Introduction
Response plans prevent and minimize the possibility of active shooters accessing healthcare facilities and mitigate any loss of life. The plan involves three steps to prevent and reduce risks for loss of life in an active shooter incidence. Run is about evacuating the area immediately, whereas hide involves seeking a secure place that the shooter cannot access (Federal Bureau of Investigation, 2017). Fight focuses on trying to attack and incapacitate the shooter. The danger of an active shooter should be avoided by creating situational awareness of the environment before the incidence occurs, planning ahead what to do and knowing escape routes (Federal Bureau of Investigation, 2017). Active shooters should be denied access to the building by closing doors. It would be best if you also defended yourself by taking action when your life is in danger. The plan involves four steps vital to preventing or minimizing loss of life during active shooter incidence, including accepting emergency, assessing what they can do next, act by locking doors, and then alert the police.
“ALICE” is five steps response plan that healthcare providers can use to increase the chances of saving lives and surviving. “ALICE” is an acronym for alert, lockdown, inform, counter, and evacuate (Federal Bureau of Investigation, 2017). A nurse can use anything to alert others about the danger, lock doors, and use all means possible to pass information to security agencies and law enforcement officers. The window of life is a response strategy that assigns nurses four responsibilities. These tasks include an obligation to their safety, duty to those immediately attacked, responsibility to all those within the healthcare facility, and responsibility to notify security and law enforcement officers. Nurses should know what they are looking for, understand all possible risks in their facility, seek support when necessary, and participate in training exercises.
Responsibility for Patients in an Active Shooter Scenario
Nurses are responsible for ensuring safety for all patients in all situations. Alerting the patients about the presence of an actor can shooter can help them take personal safety precautions such as lying on the floor. Nurses should lock all doors and use tables and other objects to reinforce them to prevent any possibility of the active shooter getting to the patients’ room.
Notably, nurses should lock the doors immediately after noticing sensing danger of an active shooter. Nurses should tell patients to get on the floor to prevent them from being hit by a bullet. Notably, some patients’ conditions may not allow them to make any movement or act faster. In such situations, nurses should help them get on the floor by carefully lifting or supporting them to prevent possible complications.
Waiting bays, wards, and consultation rooms are not usually safe places for the patients during active shooting. However, there are other places within a healthcare facility where all people can hide until support from law enforcement officers comes. It is the responsibility of nurses to guide all patients to such places and carry those who cannot walk to guarantee their safety.
In a situation where there is no safe place to accommodate all patients, nurses should use established emergency routes to safely evacuate the patients from the building where the active shooter is. Nurses should also fight the active shooter when the patients’ lives and theirs are in imminent danger. For instance, a nurse can use any object around them to hit the perpetrator, incapacitating them and limiting the possibilities of patients being harmed.
Bullying as a Problem in Nursing
Bullying in nursing is associated with various depressive symptoms, such as impairment in executing daily activities among healthcare providers. Nurses may also lose interest in participating in activities they previously enjoyed. Lever et al. (2019) indicate that more than 90% of victims of bullying suffer fem major depressive episodes. The encounter with the bullies contributes to anxiety among the nurses, characterized by intense and persistent fear and worries about everyday situations. Lever et al. (2019) add that bullying is significantly associated with reduced psychological well-being among nurses and other healthcare providers. The depression, anxiety, and stress caused by bullying can lead to physical, emotional, and mental exhaustion. Leach et al. (2020) associate bullying with increased risks of suicidal ideation by approximately 8%.
Bullying causes insomnia, sleep changes, sleep deficiency, and headaches among the victims. According to Nauman et al. (2019), exposure to workplace bullying depletes sleep due to such factors as post-traumatic stress syndrome. Inadequate or no sleep and stress associated with bullying can lead to a severe episodic headache. Bullying can further lead to gastrointestinal problems because the victims are likely to lose their interest in food because of depression. Lever et al. (2019) note that a significant number of healthcare workers who have ever been exposed to bullying report having gastrointestinal problems. Seek leaves even when nurses are not ill, and a high absenteeism rate is another adverse effect associated with bullying in nursing.
A healthcare facility with one or more bullies creates poor and harsh working conditions for other nurses. Such a working environment jeopardizes health care providers’ physical and mental well-being. Job satisfaction in the healthcare sector is vital in providing quality and safe care to patients. However, bullied nurses feel unsatisfied with their job, which can negatively impact their work and clients. Victims of nursing bullying are more likely to leave their job than other health care providers. According to Al Muharraq et al. (2022), 31.7% of victims of bullying exhibit high turnover intentions. Productivity and quality of services the nurses provide reduce due to factors like depression, anxiety, and burnout that hurt the effective execution of daily work activities. Consequently, the quality of health outcomes for the patients decreases significantly.
Suggestions for a New Nurse Being Bullied
The nurse should first research policies the healthcare organization sets to determine the appropriate protocol for reporting bullying incidences. The approach is vital to minimizing the possibility of breaching established guidelines and increasing the chances of getting needed help.
The nurse may be afraid to speak out due to concern about what other workers say, jeopardizing his mental and physical well-being. However, nurses should prioritize taking care of themselves by pulling available resources such as mental health professionals to support them.
The bullying perpetrator may not know that their behavior is affecting you. The definition of bullying is subjective, and individuals may have a varying threshold they consider intimidation. Equally, the person bullying you may be going through a hard time, which can help them relate to how you are feeling. Thus, speaking to the perpetrator effectively can deal with the issue.
Although bullying may lead to distraction, stress, and unproductivity, most victims avoid reporting it due to fear, the possible embarrassment, and lack of trust in an established support system. It is imperative to speak to someone about the behavior if you do not want to report it to alleviate the possibility of suffering from its adverse effects. Although bullying is a behavior, sometimes it may amount to a criminal offence. For instance, sexual or physical attacks, sharing of private information online, and use of prejudiced language are unlawful that should probably be reported to the police officers. Most victims of bullying submit to the urge to isolate themselves, depriving them of any form of support to handle the behavior and its effect (Lever et al., 2019). This approach does more harm than good by worsening the situation by silencing the victims and lowering their self-esteem.
Remembrance of what happened is essential to handling bullying in the workplace. Therefore, it is vital to document everything related to the incidence in detail. For example, you can write down the time, date, location and names of co-workers who witnessed you being bullied. Sometimes victims of bullying tend to think that they contribute to such incidences.
However, the nurse should understand that the perpetrator is the one with the problem, not him or her. It is also critical to note that one’s attitude towards bullying is the main reason why most people experience the factor(Lever et al., 2019). Therefore changing attitudes towards bullying can be instrumental in dealing with the behavior. It is further important to let the person bullying you know that their behavior is intolerable, and you would take action if it occurs again. Setting boundaries allows the perpetrators to understand the behaviors they are willing to accept.
Responsibility Towards a Nurse Being Bullied
Speaking to the perpetrator is essential because it can distract them from continuing to bully the victim. Additionally, it can give the victim a chance to get out of the scene or the courage to speak for themselves. Nurses witnessing the bullying should document the incidence to facilitate effective reporting or remembrance of what happened if the need arises. Notably, the victims may be so scared or traumatized that they cannot manage to document anything about what transpired. Therefore, recording the occurrence as a witness is helpful to the victims. The victim may be scared to report the incident due to fear of being attacked again, the possible embarrassment, and lack of trust in an established support system. Equally, they may not be aware of where to start. Thus, it is the responsibility of the nurses witnessing the incivility to report it to supervisors or managers for appropriate action to be taken.
Conclusion
Bullying instill fear and traumatizes the victims, increasing their risks for mental health problems. As a nurse witnessing the incident, you should encourage the victim to speak about what transpired to minimize the possibility of depression, anxiety disorder, and other conditions. The nurse may not know available resources to help them cope with the situation. Therefore, informing the victim services of such counseling is the responsibility of the witnesses. The victim may fear standing firm against the perpetrator’s behavior. As a nurse witnessing the bullying, you encourage the victim to let the perpetrator know such behavior will not be tolerated to alleviate the possibility of reoccurrence.