Heather Coleman’s Post

I can write a book on this subject but very briefly and from a perspective of practicing physician and a former C-suite executive for over two decades….I have come to the conclusion that there unfortunately exists a (false) societal expectation which in part has been created by the non healthcare professionals who run healthcare business that healthcare professionals should somehow be able to tolerate a lot more of unacceptable practices/ behaviors in their work environment than individuals in other industries!!

I totally agree, Heather. Part of the reason it has take. So long for healthcare to implement zero tolerance is that these attacks do not generally occur in front of witnesses outside of the healthcare system. In my first nursing job I was a 20-year old ICU nurse in a level one trauma center. I was verbally abused several times a week, and physically abused several times a month. My manager did not support us when we complained about abuse. She had also been abused as a nurse, so it was “normal” to her and her colleagues. She also seemed to support martyrdom in nursing. Enduring abuse was something of which to be proud; it showed you were strong and committed. Now most hospitals post signs warning patients and visitors of zero tolerance, and in NY state it is a felony to assault a nurse. Unfortunately, we haven’t all figured out how to identify the point at which it is intolerable, or how to see it coming and stop it before someone is hurt. If you say we won’t tolerate it everyone has to be trained how to respond and how to no longer tolerate it.

Preach. This is a huge problem, and it concerns me for turnover of the current workforce and safety and longevity of our future nurses training to enter the workforce. According to the ANA (2019 survey) 1 in 4 nurses reports being physically assaulted at work. I certainly have my own stories of being threatened and stalked. It’s worse for nurses in certain types of roles. We adopted High Reliability from the airlines and NASA in our hospitals to improve quality and safety- we can learn from them here too. For patients to have the best outcomes the people who care for them need to be safe, well trained and supported- thriving not surviving in their roles. These problems and solutions are interconnected.

For everyone’s safety, it shouldn’t be tolerated in the skies or the exam room

Heather, it’s striking how quickly and decisively the aviation industry handles such disruptive behavior, prioritizing the safety and well-being of all passengers and crew. This high reliability in aviation, where protocols are strictly followed and immediate action is taken to maintain a safe environment, contrasts sharply with the healthcare industry’s often inadequate response to verbal abuse. I’ve witnessed verbal abuse towards healthcare professionals almost daily, yet the swift, zero-tolerance approach seen in aviation is rarely mirrored in our field. Adopting similar high-reliability principles in healthcare, where abusive behavior is immediately addressed and not tolerated, could significantly improve the work environment and overall safety for healthcare providers.

While building my business to a livable income, I did two seasons as a security manager for a NFL team. It isn't tolerated there either, and the cost of entry far exceeds that of a plane ticket! They even have a written code of behavior. Why? Because a large group of people who have access to alcohol and strong team feelings needs guidelines. It's the human condition. The charge nurse or office manager should always have the ability to remove physically or verbally abusive people. Post a sign: "Good Manners Welcome Here -- None of Us Feel Good, Let's Not Make It Worse By Being Rude 😎" Maybe just the first 4 words of that. I think ER's and pediatric wards should have comfort dogs to keep the adults calm ... even if they're only on big screen TV's.

I can remember a patient cursing me out because they saw me go in the restroom in the back of the clinic before going into their exam room. They said I shouldn’t have made them wait. This was at about 2 o’clock in the afternoon and the first time I had briefly stopped since the day began at 7:45 that morning. Common courtesy and respect are becoming more and more rare. I’m more than willing to give my patients the best care I can, but expectations need to be realistic, and verbally abusive behavior should not be tolerated. The company I was with at the time actually posted signs in our clinics stating such aggressive behaviors towards staff would not be tolerated.

We can't directly compare the 2 experiences, healthcare visits are usually stressful for everyone as against air travel. The patients & relatives in hospital are in a vulnerable state and they react differently sometimes (to bad news). As against air travel, where the passengers are not necessarily in a stressed environment, so the passengers should be dealt in a strict & firm manner, as it can jeopardize security for everyone in a small confined airplane. Saying that verbal abuse towards healthcare is definitely not acceptable & there should be more platforms where this should be discussed openly, with both public & government & bring necessary change in the attitude of every patient / relative.

Healthcare providers deserve respect, kindness, and a safe working environment, just like any other professional. You can argue that patients are different from passengers or hospitals or different from flights. Abuse towards healthcare workers is never acceptable and can have serious consequences, including: 1. Emotional distress and burnout 2. Decreased job satisfaction and morale 3. Increased turnover rates 4. Decreased quality of care 5. Physical harm and injury Healthcare providers have the right to work in a safe and respectful environment, and patients, families, and colleagues should treat them with dignity and respect. To address abuse towards healthcare providers, we need to: 1. Raise awareness and promote zero tolerance policies 2. Implement effective reporting mechanisms 3. Provide support and resources for affected staff 4. Foster a culture of respect and empathy 5. Hold perpetrators accountable for their actions

In the context of Press Ganey scores & Magnet status, it is crucial to recognize the link between patient & staff satisfaction. Just as airlines enforce zero tolerance for abuse to ensure safety, healthcare institutions can adopt similar policies to protect staff & enhance patient experiences. Enforcing zero tolerance against abuse, providing training & support for handling abusive situations, implementing swift action protocols, establishing effective reporting systems, & promoting a culture of respect & safety are among the strategies that can be adopted. Bold implementation of these tactics may help to foster a culture of safety & respect within.