Finally! A Nursing School Simulation That Addresses Workplace Violence
- The School of Nursing at UNC Chapel Hill designed three real-life scenarios to address workplace violence in nursing live simulations.
- 8 in 10 nurses have experienced at least one type of workplace violence within the past year.
- The three approved scenarios address verbal abuse, physical escalation of a patient, and nurse-nurse bullying.
Nursing schools employ numerous teaching methodologies throughout the course of the program. Most will utilize “live” patients during simulations by employing local actors or even students from the campus. The School of Nursing at UNC-Chapel Hill is taking live simulations to the next level.
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In January, educators at UNC ran the first simulation specifically designed to address workplace violence. “We know that one out of every four nurses will experience some sort of workplace violence during their career. That could be physical, mental, emotional abuse,” said Valerie Howard, dean of the UNC School of Nursing. “It could be harassment, bullying. It’s not always just the physical violence that we think of.”
How Does it Work?
Similar to other live simulations, nursing students are given “fake” patients and taught to address them as if they were real, and the situation was occurring in the hospital setting. Educators run the simulations and may fill in the blanks, including health history, vital signs, and symptoms. When a live actor is present, there is a pre-established script.
Emily Barksdale, a nursing student at UNC, was one of the first to experience this new simulation that recreates workplace violence that nurses can encounter in the field. Barksdale walked in to see her patient and asked about the pain she was experiencing to better understand the needs of the patient and communicate with the providers.
Source: WRAL News
The patient looked Barksdale straight in the eye before saying, “WHAT? Are you trying to psychoanalyze me, bitch?”
Barksdale then had to utilize techniques she learned in the classroom to de-escalate the patient and build a more therapeutic communication pipeline with them.
Workplace Violence Prevalence
A 2023 study conducted by National Nurses United (NNU) found that
- 8 in 10 nurses have experienced at least one type of workplace violence within the past year.
- Nearly half of nurses reported an increase in workplace violence on their unit in the previous year.
- Only 3.8% of nurses reported that workplace violence had decreased on their unit in the previous year.
- The most common types of violence reported were being verbally threatened (67.8%), physically threatened (38.7%), and being pinched or scratched (37.3%).
A Plan Comes to Fruition
The use of simulation to address workplace violence was made possible with a grant from the AARP Health Equity and Nursing Innovation Fund and matched by UNC Health’s Robert A. Ingram Institute for Equitable Healthcare Access.
In Spring 2024, the Tar Heel Academic Practice Partnership, which includes nursing leadership from UNC Medical Center and UNC Health Rex, and the North Carolina Nurses Association, knew that something had to be done to help address workplace violence and make nurses more prepared from the start.
During a retreat, the team expressed the need for something that would educate the younger generation but also make a lasting impact on the profession. After winning the grant and over six months of developing, testing, and having the scenarios reviewed, three workplace violence scenarios were approved for use.
Real-Life Scenarios
The three scenarios that were developed dealt with different aspects of workplace violence and provided students with the broadest range of possible real-life scenarios.
- Verbally abusive - A confrontational parent of a child patient who was being involuntarily committed
- A patient experiencing severe pain with escalation due to the patient feeling like health care providers weren’t listening
- A co-worker is trying to bully the nurse into doing something that doesn’t align with policy.
“When people think of simulation, they think about what’s happening downstairs in our sim lab, right, the beds, the mannequin laying there,” Howard said. “We hired actors to come in and to portray these instances of workplace violence with nurses, and we had an audience sitting there. We did this in a classroom, very low budget, low cost, but very realistic.”
The program was a huge success during the initial trial period that ended in July, and many students expressed positive feelings towards it.
“All but a few of the participants, and when I say a few, I’m talking one or two, agreed that the training was extremely valuable: the pre-briefing that we did, the actual scenario, and then the debriefing, and they felt like this could translate into practice,” Howard said. “The results were very positive.”
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