By AlGene Caraulia

In the early days of the pandemic, we regarded healthcare workers as heroes, recognizing their important work of providing selfless care. Now, as the immediacy of the COVID emergency has waned, a new epidemic continues to rise: an escalation of workplace violence in healthcare. In fact, 73% of all nonfatal workplace injuries occur in healthcare settings, with workers at significant risk of physical and verbal assaults, leading to injury and psychological trauma. In a 2022 survey from National Nurses United, nearly half of hospital nurses (48%) reported increases in workplace violence (up from 30.6% in September 2021).

The Systemic Problem of Workplace Violence

Inadequate staffing is a major contributing factor in this increase of violence — paired with another exacerbating factor: the need for mental and behavioral healthcare. Recent studies show one in five Americans experience mental illness each year — and with limited behavioral health resources, many have nowhere to turn except their local emergency department. In turn, one in eight emergency department patients require mental or behavioral health services. In short, more and more Americans are seeking mental health care from professionals who are themselves stressed by lack of workplace support, potentially untrained in providing that specific type of care, and carrying the trauma of unprecedented challenges in healthcare.

When a high demand for services meets a team underprepared to provide those services, tensions, stress, and anxiety rise between patients and staff. So does the risk of workplace violence. It’s a serious problem, particularly as our industry faces staffing shortages and budget constraints that often prevent us from hiring qualified individuals to provide the care our communities need.

The time for organizations to act is now. While we need to address the rise in behavioral health care needs with adequate and appropriately trained staff, a person-centered, trauma-informed approach to care can help your team de-escalate rising conflicts — and mitigate the risk of violence in your facility — one person at a time.

Understanding Trauma
When we hear the word trauma, many people’s first thought is severe, acute trauma: neglect, poverty, violence, experiencing some type of abuse — the list goes on. In truth, trauma is a continuum, and we all experience some type of trauma in our lives — whether it’s those life-changing circumstances or even small but impactful developmental or relational trauma. Trauma of any degree shapes our stress responses.

A trauma-informed approach to care is rooted in empathy, giving patients and visitors the mental and physical space to process and express “what happened to you” rather than “what’s wrong with you?”

The Benefits of a Trauma-Informed Approach

According to the Center for Health Care Strategies (CHCS), “Implementing trauma-informed approaches to care may help health care providers engage their patients more effectively, thereby offering the potential to improve outcomes and reduce avoidable costs for both health care and social services.”

In my experience, undergoing training to become a trauma-informed organization can support your team in numerous ways:

• Better support for patients and visitors: Taking a person-centered approach puts the patient at the center of their care to focus on the individual’s unique experiences, needs, and perspectives (including age, gender identity and cultural experiences). This shifts the focus from merely treating symptoms to understanding the underlying causes of behavior. It recognizes that individuals with mental and behavioral health issues often have complex histories that require compassion and holistic treatment.
• Preparing your team for violence prevention: De-escalation training supports frontline healthcare workers by helping them understand the signs, symptoms, and potential reasons an individual might be experiencing a heightened stress response. Giving your team the skills to safely recognize and prevent violent situations among even the most complex individuals creates a safer environment for everyone.
• Creating trauma awareness among staff: Understanding the nature of trauma and trauma-informed care strategies helps staff become aware of their own stress reactions, keeping them calm and in control during challenging interactions. It’s also a tool they can use to stay mindful about their own mental health and encourage them to seek support (or use self-regulation techniques) when feeling overwhelmed themselves.

Finding Support

The benefits of adopting a trauma-informed approach within your organization can be invaluable. And can help you make meaningful progress in protecting your team.

The most successful implementations engage all levels of staff — from administrators to care providers to reception staff and security — and there are a growing number of organizations that can offer the support you need to get your organization trained and working in sync.

The crisis of workplace violence in healthcare is a pressing issue that demands immediate action. Taking a trauma-informed approach offers hope for a future where healthcare workers can provide the care they are passionate about without fear for their safety, and patients receive the right support they truly need — even for complex care needs. Implementing trauma-informed care is a realistic way for healthcare leaders to prioritize the well-being of those who selflessly care for others.

AlGene Caraulia, VP of integration and sustainability, Crisis Prevention Institute

Drawing upon his expertise in organizational behavior, program design, facilitation, and implementation, AlGene returned to CPI's Training Department of global professional managers and instructors in North America, Europe and Asia in 2011. He transitioned into his current role in 2018 partnering with enterprises and focusing on the delivery of superior customer experiences to internal and external customers. Caraulia began his career at CPI as a professional staff instructor and has provided Nonviolent Crisis Intervention^® and related training to professionals in education, health care, mental health, human service and security/law enforcement practices across the globe. Crisis Prevention Institute (CPI) is the world’s leading provider of evidence-based de-escalation and crisis prevention training.