Making Changes in Your Work Environment - Education is the Key

by: Cecily Anderson

What situations prompted you to want to make changes in your work environment?

Our psych unit closed a few years ago and patients with behavioral disorders/suicidal/aggressive tendencies were dispersed throughout the facility.

Our particular 30 bed Acute Medical Unit seemed to get more than our fair share of these type of patients. So much so, we were officially the unofficial "crazy" floor per the hospital employees (from physicians to the transport team).


Cecily Anderson

We helped each other with the aggressive and violent patients as best as we could. You see, we had little or no policies/procedures in place to assist the nursing staff to properly and safely care for them.

Finally, after discussions in the Unit Based Council, several nurses being injured and transferring off the unit and more promising to follow, we got our Manager’s attention. We had had enough!

How did you (or your team) start changes to improve your work environment? How did you or your group advocate for a healthier work environment?

Our Manager listened to us and immediately took the issue up with our Director. It went viral! Within weeks, meetings were set up with our staff and key members of Administration throughout the facility: CNO, Safety, Behavioral Health Team, Human Relations, Security and Risk Management.

What specific changes did you or your group propose to make your work environment healthier? Did you receive resistance and from whom?

Associates on our unit got to receive additional training to deal with violence and aggression. TAT (Threat Assessment Team) formed to provide immediate assistance with situations. Workplace Violence policies/procedures were formulated and put into practice. The "Code Orange" was born. We are the founders.

How did you and your group implement changes? Did you have support or encouragement from the administration? What tools did you use? Did you use information from AMSN? How did you follow-up?

Education across the facility was key. Patients were now designated as a threat or potential threat via electronically and by orange magnets placed on the door frames.

This allowed all disciplines the heads up prior to entering the room. Also, wherever the patient traveled through the hospital, associates would know. We now have Security rounding in the units several times a shift. Must fill sitter requirements are met (formerly was ya' get one if you're lucky).

Nurses from my unit were surveyed before implementation and after. There was a 19% increase in nurses feeling more secure in the environment.

What were the changes and accomplishments achieved that might inspire or empower other nurses to advocate for a healthier workplace? How did they impact quality of patient care?

Nurses are exposed to a variety of detrimental situations.

Violence in the Workplace is a genuine problem. We must have sufficient policies/practices in place to deliver the appropriate care to this specific population and to be able to give attention to the rest of our patients without fear of being injured (as this population is so time consuming).

What advice would you like to pass on to someone who is interested in becoming an advocate for a healthy work environment?

Speak up; let your concerns be known. Our concerns went from a unit level to an organizational level.

Fun Question: What do you love about being a med-surg nurse?

I have been a die-hard surg nurse for more than 40 years. I never tire of this specialty. Day in and day out it is NEVER boring.
(Read more of "What do you love about being a med-surg nurse.")

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