Unfair Park from p3 Today, Risoldi is a psychiatric nurse based in Florida and the founder and president of Nurses Against Violence Unite, which advocates for a safer workplace for nurses. She travels the country teaching seminars to fellow nurses on spotting the warning signs in a potentially violent pa- tient, how to deescalate and how nurses can best defend themselves. She structures her seminars as therapeutic experiences for nurses to work through the trauma of the vi- olence they’ve already faced and without re- ceiving the help they needed. “Everybody has a breaking point,” she says. “What more do you want?” Between the start of the pandemic and October 2021, nearly one in five healthcare workers quit, according to a study by the survey research company Morning Consult. In March, the staffing firm Incredible Health said that more than a third of nurses surveyed planned to call it quits by the end of this year. Almost half of those planning to leave cited burnout and high-stress work environments as the primary reasons, with benefits and compensation listed second. While in Texas sign-on bonuses as high as $10,700 were offered as incentives to hire more nurses, salaries in the state have stag- nated, falling behind the national average of $82,750 by 4% at $79,120. The pay is not enough to compensate for the physical and mental toll of an increas- ingly dangerous profession. The American Nurses Association (ANA) says that one in four nurses have been physically assaulted on the job, with 13% of overall missed work- days caused by workplace violence. The Oc- cupational Safety and Health Administration (OSHA) places the risk of vi- olence against healthcare workers at four times greater than that of any other industry. Violent incidents have steadily spiked throughout the pandemic, but only between 20% and 60% are reported, according to ANA. Risoldi travels the country teaching semi- nars on preventing violence. The corner- stones of her program are understanding, awareness, recognizing escalation and con- flict resolution. She trains nurses to meet pa- tients and seek out what immediate concerns and needs might cause agitation. Risoldi says to follow the trail of anxiety. She uses her organization to fill in the ed- ucational gaps that leave nurses vulnerable to potential violence and to fight for legisla- tion to combat the problem. Within the medical field, Risoldi wants to break down the barrier between physical health and mental health. She also wants hospitals to employ more mental health professionals and provide one per floor as opposed to one per building. A 2018 state report on workplace vio- 4 2 lence against nurses found that only 48% of those surveyed rated their hospitals as very safe, and only 48.5% knew whether their hospitals had violence prevention programs. The ANA calls the overall attitude toward workplace violence in healthcare “Just Cul- ture,” that accepts injuries to nurses as “just part of the job” and treats violent incidents as routine occurrences that workers have to deal with on their own. Hospital employee protections, Risoldi said, nurses fear that ad- mitting they’re not OK will lead to their re- moval from the floor should they be deemed unfit to work. lll The shortage of nurses in some ways is feeding the rise in workplace violence. Hos- pitals overrun with patients during each wave of the pandemic coupled with the loss of burned-out nurses spelled longer wait times in ERs and left admitted patients feel- ing ignored. Frustration made people agi- tated and angry, pushing them closer to the likelihood of lashing out. Desperate family members, not allowed to see hospitalized loved ones in their last moments, caused the brunt of the disruption that Bulger remem- bers during the height of the pandemic. To compensate for the loss of permanent “YOU COME IN AND WONDER WHICH ONES AREN’T GOING TO BE THERE WHEN YOU LEAVE TOMORROW MORNING.” — MICHAEL BULGER, NURSE staffers, more hospitals are turning to medi- cal staffing agencies. These firms represent travel nurses who work under contract, jumping from one medical facility to the next to fill in the gaps. Travel nurses often make as much as three times the regular hospital pay, plus room-and-board. It’s a lu- crative deal for those seeking the pay and benefits they feel are equal to their efforts, but it siphons permanent staffers from hos- pitals Those not signing on to travel nursing agencies are switching hospitals altogether for higher pay. Bulger is switching to a dif- ferent hospital in the Plano area for an $11 per hour boost over his current pay. Four or five of his colleagues who also chose to stay in healthcare all switched departments in search of less draining workloads. (Bulger spoke on the condition that we not name his employer.) The nurses who’ve chosen to stay in the Mike Brooks manuals, codes of conduct and other regulatory documents at the facility and state levels across the nation often lack clear definitions of what workplace violence is, which allows incidents to be swept aside if they’re not deemed severe enough. Only a handful of states have legislation on the pre- vention and management of workplace vio- lence, and OSHA has no requirement for healthcare organizations to implement pre- vention programs. Only voluntary guide- lines exist. Victims often don’t report incidents for fear of retaliation or concern that the incident will be counted against them as poor job performance. In November 2020, a Texas Senate bill to combat violence against healthcare workers failed to become law. Louis Kidd, a house supervisor at HCA Mainland Hospital in Texas City, said HCA has prevention protocols in place, but when pressed for specifics, he could offer only re- action plans for violence already occurring. He said he might be called to address a vio- lent situation and would then call for secu- rity or police. At many hospitals, including HCA and the Plano hospital where Bulger works, problem patients are handed off to male nurses when they’re available. Kidd said pa- tients typically aren’t as troublesome to male nurses. Bulger, who stands at 6 feet tall and is powerfully built from his years on the Dallas Warriors Hockey team as a right wing and goalie, has often been called on to help con- trol potentially violent patients. On one oc- casion an aggressive male patient got between one of Bulger’s female coworkers and the door of his room. “She was essen- tially trapped,” Bulger said. He stepped in- side and asked if there was something they needed help with. Seeing Bulger, the man immediately backed down, letting the other nurse escape. Bringing male nurses in to handle prob- lem patients and calling for security are all well and good, but Bulger pointed out that at his hospital, security might be several floors away, and much damage can be done in the time it takes for them to arrive. “It’s really hard to police that,” he said, “because if somebody gets angry and just goes off, that violence has already happened.” One of the obstacles to change in the field is, as Risoldi calls it, a culture of learned of helplessness among healthcare workers. Nurses don’t seek help when they need it because they assume a certain level of vio- lence is just part of the job. With minimal profession for now are feeling the same pressures that have driven others to leave. But they stay on not just because they want to, but because they feel they must. Continu- ing to work in nursing does not mean they’re spared the burnout that forced others out. A nurse from the progressive-care unit at HCA Mainland, who spoke on the condition of anonymity, said they love their profession and feel obligated to their community. “I feel like I make a difference and if I’m not there, who else is there?” the nurse said via text message. A Mayo Clinic study on burnout in healthcare defines it as “affective and cogni- tive changes, including emotional exhaus- tion, depersonalization and cynicism and diminished feelings of personal efficacy re- sulting from chronic occupational stress.” On a neurological level, burnout diminishes the prefrontal cortex region of the brain, re- ducing motivation and communication skill and increasing unprofessional behavior. Burnout hurts the rest of the body, too, rais- ing the risk of hypertension, cardiovascular disease and suicide. Studies from the past two years found that nearly a quarter of healthcare workers reported likely post- traumatic stress disorder, a mental condi- tion that develops after experiencing or witnessing terrifying events, and 57% of those screened for it met the criteria to be diagnosed. The brain’s ability to repair itself means that with stress relief, the damage >> p6 MONTH XX–MONTH XX, 2014 OCTOBER 20-26, 2022 DALLAS OBSERVER DALLAS OBSERVER | CLASSIFIED | MUSIC | DISH | MOVIES | CULTURE | NIGHT+DAY | FEATURE | SCHUTZE | UNFAIR PARK | CONTENTS | CLASSIFIED | MUSIC | DISH | CULTURE | UNFAIR PARK | CONTENTS dallasobserver.comdallasobserver.com
