

Host: And, Linda, how about from your standpoint, the most important thing to keep in mind here?

Linda Sistrunk: Yeah. There's so many most important things. So, the most important thing that I reiterate in any discussion I have is that, when you come to a healthcare environment, you have a right to safety. And that doesn't depend on who you are, as Andria has stated, patients, visitors, staff. So, you have a right to be safe in your environment.

In our environment, we have 26 people employed through behavioral health who are 24/7 connections to providing, safety consults to providing assistance if you feel unsafe, to remind you of how to use verbiage or policy to help you intervene with staff or visitors or patients. We have Code Berts, Code Violets. We have enough interventions in place to help support people in real-time when they feel like they are not safe in their environment.

And from a staff standpoint, I want to point out that healthcare was never meant to be a workplace where you had to be trained in self-defense. That's something that's new. It's something we're talking about. It's something that society has brought to the attention of healthcare environments. And I want to remind staff, just like Andria did, it is important for people to be transparent when things occur, to be the face of safety, and to use the tools that we've provided in order to keep them safe. They have a right to come to this campus and work and be safe in their work environment.

Host: Folks, we trust you are now more familiar with handling workplace violence. Certainly in the healthcare world, emotions are often running high. People often are not feeling themselves, And so, situations are going to arise. It's so crucial as the two of you have illustrated to know before the fact how to handle it before things get out of hand.

Linda, Andria, keep up all your great work. Thanks so much again.

Linda Sistrunk: Thank you.

Andria Rexroad: Thank you.

Host: And to learn more and connect with a provider, please visit mhsystem.org. Be sure to subscribe for more conversations from Memorial Health System. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of A Podcast A Day with Memorial Health System.