Introduction
The increased number of mass shooting incidents in medical facilities has already become a crucial problem that requires an immediate response. While shootings occur anywhere, over the past several decades, more than 50% of them took place in various medical facilities (Schwerin et al., 2022). This tendency is determined by the fact that hospitals may be regarded as soft targets – they are traditionally open to a large number of patients, visitors, and medical staff, frequently at unusual hours. Thus, they are more accessible than other facilities for people guided by mental health issues or other factors that cause violence.
Active shooters are patients, employees, or individuals not connected with a medical facility, predominantly young males who either have personal relationships with other patients, medical staff, or colleagues or have no obvious relationships. In the majority of cases, shootings are targeted, however, when they are non-targeted, victims are innocent bystanders (Schwerin et al., 2022). The most common factors that lead to an active shooting in hospitals include mental health disorders, depression, outbursts of anger, grudge, a sick or dead relative, severe financial problems, suicide ideations, ideology, poor treatment, revenge, and many others.
Protocol in the Case of an Active Shooting
In general, there are several response actions created for the minimization of victims’ number in the case of a shooting. However, the following protocol was developed by Department of Homeland Security, ALICE Training Institute, FEMA, Ready.gov, and other entities that support its validity and efficiency (Schwerin et al., 2022). First of all, in order to determine subsequent actions, it is essential to figure out that an intruder is in the medical facility by hearing a radio announcement or shooting itself, determine its location, and evaluate the expediency of running or hiding.
RUN:
- First of all, a nurse should have an escape plan in mind;
- A nurse should evacuate quickly regardless of others’ decision to follow or not (Schwerin et al., 2022);
- At the same time, a nurse should encourage others to evacuate and help them in this preventing from entering a location where a shooter may be (“Active shooter/workplace violence,” n.d.);
- A nurse should leave all his or her belongings behind;
- After the evacuation, a nurse should immediately call 911, inform about an incident and follow any police officer’s instructions (Schwerin et al., 2022).
HIDE (This option should be used when evacuation is not available.)
- It is necessary to find a place invisible for a shooter;
- A nurse should lock the door and block it with objects if possible;
- All possible sources of noise, including mobile phones, TV, radio, and others, should be turned off (Schwerin et al., 2022);
- Everyone should hide behind desk, cabinets, or other large items and remain quiet;
FIGHT (This option should be used when any other is unavailable and life is in danger (Schwerin et al., 2022). The purpose of these actions is to incapacitate or disrupt an active shooter.)
- A nurse may act aggressively, scream, or throw items that may be used as improvised weapons at a shooter.
Responsibility of a Nurse Caring for Patients
Nurses are responsible for patients’ safety, however, there are multiple concerns connected with actions that should be taken in relation to patients who cannot move to evacuate by themselves. In general, when running away is available, nurses should encourage patients who are not bedridden to leave the location as well (Schwerin et al., 2022). Other patients who are old, bedridden, incapacitated, acutely ill, on the ventilator, in the ICU, NICU, dialysis unit, or after surgery cannot escape as their health may deteriorate. In this case, nurses should undertake all efforts to provide safety for them as well by closing their areas. All in all, it is the responsibility of a medical facility to elaborate on a policy that will determine the algorithms of actions in relation to these patients.
Prevention of an Active Shooting
The prevention of active shooting in medical facilities has two aspects – facilities initiatives and staff training. In general, all preventative measures require thorough planning with a multidimensional approach of an interprofessional team. A framework of actions in the case of a shooting in which law enforcement and all medical staff should be involved is essential. On the basis of a well-elaborated plan, employees should have training that will include the algorithm of actions depending on the situation, communication between workers in the case of a shooting, the use of first aid kits, harm reduction and self-defense, and security measures. Although health care providers are ordinary people who are afraid to find themselves in a situation when their lives are in danger, training may raise their self-confidence and contribute to more positive outcomes in the case of an incident. In addition, specialists will learn to detect any suspicious behavior of patients, their friends or family members, and colleagues that may be associated with violence and report it to prevent a mass shooting.
Bullying of Nursing
In the present day, bullying in nursing has already become a critical topic of concern that requires an immediate response. While nursing is an occupation associated with compassion, tolerance, deep understanding of others’ peculiarities, and care, the phenomenon of nurse bullying may be regarded as widespread and common. According to clinical literature, the repetition of inappropriate and destructive behavior starts in the classroom, and 78% of students report bullying in nursing schools (Edmonson & Zelonka, 2019). As a result, “within the first 6 months, 60% of nurses leave their first job due to the behavior of their coworkers” (Edmonson & Zelonka, 2019, p. 274). The most common scenario of bullying in nursing is an overt or hidden humiliation of young specialists by older ones.
As a highly serious and complex problem, nurse bullying has multiple serious consequences. As previously mentioned, a critical number of specialists are forced to leave their jobs due to the unacceptable behavior of colleagues. As a result, bullying contributes to the shortages of health care providers that may be regarded as a serious issue in the health care system. In addition, bullying leads to nurses’ decreased job satisfaction, demoralization, sadness, anxiety, and depression. Although these mental health issues have a highly negative impact on a person’s well-being, they affect the quality of his work as well. For instance, constant stress, anxiety, and depression due to bullying may result in burnout characterized by indifference to patients’ states and needs. Therefore, there is a direct connection between bullying in nursing and poor quality of health care delivery.
That is why it is essential to pay attention to the inappropriate behavior of nurses in relation to their colleagues in clinical settings and teach young specialists to withstand it. It goes without saying that it should be the responsibility of nurse leaders to prevent bullying through the creation of an organizational culture with zero tolerance for humiliating behavior (The Joint Commission, 2021). It is them who should demonstrate that any act of bullying will be addressed and a bully will be punished to prevent misconduct (Smith et al., 2020). At the same time, any nurse being a target of bullying may take the following actions for personal protection even if bullying is ignored or even supported in the facility:
- Document bullying. In order to prove that bullying takes place, every act should be recorded with names, dates, times, and facts.
- Make an official complaint. Documented bullying will allow a nurse to make an official complaint with a representative of the facility’s human resource department. If it will not pay attention, legal authorities should be addressed, as any employee is protected against bullying by law.
- Engage in professional development. Continuous professional development helps a bullied nurse improve not only the quality of health care delivery but self-esteem and self-confidence essential for mental stability.
- Develop skills to recognize and confront bullying. A nurse should improve his or her interpersonal and intrapersonal skills to define bullying behavior and utilize confronting techniques.
In addition, for a young specialist, it is essential to know that there are people in the workplace who do not support bullying and are ready to protect. Thus, every health care professional is responsible for standing against the unacceptable behavior of a bully, especially when a fellow nurse is affected, and may act in the following ways:
- Confront a bully individually;
- Attract the attention of other colleagues to the act of bullying;
- Help a fellow nurse make an official complaint;
- Promote the culture of zero tolerance to bullying;
Even if a supportive environment does not exist and the organizational culture is tolerant of bullying, the initiatives of even one person may change the situation. While bullying may be copied by others, a mirror phenomenon may occur in the case of protection against it as well.
Conclusion
This teaching presentation may be regarded as highly informative – it addresses the issues of an active shooting in clinical settings and bullying in nursing. It provides a clear protocol that describe a nurse’s actions and the measures of an incident’s prevention. Due to this material, the cases of an active shooting will be both minimized and addressed more efficiently if they occur. In relation to bullying, the presentation informs about its devastating impact on both the system and individuals and provides essential suggestions for both a bullied nurse and a nurse who witnesses bullying to confront the inappropriate behavior and reduce its repetition.
References
Active shooter/workplace violence. (n.d.). Web.
Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic.Nursing Administration Quarterly, 43(3), 274-279. Web.
Schwerin, D. L., Thurman, J., & Goldstein, S. (2022). Active shooter response. National Library of Medicine. Web.
Smith, C. R., Palazzo, S. J., Grubb, P. L., & Gillespie, G. L. (2020). Standing up against workplace bullying behavior: Recommendations from newly licensed nurses. Journal of Nursing Education and Practice, 10(7), 35. Web.
The Joint Commission. (2021). Quick Safety 24: Bullying has no place in health care. Web.