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How to Prevent Workplace Violence
In 2022, the Joint Commission initiated Workplace Violence Prevention Standards to help curb the rise in workplace violence in healthcare. In the latest Nurse Essentials podcast, Erica Shields, MBA, BSN, RN, NE-BC, associate chief nursing officer of Emergency Services and Behavioral Health at Cleveland Clinic, and Tony Roetzel, deputy chief of Cleveland Clinic Police, share strategies for reducing workplace violence.
In 2022, the Joint Commission initiated Workplace Violence Prevention Standards to help curb the rise in workplace violence in healthcare. In the latest Nurse Essentials podcast, Erica Shields, MBA, BSN, RN, NE-BC, associate chief nursing officer of Emergency Services and Behavioral Health at Cleveland Clinic, and Tony Roetzel, deputy chief of Cleveland Clinic Police, share strategies for reducing workplace violence.
Carol Pehotsky (00:05):
Workplace violence is not a topic we like to think about, but we must. I can only deliver my best safest care to patients if I feel safe too. I'm joined today by Erica Shields and Tony Roetzel to learn more about workplace violence and how to prevent it.
(00:23):
Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of Surgical Services Nursing.
(00:44):
Welcome back, everyone. In my almost 25 years in healthcare, so (laughs) much has changed. And when I think back over all that time and the various roles I've had and settings I've had the opportunity to be a nurse in and there were times when I found myself in a situation that today would probably be defined as some form of workplace violence. And those moments that resonate most in my memory, those are also all moments that probably could have been avoided. They were earlier in my career. And in situations where had I been more mindful of the environment, the patient, what was going on, I probably would have been able to prevent these acts from happening. I am very grateful that those were not dangerous or, or injurious in nature, but I, I learned from those.
(01:25):
And with more road under my tires, I can appreciate those patients' behaviors which were striking out in the two episodes that I think most clearly of. They were really the last act in a series of behaviors that showed signs of escalation. For those of you who've been in healthcare that long though, reflecting back, I think we can all appreciate that back then, we, we received support from leaders, and we received de-escalation classes hopefully. And, and I know I did, but there was a lot of common thinking on the floor that at least in behavioral health, violence was unavoidable.
(01:54):
As with many things though, thank goodness, times have changed. Violence anywhere, especially in healthcare, should not be unavoidable. And keeping ourselves and our colleagues safe in the course of our health care and nursing lives is a must be compatible with safe patient care. To that end, I'm delighted to be joined today by two experts to talk about just that. Erica Shields is our associate chief nursing officer of Emergency Services and Behavioral Health for Cleveland Clinic, and Tony Roetzel is our deputy chief of Cleveland Clinic Police. Welcome to you both. Thanks for joining us today.
Erica Shields (02:22):
Thanks, Carol.
Tony Roetzel (02:23):
Thanks for having us. I appreciate it.
Carol Pehotsky (02:24):
All right. So, I sat at the top. I think what happened to me (laughs) might have been workplace violence. So, to center ourselves at hoping you can share with our audience, how would we define workplace violence? What does that look like?
Erica Shields (02:34):
Yeah. So, Carol, there's a definition that we use at Cleveland Clinic. It's from-
Carol Pehotsky (02:34):
Hmm.
Erica Shields (02:37):
... The Joint Commission. So, it's a-
Carol Pehotsky (02:37):
Hmm.
Erica Shields (02:39):
... little, long. I'm gonna go ahead and just read that for you.
Carol Pehotsky (02:41):
(laughs) [inaudible 00:02:42] clarity, yes.
Erica Shields (02:42):
So, I, I think it's important for everyone to understand exactly what it is-
Carol Pehotsky (02:45):
Perfect.
Erica Shields (02:45):
... and who's committing those acts.
Carol Pehotsky (02:47):
Mm-hmm.
Erica Shields (02:47):
So, it's an act or threat occurring in the workplace that can include any of the following, verbal, nonverbal, written, or physical aggression-
Carol Pehotsky (02:56):
Mm-hmm.
Erica Shields (02:56):
... threatening, intimidating, harassing or humiliating words or actions, bullying, sabotage, sexual harassment, physical assault, or other behaviors of concerns that involve our staff, our licensed practitioners, our patients-
Carol Pehotsky (02:57):
Mm-hmm.
Erica Shields (03:11):
... and visitors. And I know specifically at the clinic, we kinda of clump those into three buckets.
Carol Pehotsky (03:16):
Okay.
Erica Shields (03:16):
So, we look at whether it's physical, verbal, or environmental.
Carol Pehotsky (03:20):
Mm-hmm.
Erica Shields (03:20):
And environmental, sometimes, is hard to, you know, explain, or really define.
Carol Pehotsky (03:24):
Okay.
Erica Shields (03:24):
But for us, that is vandalism, stalking, things that-
Carol Pehotsky (03:24):
Oh.
Erica Shields (03:28):
... may not necessarily be physical or verbal in nature. But there's still forms of workplace violence.
Carol Pehotsky (03:33):
Well, and as you were reading the definition, one of the things that struck me is written. It makes sense. But again, I don't know that if I received a letter from a patient, I would really go that far to say that's violence, but it's good to know that our regulatory bodies agree that that is also not acceptable.
Erica Shields (03:50):
I would agree with that, yes.
Carol Pehotsky (03:51):
Yeah. So not just physical then. (laughs)
Erica Shields (03:51):
No.
Carol Pehotsky (03:53):
So, everybody, you've already learned something this early on (laughs) three minutes in, that really knowing what it is can help us prevent it. I also said in my opening salvo that, you know, a lot of us thought it was unavoidable. And thankfully, there's been movements from unavoidable to prevention. What do the two of you attribute that to that really that gestalt in not just EDs and behavioral health, but o- everywhere really getting to a point where we're encouraging caregivers to, to realize it is avoidable?
Tony Roetzel (04:21):
Yeah. I think it starts at the top.
Carol Pehotsky (04:21):
Okay.
Tony Roetzel (04:22):
And, and we have great leadership here at Cleveland Clinic-
Carol Pehotsky (04:22):
Yes. Indeed. (laughs)
Tony Roetzel (04:25):
... that's kind of steered the ship and-
Carol Pehotsky (04:25):
Mm-hmm.
Tony Roetzel (04:27):
... said that this is not acceptable. This is not part of any caregiver's job. So, you, you-
Carol Pehotsky (04:32):
Okay.
Tony Roetzel (04:32):
... wouldn't go to a grocery store and-
Carol Pehotsky (04:32):
(laughs)
Tony Roetzel (04:34):
... assault a clerk or someone there.
Carol Pehotsky (04:34):
Right.
Tony Roetzel (04:36):
So why should you be able to assault or-
Carol Pehotsky (04:38):
Yeah.
Tony Roetzel (04:38):
... verbally or physically our nurses-
Carol Pehotsky (04:38):
Mm-hmm. Mm-hmm.
Tony Roetzel (04:40):
... or, or other clinical staff. So, I think we have a great leadership at the top that's, kind of steering the ship like I said.
Carol Pehotsky (04:45):
Mm-hmm.
Tony Roetzel (04:46):
You know, I think in society, in general, stress is at a higher level.
Carol Pehotsky (04:50):
(laughs)
Tony Roetzel (04:50):
There's more violence out there in society.
Carol Pehotsky (04:52):
Mm-hmm. Mm-hmm.
Tony Roetzel (04:52):
On top of that too, there's been, you know, a lot of closures of institutions that used to, used to help with that stuff.
Carol Pehotsky (04:53):
Yeah.
Tony Roetzel (04:58):
So unfortunately, hospitals have become kind of a band-aid for, for society's problems because there's not a whole lot of other places to turn, and-
Carol Pehotsky (05:06):
Band-Aid and a mirror.
Tony Roetzel (05:07):
A... Right. Exactly.
Carol Pehotsky (05:07):
Yeah.
Tony Roetzel (05:08):
Yeah, but having that leadership at the top and guiding us and saying that- that's okay, we will be a Band-Aid, but we're not gonna accept some of the other things that are happening has been, has been huge for us and we're-
Carol Pehotsky (05:09):
For sure.
Tony Roetzel (05:18):
... we're trying to take advantage of that.
Carol Pehotsky (05:19):
Absolutely. Any other thoughts around that, Erica?
Tony Roetzel (05:21):
You know, I think, you know, what you said is the culture has changed.
Carol Pehotsky (05:25):
Mm-hmm.
Erica Shields (05:25):
It's, it's taken a while to get there, but it has changed. And it does start with our leadership support.
Carol Pehotsky (05:25):
Mm-hmm.
Erica Shields (05:29):
We've heard Kelly Hancock and Dr. Mihaljevic say that it's zero tolerance for-
Carol Pehotsky (05:30):
Mm-hmm.
Erica Shields (05:35):
... workplace violence against our caregivers. And we... It has shifted. We used to see-
Carol Pehotsky (05:35):
Hmm.
Erica Shields (05:39):
... it in behavioral health in the emergency departments. But the problem now-
Carol Pehotsky (05:42):
Not just there anymore. Yeah.
Erica Shields (05:43):
... is it's, it's happening everywhere.
Carol Pehotsky (05:43):
Hmm.
Erica Shields (05:44):
And we need to make sure that our caregivers everywhere are equipped-
Carol Pehotsky (05:44):
Mm-hmm.
Erica Shields (05:47):
... and have the skills to manage these patients, visitors, family members when these events happen.
Carol Pehotsky (05:53):
Absolutely. And so, for those of you who are listening who are not part of the Cleveland Clinic organization, it's a good time to reflect on what is your organization's approach to workplace violence to situations? What are some things that your organization is doing to protect you as you protect yourselves with education? I read a statistic that healthcare workers are four times more likely to suffer a violent injury at work than those in any other industry. What do the two of you think is behind that... the specific factors that might contribute to the problem?
Erica Shields (06:22):
I think Tony touched on it a little bit.
Carol Pehotsky (06:22):
Mm-hmm.
Erica Shields (06:24):
You know, society, we've seen such an increase in violence and stress within our society. And those are things that we continue to see then within our four walls and within the patients-
Carol Pehotsky (06:24):
Sure.
Erica Shields (06:33):
... that we're taking care of. So it is that stress, that anxiety, you know, not knowing if you're gonna have an illness, you know, not knowing what-
Carol Pehotsky (06:33):
Right.
Erica Shields (06:40):
... the outcome's gonna be, that loss of control that sometimes-
Carol Pehotsky (06:43):
[inaudible 00:06:43].
Erica Shields (06:42):
... we experience-
Carol Pehotsky (06:44):
Yeah. Mm-hmm.
Erica Shields (06:44):
... when we're patients in the hospital.
Carol Pehotsky (06:45):
Sure.
Erica Shields (06:46):
You're right, vulnerable.
Carol Pehotsky (06:46):
(laughs)
Erica Shields (06:47):
And that vulnerability causes us to sometimes want to act out or be... take that aggression on our caregivers that are taking care of us. We also know substance abuse some of our patients are under the influence of some substances when they come in, that also increases the likelihood. And, you know, those with mental health disorders and diagnosis are more likely to have these violent outbursts in our care. And then we also know we take care of patients with dementia and delirium-
Carol Pehotsky (07:12):
Right. Yeah.
Erica Shields (07:13):
... that, you know, it is part of their illness, and they're not intending to harm us. But, you know, through their illness, we are ending up getting harmed.
Carol Pehotsky (07:20):
Mm-hmm. Well, and we think about, you know, those are patients where we generally know what's going on with them and we hopefully know the medications they're on. We know their diagnoses. Then you insert the family members who are also probably feeling very stressed and vulnerable, huh?
Tony Roetzel (07:33):
Yeah. I mean, so, so hospitals can be an anxious place.
Carol Pehotsky (07:36):
Yeah.
Tony Roetzel (07:36):
I- it's not always good. That's, that's happening in hospitals for loved ones. And when you put that into the environment of a loved one coming to, to visit with someone who might be going through something health related at the hospital-
Carol Pehotsky (07:47):
Mm-hmm.
Tony Roetzel (07:47):
... that anxiety can create almost like drugs and alcohol.
Carol Pehotsky (07:50):
Mm-hmm.
Tony Roetzel (07:51):
It can, it can create a situation where it's just unsafe.
Carol Pehotsky (07:54):
Mm-hmm.
Tony Roetzel (07:54):
And I think we're seeing that more and more in today's age.
Carol Pehotsky (07:57):
Yeah, unfortunately. So, we've talked a little bit about this. But looking for your thoughts, we're obviously fortunately doing a better job of talking about it in our organization. We have various mechanisms, ways that caregivers can escalate concerns, seek help in the moment, report it out the next day so that we're aware of what's happening. How much of this do you think is true increases in incidences versus we're doing a better job of talking about it and reporting it?
Erica Shields (08:22):
That's a great question and one that we're still trying to answer. (laughs)
Carol Pehotsky (08:22):
(laughs)
Erica Shields (08:25):
We just recently went live with our dashboard. So, all of the-
Carol Pehotsky (08:26):
Okay.
Erica Shields (08:28):
... information that's entered into service, we now are able to collect and analyze through our workplace violence dashboard. In 2023, we had new health systems coming on board-
Carol Pehotsky (08:38):
Sure.
Erica Shields (08:38):
... with SERS, that automatically includes that increase that we're seeing. We'd like to think that it's education and that awareness that's out there that's leading others to, you know, continue to report these events because we know how important reporting is to help us allocate resources and training and education. But unfortunately, we do feel that we're continuing to see some increase just-
Carol Pehotsky (08:59):
True.
Erica Shields (08:59):
... based on the number of events that are happening.
Carol Pehotsky (09:01):
Mm-hmm. And for some of our listeners who aren't part of the Cleveland Clinic, we call SERS our Safety Event Reporting System. And so for any of you listening, really thinking about what is the mechanism and where you are, where you work, where you can similarly say to somebody, "This thing happened," and I need some help with it or it resolved, but I still, still need somebody to know about it when I think back to again all that time ago. There were Safety Event Reporting Systems back then.
(09:25):
But I think the one happened in front of my manager (laughs) when, when a patient struck out. And so other than supporting me, there really wasn't that culture of saying, "We need to keep track of this. We need to record this, so that we can really capture what's going on." It's a great opportunity that we have to collect that data. So as nurses, we go into all sorts of healthcare providers. But specifically, to nurses, right, we go into this field with an attitude of carrying, wanting to give back.
[NEW_PARAGRAPH] And so I think sometimes that probably puts us in situations where, in our head, we're thinking, "Well, well, my, my duty is to serve and to protect this patient and and put their best interest in heart." How do we balance that trusting that... establish that rapport with the patient while setting healthy boundaries?
Erica Shields (10:07):
That's another tough one-
Carol Pehotsky (10:08):
(laughs)
Erica Shields (10:09):
... and one that we're really, you know, working with our caregivers and empowering them that it's okay, you know. We have many new nurses and new-
Carol Pehotsky (10:09):
Mm-hmm.
Erica Shields (10:15):
... caregivers in all of our positions, but really, it is okay to have those safe boundaries to speak up to build that trusting relationship with the patient, but also establish those boundaries that, you know, I am here to care for you.
Carol Pehotsky (10:28):
Mm-hmm.
Erica Shields (10:28):
Let's be respectful towards each other. I have the right to go about my work without being, you know, verbally or physically assaulted. And I want to provide the best care for you. So, if we can work together to reach that mutual, you know, goal that you have as a patient. You know, and - ... again teaching our nurses because it's gonna take-
Carol Pehotsky (10:28):
Yeah.
Erica Shields (10:46):
... a while. It's hard.
Carol Pehotsky (10:46):
Mm-hmm.
Erica Shields (10:46):
You know, they're there-
Carol Pehotsky (10:47):
Right.
Erica Shields (10:48):
... to serve our patients.
Carol Pehotsky (10:49):
Mm-hmm.
Erica Shields (10:49):
They want to be respectful. They want to be professional, but it is okay to have that strong voice and advocate for your safety and your health, and wellbeing too.
Carol Pehotsky (10:58):
Safe caregivers give better care.
Erica Shields (11:00):
Absolutely.
Carol Pehotsky (11:01):
One, when you think about over the course of this podcast, we- we've spent several episodes talking about speaking up. This becomes sort of a different way of speaking up to the patient around safety.
Erica Shields (11:11):
It does, yeah. And, you know, we are... we're very fortunate to have our police department-
Carol Pehotsky (11:11):
Mm-hmm.
Erica Shields (11:15):
... too. And I think that they're a great resource. So, when you find yourself in those situations, you know, be proactive-
Carol Pehotsky (11:21):
Mm-hmm.
Erica Shields (11:21):
Reach out. Make sure that they're around because you know that the conversation could be difficult. And at times, it is.
Carol Pehotsky (11:21):
Yeah. Mm-hmm.
Erica Shields (11:26):
And at times, it's not well received by the patient either-
Carol Pehotsky (11:29):
Mm-hmm.
Erica Shields (11:29):
... but making sure that we're, you know, reaching out ahead of time, letting our police and security know that these conversations are gonna be happening. Using our ombudsmen, they're also-
Carol Pehotsky (11:29):
Mm-hmm.
Erica Shields (11:38):
... great resources in these situations.
Carol Pehotsky (11:41):
Sure. And so, at conversation, it's maybe listened to for a bit, but then we struggle again. When should I ask for help? Where should I go? How can leaders support me in that?
Tony Roetzel (11:53):
I think help should be asked for early and often. We talk about you're here to help people, but you can't help anyone if you've been injured, or something happens to you-
Carol Pehotsky (11:53):
Right.
Tony Roetzel (12:02):
... at the job or even, even the mental stress that comes along with some of our-
Carol Pehotsky (12:02):
For sure, yeah.
Tony Roetzel (12:05):
... some workplace violence.
Carol Pehotsky (12:05):
Mm-hmm.
Tony Roetzel (12:07):
So, you know, Cleveland Clinic has done a great job focusing on, first, the prevention side of things, but also the aftereffects of what may happen. We know that it may happen, but what can we do to help the caregiver get back on track to get back to work? So, we have several programs dedicated to-
Carol Pehotsky (12:07):
Hmm.
Tony Roetzel (12:24):
... to try to make sure that, that they are cared for because it can be mentally draining to go through something like this.
Carol Pehotsky (12:30):
Sure.
Tony Roetzel (12:30):
Our brains aren't wired to deal with being-
Carol Pehotsky (12:30):
(laughs) Constant, yeah.
Tony Roetzel (12:33):
... yelled at, assaulted. So, we have lots of programs that are dedicated to trying to get them back on track because we know-
Carol Pehotsky (12:33):
Hmm.
Tony Roetzel (12:38):
... we would love it or not to happen, but it is going to happen. So, we have to think about that side of it as well.
Carol Pehotsky (12:43):
And when you think about any distraction can lead to a safety event, right? If I'm not paying attention to what I'm doing when I'm pulling medications or et cetera, and this is absolutely a distraction. If I'm thinking about... If I'm pepping myself up to go into that room, I'm so focused on that, that I could make an error. So maybe, it's something as nurses we need to think about is that we can't deliver safe care if we're preoccupied.
Erica Shields (13:03):
Right. Correct.
Carol Pehotsky (13:04):
Yeah.
Erica Shields (13:04):
And the other hard part of, of that is, two, you could be in one room, and you could be verbally assaulted by that patient, their family. And then you have to put on a smiling face-
Carol Pehotsky (13:13):
Sure.
Erica Shields (13:13):
... and walk into the next room-
Carol Pehotsky (13:14):
Go to the next room. Yeah.
Erica Shields (13:14):
... make sure that you're delivering-
Carol Pehotsky (13:16):
Mm-hmm.
Erica Shields (13:16):
... you know, great care for that next patient who deserves it.
Carol Pehotsky (13:18):
Right. So, because a lot of us grew up in an era (laughs) where we're learning this too, any advice for leaders who are listening in, in terms of, you know, they may not be the first person who has that interaction. But, you know, a nurse comes to, if I'm an assistant nurse manager, if I'm a manager, if I'm a director, somebody comes to me and says, "I, I need some help." What are some other things that leaders can be doing or thinking about when they're providing that support to the nurse with the patient and family members?
Erica Shields (13:46):
I think, like you said, just that support. Make sure they're available.
Carol Pehotsky (13:46):
Mm-hmm.
Erica Shields (13:49):
Make sure that the leaders set the culture for their unit-
Carol Pehotsky (13:53):
Mm-hmm.
Erica Shields (13:53):
... or their department that, you know, workplace violence is not tolerated regardless of the form, and that it impacts people differently.
Carol Pehotsky (14:00):
Mm-hmm.
Erica Shields (14:00):
You know, a verbal assault could be just as, you know-
Carol Pehotsky (14:04):
Sure. That's right. Yeah.
Erica Shields (14:04):
... detrimental as a physical assault.
Carol Pehotsky (14:06):
Mm-hmm.
Erica Shields (14:06):
So, you know, really take everything that the caregiver is saying seriously. Support them.
Carol Pehotsky (14:11):
Mm-hmm.
Erica Shields (14:12):
Encourage them to complete the SERS-
Carol Pehotsky (14:12):
Mm-hmm.
Erica Shields (14:13):
... the Safety Event Report. And then, you know, our... caring for caregivers, we have amazing resources-
Carol Pehotsky (14:19):
Mm-hmm.
Erica Shields (14:19):
... that are available, and we're very fortunate at Cleveland Clinic to have those resources. So, encourage them to take advantage of those resources. Show them where the resources are located, encourage them to call, and get the help that they need.
Carol Pehotsky (14:31):
It's in the eye of beholder, right? So, something that I could maybe shake off may not be something that the person who was in receipt of that can. And instead of perpetuating some judgment as the leader, really listening to them, and saying, "You know, I'm, I'm hearing that we need to get you some resources or connect you with some resources to help you process this whether I think it'd be traumatic to me or not." That's a great point you just made.
Erica Shields (14:51):
Yeah. And I think as leaders too, you know, not only focusing on what happens when these events occur, but what can-
Carol Pehotsky (14:51):
Hmm.
Erica Shields (14:56):
... we do before.
Carol Pehotsky (14:57):
Sure.
Erica Shields (14:57):
So again, in that culture we don't want to have these events happen. So how do we prevent it? That is the first step. So, getting-
Carol Pehotsky (15:03):
Right.
Erica Shields (15:04):
... our caregivers to those de-escalation training classes, having, you know, our protective services come to the unit-
Carol Pehotsky (15:10):
Hmm.
Erica Shields (15:10):
... do the run, hide, fight training at the unit level. We have mock code violet drills that happen-
Carol Pehotsky (15:16):
Oh, okay.
Erica Shields (15:16):
... across the enterprise.
Carol Pehotsky (15:17):
Yeah.
Erica Shields (15:18):
They're multi-disciplinary. We know that this not just impacting our nurses, get everybody to those drills-
Carol Pehotsky (15:18):
Mm-hmm.
Erica Shields (15:23):
... and to those trainings. So, if or when they find themselves in that situation, you know, they know how to deescalate. So, I think that's important to really as leaders embracing that prevention strategy-
Carol Pehotsky (15:35):
Mm-hmm. Mm-hmm.
Erica Shields (15:35):
... and, uh, making sure we're doing what we can, you know, surveying your units, your departments-
Carol Pehotsky (15:35):
Sure.
Erica Shields (15:39):
... making sure that things aren't there that could be used as weapons-
Carol Pehotsky (15:42):
Right.
Erica Shields (15:42):
... or, you know, used against our caregivers-
Carol Pehotsky (15:42):
Mm-hmm.
Erica Shields (15:45):
... and really just supporting them in making sure that they're aware of how to prevent workplace violence.
Carol Pehotsky (15:51):
Sure. So, you flip right very seamlessly into my next question, it is talking about prevention, obviously, education, assessment, preparation are all those things that can help. That's a whole separate curriculum, et cetera. But, but it's sort of a high level really from both of your perspectives. I'm, I'm hoping we can talk a little bit more about how we should be educating ourselves, what are some signs that whether I'm a nurse or somebody in protective services, things that you'd pick up on to say, "Argh, I need to intervene here. I need to do something different because we're escalating"?
Tony Roetzel (16:22):
Yeah. So, one thing I've noticed a- about people who may be becoming escalated is they'll, they'll get shaky.
Carol Pehotsky (16:28):
[inaudible 00:16:28]
Tony Roetzel (16:28):
And that's, that's the adrenaline going through their body.
Carol Pehotsky (16:28):
Oh, okay. Yeah.
Tony Roetzel (16:31):
It's starting, it's starting to increase.
Carol Pehotsky (16:31):
Mm-hmm.
Tony Roetzel (16:32):
So, you can tell if you match that with someone starting to curse and, and just clearly getting visibly getting angry.
Carol Pehotsky (16:39):
Mm-hmm.
Tony Roetzel (16:39):
And they're starting to shake, and there's adrenaline running through their body.
Carol Pehotsky (16:42):
Sure.
Tony Roetzel (16:42):
They may be starting to turn to pace-
Carol Pehotsky (16:44):
Yeah.
Tony Roetzel (16:44):
... e- e... are very pretty clear signs-
Carol Pehotsky (16:47):
Mm-hmm.
Tony Roetzel (16:47):
... that a healthcare worker may not notice because you're, you're there to help them.
Carol Pehotsky (16:47):
Sure.
Tony Roetzel (16:50):
But you, you have to recognize those signs early and, and try and get some help there before it can escalate to something dangerous.
Carol Pehotsky (16:58):
Mm-hmm.
Tony Roetzel (16:59):
But those are some very early signs of something that may be going wrong there.
Carol Pehotsky (17:02):
Okay. What... Anything else we should be looking for, Erica?
Erica Shields (17:05):
No. I think pacing, you'll see them-
Carol Pehotsky (17:05):
Yeah.
Erica Shields (17:07):
... to get pretty anxious.
Carol Pehotsky (17:08):
Mm-hmm.
Erica Shields (17:08):
They start to pace. Their voice becomes louder.
Carol Pehotsky (17:11):
Mm-hmm.
Erica Shields (17:11):
I think they become demanding at times-
Carol Pehotsky (17:13):
Mm-hmm.
Erica Shields (17:14):
... because, again, that loss of control. And they're-
Carol Pehotsky (17:14):
Sure.
Erica Shields (17:16):
... maybe trying to take back some control. So those are the things that we tend to see and have, you know, some inkling that an event might happen.
Carol Pehotsky (17:16):
Mm-hmm.
Erica Shields (17:24):
And I think the best thing in those situations is communication.
Carol Pehotsky (17:27):
Okay.
Erica Shields (17:28):
You know, a lot of these events center around wait times.
Carol Pehotsky (17:32):
Yeah. (laughs)
Erica Shields (17:32):
So, you know, that increases-
Carol Pehotsky (17:33):
Mm-hmm.
Erica Shields (17:33):
... people's anxiety-
Carol Pehotsky (17:34):
Mm-hmm.
Erica Shields (17:34):
... and their stress level. So how can we do a better job communicating what the delays are or what the wait times are and increasing our communication to help deescalate those situations.
Carol Pehotsky (17:45):
So, appreciating that there are whole techniques in de-escalation, (laughs) but maybe right before we get to the pacing or we're pacing, what are some, some tools that a nurse should have pretty readily at their tool belt to try to deescalate in that moment before they need to remove themselves?
Erica Shields (18:00):
We all have training-
Carol Pehotsky (18:00):
Mm-hmm.
Erica Shields (18:02):
... you know, S.T.A.R.T. with Heart.
Carol Pehotsky (18:02):
Mm-hmm. Mm-hmm. Hmm.
Erica Shields (18:02):
So really, you know, using those tools that we have, maintaining a safe distance.
Carol Pehotsky (18:07):
Mm-hmm.
Erica Shields (18:08):
I think you always want to make sure that you have a way out in case-
Carol Pehotsky (18:11):
Mm-hmm.
Erica Shields (18:11):
... it does become physical.
Carol Pehotsky (18:12):
Sure.
Erica Shields (18:13):
Remaining calm-
Carol Pehotsky (18:14):
Mm-hmm.
Erica Shields (18:15):
... you know, having a body language and, you know, your words that aren't threatening-
Carol Pehotsky (18:19):
Mm-hmm.
Erica Shields (18:19):
... that the patient isn't or visitor caregiver seeing as-
Carol Pehotsky (18:22):
Mm-hmm.
Erica Shields (18:22):
... threatening. You know, again being empathetic. I can't enforce more the communication, just good clear communication and setting expectations with that communication, again setting the boundaries.
Carol Pehotsky (18:33):
Mm-hmm.
Erica Shields (18:34):
It's okay to set, you know, professional boundaries. And then just offering realistic solutions.
Carol Pehotsky (18:39):
Hmm. Okay. Tell me more about that one.
Tony Roetzel (18:41):
Yeah. So, I think on top of that too, the communication with the patient of course is, is important-
Carol Pehotsky (18:42):
Mm-hmm.
Tony Roetzel (18:46):
... but communication internally with your team. So, if, if you were aware of this-
Carol Pehotsky (18:50):
Sure.
Tony Roetzel (18:50):
... patient-
Carol Pehotsky (18:50):
Mm-hmm.
Tony Roetzel (18:51):
... in an earlier shift or an earlier stay that you know that they lash out or that there might be drugs and alcohol impairment-
Carol Pehotsky (18:58):
Maybe they received some bad news. Yeah.
Tony Roetzel (18:59):
Yeah. Th- those are things that you should pass on to your co-workers taking over-
Carol Pehotsky (19:00):
Sure.
Tony Roetzel (19:03):
... for the next shift-
Carol Pehotsky (19:04):
Hmm.
Tony Roetzel (19:04):
... because it can make a huge difference-
Carol Pehotsky (19:06):
Sure.
Tony Roetzel (19:06):
... in, in how they communicate with that person as well.
Carol Pehotsky (19:08):
Well, and I think too about even in the shift, you know, sometimes, we just muscle through a shift and, you know, I can do this because we've already talked about that in other episodes. Sometimes, we aren't great about asking for help, but another good opportunity to tell your team, so that they don't... Somebody coming in trying to answer a call light for you doesn't end up walking into a situation. We're, we're there unsafe-
Tony Roetzel (19:08):
Exactly.
Carol Pehotsky (19:30):
... or exacerbating situation.
Tony Roetzel (19:30):
Yup. Right.
Carol Pehotsky (19:31):
Yeah. Sometimes, we know we get into situations. Maybe I, as the nurse, I've gotten to the point where, you know, I've run out of tools in my tool belt, or I'm really uncomfortable and I don't know how to exit it. What other resources should I be tapping into to get some other folks in place to help sport or things that my leader and I should be doing about my assignment? What does that look like?
Erica Shields (19:53):
Yeah. I think, you know, you said ask for help. It's always important to ask for help. So, you may have that patient that, for whatever reason, you're, you know, did not get off on the right foot-
Carol Pehotsky (20:03):
Mm-hmm.
Erica Shields (20:03):
... and you can't reestablish that trust. You know, talking to your charge nurse, talking to your leader, seeing if there's a way to readjust the assignment, again calling police and security to be-
Carol Pehotsky (20:03):
Sure.
Erica Shields (20:14):
... there is a little bit earlier-
Carol Pehotsky (20:15):
Mm-hmm.
Erica Shields (20:15):
... instead of waiting for an event to happen, reaching back out to the ombudsman.
Carol Pehotsky (20:16):
Hmm.
Erica Shields (20:20):
You know, we have again great support with our team in the office of the ombudsman. So, what could they do? There are safety contracts that we can establish with-
Carol Pehotsky (20:20):
Hmm. Okay.
Erica Shields (20:28):
... um, the patients. So again, I think realizing who your resources are on your floor, great teamwork. You know who those nurses are, your caregivers, your colleagues that-
Carol Pehotsky (20:28):
Mm-hmm.
Erica Shields (20:38):
... really do well in those situations and may have had more experience dealing with patients who are having challenges. So, they may be a good resource for you.
Carol Pehotsky (20:46):
Well, and just... Uh, when we talk in safety huddles throughout the day about these situations, sometimes, it can be as simple as changing from a female caregiver to a male or vice versa. It just... Sometimes, that's all it takes to reset some boundaries. I know sometimes we also talk about bringing a figure of authority like a police officer or a physician especially if we're not to the full escalation. What's your opinion on that? Does that work? Does it depend on the situation? Does it (laughs) sometimes make it worse?
Tony Roetzel (21:11):
Yeah. I think it does depend on the situation.
Carol Pehotsky (21:12):
Okay.
Tony Roetzel (21:13):
And Erica and I talk about, uh, this collaborative effort between security or police and-
Carol Pehotsky (21:13):
Mm-hmm. Mm-hmm.
Tony Roetzel (21:19):
... and, and nursing. I think there used to be a thought that we were kind of siloed in our own teams.
Carol Pehotsky (21:24):
Hmm.
Tony Roetzel (21:24):
But now, the focus is that this needs to be a team approach to try and-
Carol Pehotsky (21:24):
Sure.
Tony Roetzel (21:28):
... deescalate a situation and combat workplace violence. Yeah. So, a police officer or a security officer may come in there and be in uniform and be in authority. That patient may look at that person and say, "I need to listen to what they're saying because they are the, the authority."
Carol Pehotsky (21:42):
Mm-hmm.
Tony Roetzel (21:43):
But on the same side, a law enforcement officer may be bringing-
Carol Pehotsky (21:45):
(laughs)
Tony Roetzel (21:45):
... in someone into one of our EDs.
Carol Pehotsky (21:47):
Mm-hmm.
Tony Roetzel (21:47):
And it helps to have nursing take over that situation-
Carol Pehotsky (21:50):
Sure, yeah. (laughs)
Tony Roetzel (21:51):
... because, you know, maybe they had a negative-
Carol Pehotsky (21:52):
Mm-hmm.
Tony Roetzel (21:53):
... uh, outcome with them-
Carol Pehotsky (21:53):
Mm-hmm.
Tony Roetzel (21:53):
... outside of the hospital system. So really, it's, it's a collaborative effort. And, and there needs to be a team-
Carol Pehotsky (21:54):
Mm-hmm.
Tony Roetzel (21:59):
... effort to try and combat workplace violence.
Carol Pehotsky (22:02):
One, we have interprofessional teams taking care of patients all the time. So, it's just inserting-
Tony Roetzel (22:02):
Right.
Carol Pehotsky (22:02):
... some different people in that interprofessional team.
Tony Roetzel (22:08):
Right.
Carol Pehotsky (22:08):
Excellent. So, we are very fortunate in our organization to have such a lovely partnership between our co- colleagues in protective services. You all have been in these roles for a little bit of time. What's been the evolution of that? You mentioned being in silos before. What's sort of been the evolution of coming together as a team?
Tony Roetzel (22:25):
Well, I... So, I know when I, when I took, took this job, my wife is, is a nurse. (laughs)
Carol Pehotsky (22:30):
(laughs) Very good.
Tony Roetzel (22:31):
And it definitely helped me understand the nursing side of things.
Carol Pehotsky (22:34):
Hmm.
Tony Roetzel (22:34):
Our jobs are very similar. And then, the stresses and things that we go through are things that really can help bond the group together.
Carol Pehotsky (22:34):
Sure. Mm-hmm.
Tony Roetzel (22:42):
So, we've really ingrained in our officers that one of our biggest populations of caregivers here is nurses.
Carol Pehotsky (22:47):
Mm-hmm.
Tony Roetzel (22:48):
They're dealing with very similar things to us in, in dangerous situations especially in our EDs and behavior health units that we, we need to work together.
Carol Pehotsky (22:55):
[inaudible 00:22:55]
Tony Roetzel (22:55):
So, I, I think again from, from the top, and that's what we to do, is, is-
Carol Pehotsky (22:55):
Mm-hmm.
Tony Roetzel (22:59):
... ingrain that into our officers' heads and, and, uh, same thing with nursing-
Carol Pehotsky (23:02):
Mm-hmm.
Tony Roetzel (23:02):
... that-
Carol Pehotsky (23:02):
Oh, yeah.
Tony Roetzel (23:03):
... you know, we, we are a team-
Carol Pehotsky (23:04):
Yeah.
Tony Roetzel (23:05):
to try and try and fix this. It's not us versus them. Uh, we are one team, and that's the way we need to tackle things.
Erica Shields (23:10):
Yeah. I couldn't agree with that more. Teamwork, a- again, it... One team isn't gonna be successful without the other.
Carol Pehotsky (23:10):
Right.
Erica Shields (23:16):
So really, you know, leaning in on each other and making sure that we're supporting them.
Carol Pehotsky (23:16):
Mm-hmm.
Erica Shields (23:21):
We know that they're supporting us and working through these situations because they're difficult situations. You know, again, being the eyes and ears-
Carol Pehotsky (23:28):
Sure. Yeah.
Erica Shields (23:29):
... they can't be everywhere.
Carol Pehotsky (23:29):
Right.
Erica Shields (23:30):
So again, it's so important for all of us to speak up. If we see something that's just not sitting right with us, even-
Carol Pehotsky (23:30):
Hmm.
Erica Shields (23:35):
... if it's walking to your car and you see an-
Carol Pehotsky (23:37):
Right.
Erica Shields (23:38):
... interaction or something going on that, you know, looks suspicious, you know, just make that-
Carol Pehotsky (23:44):
[inaudible 00:23:44].
Erica Shields (23:43):
... make that call-
Carol Pehotsky (23:44):
Yeah. Mm-hmm.
Erica Shields (23:44):
... Because... Yeah. Exactly. You don't want to hear the next day-
Carol Pehotsky (23:46):
Right.
Erica Shields (23:46):
... that something happened to a caregiver-
Carol Pehotsky (23:49):
Mm-hmm.
Erica Shields (23:49):
... or, you know, a, a visitor or patient when you saw something that may have looked dangerous.
Carol Pehotsky (23:53):
Right.
Erica Shields (23:53):
So, I think, you know, it really is it takes a village, um-
Carol Pehotsky (23:53):
Mm-hmm.
Erica Shields (23:57):
for many things.
Carol Pehotsky (23:57):
(laughs)
Erica Shields (23:58):
But I think in this situation, you know, we, we really need to rely on each other, and that teamwork.
Carol Pehotsky (24:02):
Mm-hmm. You know, so we're, we're a very fortunate organization. We've had an organizational wide workplace violence committee for quite some time. And, and now, it is an expectation of joint commission that hospitals and healthcare organizations are, are focusing on workplace violence. Can you, can you each share with us a... some of the initiatives that have come out of our organization's workplace violence committee?
Tony Roetzel (24:21):
Yes. So, I, I think we were a little bit ahead of the game actually with some of the standards that came out.
Carol Pehotsky (24:21):
Yeah.
Tony Roetzel (24:26):
We were already doing some of-
Carol Pehotsky (24:26):
Mm-hmm.
Tony Roetzel (24:26):
... the... those things. Uh, I think, to me, the perception of safety is, is a huge part of-
Carol Pehotsky (24:27):
Sure. Yeah.
Tony Roetzel (24:32):
... of actual safety. So, for one, if a nurse sees a police officer working in our EDs-
Carol Pehotsky (24:37):
Mm-hmm.
Tony Roetzel (24:38):
... they will most likely feel more safe (laughs) at being at work.
Carol Pehotsky (24:38):
Sure. Yeah.
Tony Roetzel (24:41):
So being able to show them that, that we are there and doing things like testing panic alarms with, with-
Carol Pehotsky (24:41):
Oh, okay. Yeah.
Tony Roetzel (24:47):
... with, with our nursing teams to show them-
Carol Pehotsky (24:47):
Mm-hmm.
Tony Roetzel (24:48):
... how they work, show them what the response may be like has been huge in, in creating that, that increased perception of safety.
Carol Pehotsky (24:48):
Mm-hmm.
Tony Roetzel (24:55):
But also, you know, we, we have magnetometers at all of our ED entrances along with our police officer presence there. You would think that anyone who, who may be thinking of doing something bad, if they see a police officer or a police car or a magnetometer might think differently. And again, it goes back to the, the perception-
Carol Pehotsky (24:55):
Yeah.
Tony Roetzel (25:09):
... of safety and training to-
Carol Pehotsky (25:09):
Sure. Yeah.
Tony Roetzel (25:10):
... increase that, that this probably isn't a good place to, to do something bad-
Carol Pehotsky (25:14):
Mm-hmm.
Tony Roetzel (25:14):
... even though it still happens. But again, increasing that perception of safety has been a big part of our plan-
Carol Pehotsky (25:19):
Mm-hmm.
Tony Roetzel (25:19):
... to keep our actual safe-
Carol Pehotsky (25:21):
Yes. (laughs)
Tony Roetzel (25:21):
... our [inaudible 00:25:22] safe. (laughs)
Carol Pehotsky (25:22):
And not just perception. That's right.
Tony Roetzel (25:22):
Yeah.
Erica Shields (25:23):
Yeah. I couldn't agree more. You know when The Joint Commission initiated those standards in January-
Carol Pehotsky (25:28):
Mm-hmm.
Erica Shields (25:28):
... of 2022, I think we were well ahead of the game.
Carol Pehotsky (25:31):
Mm-hmm.
Erica Shields (25:31):
The four standards we were meeting. The only one that we had to kinda close the gap a little bit on was the data and the analysis-
Carol Pehotsky (25:31):
Oh, okay.
Erica Shields (25:38):
... of that data which we-
Carol Pehotsky (25:38):
Right.
Erica Shields (25:39):
... we, we have done since then-
Carol Pehotsky (25:39):
Yeah.
Erica Shields (25:40):
... with the dashboard. So, you know, really the workplace site analysis that we do, it's a very comprehensive site analysis that's done-
Carol Pehotsky (25:47):
Mm-hmm.
Erica Shields (25:47):
... by multi-disciplinary teams at each of the locations and really identifying, you know, areas for opportunity, and then reviewing that with that local leadership team or, you know, are any areas that, you know, we're really doing well on and, and calling that out and sharing those best practices with other sites.
Carol Pehotsky (26:03):
Hmm.
Erica Shields (26:04):
Again, the reporting system, you know, we've been live with the, the workplace violence specific SERS reporting since 2020.
Carol Pehotsky (26:11):
Oh, wow. Great. Yeah.
Erica Shields (26:11):
So really going back and looking at the data that we have from that. And then the education, you know-
Carol Pehotsky (26:12):
Mm-hmm. Mm-hmm.
Erica Shields (26:12):
... that is key.
Carol Pehotsky (26:12):
That's come a long way. (laughs)
Erica Shields (26:18):
Yeah. We know that that's key too. And then, you know, the data is helping us, um-
Carol Pehotsky (26:19):
Mm-hmm.
Erica Shields (26:22):
... allocate our resources-
Carol Pehotsky (26:23):
Sure.
Erica Shields (26:24):
... focus on specific populations of caregivers that are being impacted, specific areas that are impacted more than others.
Carol Pehotsky (26:30):
Mm-hmm.
Erica Shields (26:30):
So, you know, as far as The Joint Commission standards, I think we're doing a great job in meeting those and being compliant.
Carol Pehotsky (26:36):
So, gosh, I could talk to you all for hours about this. But we do start wrapping it up. W... Hopefully, we have people who are listening from all over, and they may not be in an organization that has a formal committee, or maybe the organization has a committee and they're just not aware of it. So, somebody's listening now thinking, "Well, how can I help? What should my organization be doing? What questions should I ask when I'm interviewing, for example?" So, what can other nurses do to educate themselves or to reach out for resources if they want to take on some of this work in their own organizations?
Erica Shields (27:07):
Yeah. So, Carol, I think-
Carol Pehotsky (27:07):
Mm-hmm.
Erica Shields (27:08):
... just again reviewing those Joint Commission standards, you know, if their hospital is Joint Commission accredited, they would be important to be in-
Carol Pehotsky (27:14):
Hmm.
Erica Shields (27:14):
... compliance with them. But e- even if they're not, we also have OSHA which-
Carol Pehotsky (27:14):
Mm-hmm.
Erica Shields (27:17):
... really helps protect-
Carol Pehotsky (27:18):
Sure.
Erica Shields (27:18):
... our safety. Yes-
Carol Pehotsky (27:19):
Mm-hmm.
Erica Shields (27:20):
- the safety of our caregivers in any workplace environment. So, I think those are good, good places to start-
Carol Pehotsky (27:20):
Mm-hmm.
Erica Shields (27:25):
... the literature, reading our journals.
Carol Pehotsky (27:26):
Sure.
Erica Shields (27:28):
All of the journals right now are talking about the increase in violence-
Carol Pehotsky (27:28):
Okay.
Erica Shields (27:31):
... uh, within the healthcare systems.
Carol Pehotsky (27:32):
Mm-hmm.
Erica Shields (27:32):
So, I think... And, and talking about it not being afraid to talk about it, I know in the past, we would call it workplace safety, but really calling it what it is now-
Carol Pehotsky (27:33):
Yeah. Changes.
Erica Shields (27:41):
... you know, workplace violence.
Carol Pehotsky (27:42):
Yeah.
Erica Shields (27:42):
... and, and engaging their leaders-
Carol Pehotsky (27:44):
Okay.
Erica Shields (27:45):
... to support the safety of all caregivers.
Carol Pehotsky (27:48):
Wonderful. So, we certainly can appreciate workplace violence mitigation strategies are important. They're important for our regulatory (laughs) bodies as well. But what are the effects that can happen to healthcare workers if they've been on the receiving end of any of those items that you defined?
Erica Shields (28:04):
So, I think they also have that increased stress.
Carol Pehotsky (28:07):
Mm-hmm.
Erica Shields (28:08):
Um, you know, we know our patients are stressed.
Carol Pehotsky (28:08):
Sure.
Erica Shields (28:10):
But when they're lashing out at our caregivers, it also causes-
Carol Pehotsky (28:10):
Yeah. Hmm.
Erica Shields (28:13):
... them to have increased stress. It does impact retention and recruitment efforts.
Carol Pehotsky (28:17):
Oh, sure. Yeah.
Erica Shields (28:18):
Um, some people are thinking, "Is this really what I signed up for?
Carol Pehotsky (28:20):
Hmm. Mm-hmm.
Erica Shields (28:20):
Do I want to continue to come in, you know, to work when, when these things are happening?" It leads to missed days from work.
Carol Pehotsky (28:20):
Oh, sure.
Erica Shields (28:28):
You know if you had a really bad day-
Carol Pehotsky (28:29):
Yeah.
Erica Shields (28:29):
... do you really feel like coming back in and doing it the next day?
Carol Pehotsky (28:29):
Right. Yeah.
Erica Shields (28:31):
So again, really important that we support our caregivers-
Carol Pehotsky (28:32):
Mm-hmm.
Erica Shields (28:35):
... so that they're not feeling this way after these events that we have support and resources for them.
Carol Pehotsky (28:39):
Mm-hmm.
Tony Roetzel (28:40):
Yeah. I, I, I would add that, you know, these, these traumatic events are similar really to, to how our soldiers in combat deal... hear things.
Carol Pehotsky (28:47):
Sure. Yeah.
Tony Roetzel (28:48):
Uh, it can... And it can affect you the same way. Our, our brains-
Carol Pehotsky (28:48):
Hmm.
Tony Roetzel (28:48):
... are not wired.
Carol Pehotsky (28:48):
Mm-hmm.
Tony Roetzel (28:50):
I think I said it earlier, our brains are not wired to deal with these types of traumatic events, and that's where-
Carol Pehotsky (28:56):
Right.
Tony Roetzel (28:56):
... fight or flight comes from.
Carol Pehotsky (28:57):
Yeah.
Tony Roetzel (28:57):
So really as a leader or a manager, you need to know that it's going to affect everyone differently. And something that you may think is minor may affect someone-
Carol Pehotsky (29:06):
[inaudible 00:29:06] them. Yeah.
Tony Roetzel (29:07):
... very traumatically. And I mean-
Carol Pehotsky (29:07):
Mm-hmm.
Tony Roetzel (29:08):
... these, these types of things can take someone out of their normal routines for months-
Carol Pehotsky (29:14):
Mm-hmm.
Tony Roetzel (29:14):
... if not years.
Carol Pehotsky (29:14):
Sure.
Tony Roetzel (29:15):
So, they're very serious. And you, you definitely need to focus on the proper healing approach-
Carol Pehotsky (29:19):
Mm-hmm.
Tony Roetzel (29:20):
... for them.
Carol Pehotsky (29:20):
What are some specific training platforms or things that we can do to educate ourselves about de-escalation?
Erica Shields (29:26):
Well, all caregivers are assigned our workplace violence module-
Carol Pehotsky (29:30):
Okay.
Erica Shields (29:30):
... as an annual competency. We also have de-escalation training-
Carol Pehotsky (29:34):
Okay.
Erica Shields (29:34):
... for caregivers depending on what area you're working. And I think we mentioned before the code violet drills-
Carol Pehotsky (29:39):
Mm-hmm.
Erica Shields (29:39):
... really important to-
Carol Pehotsky (29:40):
Yeah.
Erica Shields (29:40):
... simulate that real life situation during code-
Carol Pehotsky (29:41):
Sure.
Erica Shields (29:44):
... violet.
Carol Pehotsky (29:44):
So, they know how they could react-
Erica Shields (29:46):
And what your role is.
Carol Pehotsky (29:47):
... f- for the first time. Yeah.
Erica Shields (29:48):
Yeah. And what your role as a caregiver is in that situation. You know, the place department does the run, hide, fight training.
Carol Pehotsky (29:54):
Oh, okay.
Erica Shields (29:54):
Very important. Again, doing those on your units is really helpful, so you can identify, you know, where your exits are, you know, what equipment-
Carol Pehotsky (30:01):
Sure. In your own environment.
Erica Shields (30:03):
... you could use it in your own work.
Carol Pehotsky (30:03):
Yeah.
Erica Shields (30:03):
It makes it more-
Carol Pehotsky (30:03):
Mm-hmm.
Erica Shields (30:04):
... real than sitting in a classroom. And then, you know, they do lockdown drills. I don't know, Tony, if you want to expand on that a little bit.
Tony Roetzel (30:11):
Yeah. I mean, so I think the, the point is that they're, they're realistic.
Carol Pehotsky (30:11):
Mm-hmm.
Tony Roetzel (30:16):
You, you have to do a... You have to have a realistic drill because-
Carol Pehotsky (30:17):
Sure.
Tony Roetzel (30:17):
... you're not going to be able to act unless you practice it how you would actually-
Carol Pehotsky (30:21):
Yeah.
Tony Roetzel (30:21):
... do it in real life.
Carol Pehotsky (30:22):
Mm-hmm.
Tony Roetzel (30:22):
So, we do lock down drills of our EDs. But it's important that everyone knows how to function those incidents-
Carol Pehotsky (30:28):
Right.
Tony Roetzel (30:29):
... what's going to happen with the doors locking, which doors are going to lock. How do I get in and out?
Carol Pehotsky (30:32):
Oh, sure. Yeah.
Tony Roetzel (30:33):
So... And, and it goes back to that... the, the team mentality o- of doing-
Carol Pehotsky (30:36):
Mm-hmm.
[NEW_PARAGRAPH] ... this, it's not just security locking down the, the building. It's we'll have a conversation with-
Tony Roetzel (30:36):
Mm-hmm.
Carol Pehotsky (30:41):
... all the clinical teams and whoever else might be in the room about what may happen just to keep it realistic, so that everyone understands their roles and responsibilities in those situations.
Tony Roetzel (30:50):
Just like running a code blue drill.
Carol Pehotsky (30:52):
Yeah. Exactly.
Tony Roetzel (30:53):
Excellent. Well, this half an hour has gone by crazy (laughs) fast. So, I want to flip a little bit. You have both been amazing subject matter experts, but we like to do a little speed round at the end, so that our listeners can get to know you a little bit as the amazing human beings you are. So, I'll ask you both the same question. We have stressful jobs (laughs) in, in this world. What do each of you do for yourselves to recharge?
Carol Pehotsky (31:16):
Yes. S- so I have a, a four-year-old-
(31:18):
Oh. (laughs)
Tony Roetzel (31:19):
... and an almost two-year-old at home.
Carol Pehotsky (31:20):
Oh.
Tony Roetzel (31:21):
And as stressful as that may sound-
Carol Pehotsky (31:23):
(laughs)
Tony Roetzel (31:23):
... and it is also stressful, sometimes, I just enjoy being with them-
Carol Pehotsky (31:23):
Sure.
Tony Roetzel (31:26):
... and a little pond in our backyard.
Carol Pehotsky (31:28):
Oh.
Tony Roetzel (31:28):
And we, we go back there and fish and-
Carol Pehotsky (31:30):
Yehey.
Tony Roetzel (31:30):
... hike around our... around our house. But being with, with my family and focusing on them and seeing my boys grow up is, uh-
Carol Pehotsky (31:30):
Yeah.
Tony Roetzel (31:38):
... just, just brings me a lot of, of happiness and helps separate me a little bit from-
Carol Pehotsky (31:42):
Yeah.
Tony Roetzel (31:42):
... s- some of the, the other stress that's at work. (laughs)
Carol Pehotsky (31:46):
Yep. Yep. (laughs) How about you, Erica?
Erica Shields (31:46):
Yeah. I would agree with that, just being with family and friends-
Carol Pehotsky (31:49):
Mm-hmm.
Erica Shields (31:49):
... and really making sure take time for yourself. I also enjoy doing a lot of outdoor activities and hiking.
Carol Pehotsky (31:54):
Mm-hmm.
Erica Shields (31:55):
So, I think it's important you need to kind of recharge-
Tony Roetzel (31:58):
Yes.
Erica Shields (31:58):
... um and take that time for yourself whatever it happens to be, and do things that bring you joy, so that when you come back, you can bring that same joy to your patients and your caregivers.
Carol Pehotsky (32:07):
Beautifully said. Thank you so much for joining me today.
Tony Roetzel (32:10):
Thanks for having us.
Erica Shields (32:11):
Thanks, Carol.
Carol Pehotsky (32:15):
As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves, and take care of each other.
(32:49):
The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local State Boards of Nursing for any specific practice questions.