Becker's Hospital Review

23 CLINICAL LEADERSHIP A nurse-led violence prevention program that cut incidents to zero By Mariah Taylor W akeMed Raleigh (N.C.) has gone 20 consecutive months without a single workplace violence incident on its medical-surgical unit. It is all thanks to a program created by three nurse leaders. The program started with a partnership between med- surg and psychiatric nurses. "It was pretty novel to partner between med-surg and psychiatric nursing," Sarah Crowley, MSN, RN, nursing director for behavioral health services at WakeMed, told Becker's. "I think we tend to stay in our silos in big systems, and we don't always partner together." Ms. Crowley teamed up with Jaime Penninger, BSN, RN, nurse manager for 5C medical-surgical and intermediate care at the system, to learn about the staff's comfort level with caring for behavioral health patients and de- escalating. "At that time, we also had contract nurses mixed in with our core staff, and it was very evident that we had practice gaps," Ms. Penninger said. For patients Once they understood the needs of the unit, Ms. Crowley and Ms. Penninger began creating a program bundle. First, they implemented a tool to identify patients at high risk for outbursts. This allowed staff to react and respond appropriately. Second, psychiatric nurses began rounding with med-surg nurses so they became a regular part of the team. Third, they worked with Melissa McAllister, MSN, RN, nurse manager of the mental health patient population for both pediatric and adults at the system, to bring mental health response nurses into the pilot. These are expert nurses with extensive mental health experience across settings. Their job is to respond to any code called on the campus that involves a behavioral patient. There are two types of calls, similar to medical calls like rapid response and code blue. Therapeutic intervention calls are for when something does not seem right, and behavioral emergency response calls are for when an emergent event is happening. The mental health response nurse responds to all calls and acts as the expert at the bedside. These tools were impactful for addressing patient needs, but the program had a greater impact on nurses. For nurses When the team created the program in February 2024, it focused on using customer service principles. "Part of it is recognizing that we have internal customers," Ms. Crowley said. "As the mental health and well-being service line, our internal customers are our colleagues in other areas. We're here to support them with our services." When the program launched, the mental health team hosted meet-and-greet breakfasts at which it explained how nurses can help the unit, the most common scenarios they see and how to reach out for support. Support took on a number of forms, including having psychiatric nurses consult on administering behavioral medications. "Psychiatric nurses are comfortable managing agitation with medication, but for many med-surg nurses, that isn't their forte," Ms. Crowley said. "We worked on making sure patients had proactive agitation management orders available, so nurses didn't have to call in the heat of the moment. The orders were ready to use if needed." Psychiatric nurses also take on a customer service attitude when they respond to calls. "They walk in and say, 'I'm here to help,'" Ms. McAllister said. "They're there for the staff and for the patient. That immediate sense of support matters." Having mental health and med-surg nurses round together has also helped staff build relationships they can rely on in the midst of stressful patient interactions. The staff also received training on both trauma-informed care and workplace violence reduction. Both of these helped staff better connect to patients and know how to respond when behaviors escalate to violence. The results The program resulted in positive outcomes for patients and staff. It has boosted nurses' confidence in de-escalation by 30%, and their comfort with agitation management orders by 70%. It cut violent restraint use and helped nurses be more proactive in medication use. All of this combined into no workplace violence events on the unit for 20 months. "We thought we were going to improve the numbers — and we did," Ms. Crowley said. "But what really happened is our colleagues felt supported, and we built relationships that have lasted." This year, the program is being rolled out to two more units at the system's Cary and North hospitals, as well as being implemented at its Briar Creek ED. n

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