When the Nurse is the Subject of Violence

By Tina Brooks (Experienced by me....islern)

SOME LIFE EXPERIENCES, both positive and negative, have so much impact that they change the course of one's life; just ask Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the department of nursing at Xavier University in Cincinnati, Ohio.

"I was a victim as a student nurse," McKoy says. "I was also victimized when I was working with a client. In fact, I received a concussion. Instead of me saying 'No' to the field, it made me want to be in the field even more."

McKoy's background includes psychiatric nursing with 19 years of forensic nursing experience. She was always interested in the area of human behavior and what motivates individuals. McKoy believes that other forces, and not just mental illness, drive people to hurt others.

"I was in shock initially when I realized that I was actually hurt that badly," McKoy says. "I didn't go through phases of detachment. I accepted what happened. I regrouped and said, 'I have to make some changes.'"

She adds, "Did it make me change how I went about my job? Yes, it did. I became more astute about my surroundings, not as trusting in my relationships with clients. When you've been hit (before), it puts you more on guard."

Becoming a forensic nurse because of personal or professional victimization may not be as uncommon as one thinks. McKoy mentions that she has a student who wishes to enter the field because of past negative experiences with teenagers. The student has already become nationally certified.

Julie Jervis, RN, MD, MBA, senior faculty and program director at Kaplan College, says she knows another forensic nurse who had been a former victim as well. "People who have been victimized, whether it is prior to them becoming a forensic nursing professional or not, I think might be motivated to help. It could be as a result of having a bad experience with the system and wanting to make it better, or having a good experience with the system and wanting to be another person who helps."

McKoy says that forensic nursing is an excellent area to go into for individuals who have been victimized. "It makes me want to be a better educator, researcher and practitioner because it really gives me more of a driving force not only to help myself, but help others," she says.

One study has explored how eight nurses experienced and evaluated the relation between their childhood adaptation to dysfunctional families and their nursing careers.¹ The study's findings did not support the view that children of alcoholics sought careers in nursing to meet codependent needs, but rather some of them became competent nurses by finding positive application for the coping skills they learned in their families.

"Having been a victim, it places individuals in a perfect position to be empathetic toward other victims," Jervis says. "If the victim says, 'Has this happened to you?" It is OK to say 'Yes,' but it shouldn't become a war story. 'Oh yeah, when this happened to me, this happened,' or 'Well, it went this way for me."

Jervis suggests this response instead: "'That was in the past and we are here to concentrate on you and make you better.'"

Each individual enters nursing with varying degrees of motivation, values, beliefs and unresolved family-of-origin issues.²

However, circumstances that generate anxiety or strong emotion can interfere with objective, logical decision making.³ "A sexual assault is a critical incident," Jervis says. "Some people have problems with critical-incident stress and relive the incident when faced with something similar that reminds them of it. If the nurse is falling apart, that's not a good thing. If it's a tragic story and the nurse sheds a few tears and is empathetic ... there's a fine line of what's OK and not OK. The caring definitely has to be there, but complete detachment is just going to make the victim feel worse."

The literature suggests that negative reactions, biases, and stereotyping should be recognized and explored.⁴ Often, self-awareness begins unconsciously with the internal organization of life experiences.⁵ McKoy's students use case studies, journaling and discussions.

"How do they guide other people to explore these things if they have not explored these feelings themselves," McKoy says. "The best arena in which to do this is a safe environment where other people can give them different perspectives on how to look at things. Students often say 'I never thought about that. Sometimes it's good for people who aren't in forensics but who want to do this, to be in a safe place to talk about it, such as in a classroom setting. Don't let the first experience be the crime scene."

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SAYING NO to Violence Against Nurses

By Tina Brooks

WORKPLACE VIOLENCE takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses by patients, relatives, other nurses and other professional groups.⁷

Nurses experience workplace crime at a rate of 72 percent higher than medical technicians and at more than twice the rate of other medical fieldworkers, according to the Bureau of Justice statistics.

Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the Department of Nursing at Xavier University in Cincinnati, Ohio, would not be surprised by these numbing statistics. She has done extensive research in this area herself.

McKoy says, "I found that nurses thought this came with the territory. We thought and said for a long time that we were not willing to sue patients or to sue clients because this is a part of what we did. We accepted this."

Part of McKoy's research explored if nurses knew patients were in their right mind and why were nurses accepting of this behavior. "They thought that their colleagues would not understand and their employers would think that they were not doing their jobs. It must have been something about them that caused the behavior," she says.

McKoy, who was also victimized on the job several years ago, felt that the community where she worked did not understand her plight. "They saw it as part of what I did," she says. "When I was victimized, I was in the area of mental health."

Some of the injuries that McKoy received could have been life threatening, including a concussion, could have been life threatening.

Through her research, McKoy discovered that other nurses received physical injuries as well. Some individuals were able to go back to work in a couple of days, but in some instances the experience had lasting effects. Nurses changed areas where they worked or changed jobs. Others experienced nightmares, which lasted for some time. Some individuals had psychological problems while others had physiological problems such as nausea or vomiting. Other research suggests that consequences of violence also include the deterioration in the quality of patient care, low morale, high stress levels, and increased errors.

Violence against these nurses had implications for their families as well. "My family was most concerned about me being hurt," McKoy says. "They immediately wanted me to look at other employment, but I couldn't do that. My feelings were that I was called to do what I did."

When McKoy asks former victims if they would now prosecute the perpetrator, some of the individuals at this point say 'Yes.' They feel the person knew the difference between right and wrong. "So we stand on the edge of certain areas of the law where nurses are now saying 'If you know what you're doing to me I may not take it,'" she says.

Mental illness is one thing, but even in this area nurses are beginning to question patients' cognitive abilities. Do patients know what they are doing? Do patients know what they are doing when they hit a nurse? "Nurses are definitely fighting back differently now," McKoy says. "It doesn't mean that we're not compassionate."

As McKoy travels throughout the country presenting at different professional conferences, she is encouraging the profession to investigate this subject. The link between workplace violence, recruitment and retention and diminished job performance of nurses cannot be ignored.8 The Bureau of Health Professions' 2000 Survey revealed that too few young people are choosing careers in nursing, and the average age of registered nurses has increased substantially. In 1980, 52.9 percent of RNs were younger than age 40; in 2000, 31.7 percent were younger than 40. In 1980, 26 percent of RNs were under the age of 30, but by 2000, less than 10 percent were under age 30.

"Nurses are not willing to be victimized as much as they used to be and still stay on the job," McKoy says. "That is a critical issue to look at."

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References:

1. Biering P. Codependency. A disease or the root of nursing excellence. Journal of Holistic Nursing. 1998;16(3):320-337.

2. Jerome AM, Ferraro-McDuffie AR. Nurse self-awareness in therapeutic relationships. Pediatric Nurse. 1992;18(2):153-156.

3. Echroth-Bucher M. Philosophical basis and practice of self-awareness in psychiatric nursing. Journal of Psychosocial Nursing of Mental Health Service. 2001;39(2):32-39.

4. Ibid.

5. Ibid.

6. O'Keefe ME. Nursing Practice and the law. Philadelphia: F. A. Davis Co. 2001. p.403.

7. Jackson D, Clare J, Mannix J. Who would want to be a nurse? Violence in the workplace - A factor in recruitment and retention. Journal of Nursing Management. 2002;10:13-20.