There are many things you could do if you have experienced workplace violence. Only you can decide which actions, if any, may be appropriate for you. The first three are strongly recommended:

• GO HOME

• GET HELP AND SUPPORT

• WRITE EVERYTHING
  

Below is a list of possibilities, synthesized from the experiences and knowledge of many people. These are not recommendations, just possible courses of action.

The Initial Period

The first few hours after the event are characterized by the crisis reactions of shock, numbness, disbelief, and/or denial. Physical symptoms may include fight or flight autonomic responses such as increased heart and respiratory rate, heightened or distorted awareness, dilated pupils, and reduced perception of pain.

• Remove yourself from immediate danger.

• Call for assistance

• Report the event to your immediate supervisor.

• Report the event to Safety & Security personnel.

• Seek medical treatment if there was a physical component to the assault, even if you don't believe you are seriously injured. Request that photographs be taken of any injuries.

 Unfortunately, many nurses report that their experience was trivialized and minimized by ER or Employee Health nurses and doctors, and that they received minimal treatment, and that fractures and serious, even life-threatening injuries, were missed. If you are feeling shocked or numb, your ability to advocate for yourself may be temporarily diminished. It may be advisable to take a trusted friend, coworker, or family member to stay with and assist you at this time. You can call such a person or you can ask treating personnel to call for you.

Consider reporting the assault to the police.

Some nurses report that police officers discouraged them from filing a report, particularly if the perpetrator was a patient. If there is any possibility that you may later want to press charges, insist that a report be taken. Some nurses report that their supervisors and coworkers pressured them to not call the police or file a report. You have been assaulted, and this assault is just like any other which might occur on the street or in a home. You have the same rights for protection and justice that you would have in any of these other situations. Do not let others dissuade you if you feel that you want to file a police report.

Consider going home.

Nurses who have been assaulted frequently feel numb and shocked after the event. Often they return to the work environment while in this state. Nurses report difficulty concentrating and that they were more likely to make mistakes during this period, which may last for hours or longer. In addition, nurses report that returning into the situation later exacerbated their feeling of trauma, and further, some nurses have been re-assaulted at this point. Some supervisors have insisted that the nurse continue working. DO NOT ACCEPT THIS. You have been assaulted and your employer is obligated to provide you with the care you need. YOU ARE THE PRIORITY.

Documentation

• Complete an incident report or other designated report form.

• Be brief and factual. You will have later opportunities to write in depth about the incident if you so choose. Keep a copy!

• Once home and when you feel able, write in detail, at this point for your eyes only, everything that happened.

• Include names, times, places, circumstances, who said and did what, every detail you can think of. It is not possible for you to immediately anticipate your future need for this information. Over the next several weeks your feelings are going to vacillate, and there will be many options which you may need to exercise for your own welfare. You will need this information.

• Request copies of any medical treatment records.

• Obtain copies of the facility policies and procedures related to violence.

• Note in particular any employer policies about reporting, that is, what is required of the employee. You want to make sure that you have complied with the policy fully.

Advice from a B.C. nurse that was assaulted.

* Disclaimer: The following excerpt is provided for informational purposes only and does not necessarily reflect the views & opinions of the Proactive Nurse Network.

--- before a violent incident occurs and you have noted some warning signs (remember the best

predictor of future violence is a history of previous violence), document this information onto the

patient's chart even if it is an individual/s other than the patient but related by contact (patients family/friends/doctor) If it is a co-worker than fill out an incident report . Then request an immediate meeting with the manager of your area. DO NOT MEET WITH THE MANAGER ALONE---TAKE A TRUSTED CO-WORKER OR EVEN A GROUP TO VOICE YOUR CONCERNS!!! Then document that you have met with the manager and what was said and who was present--again, do this in the patients chart and any other incident reports---you need to leave a paper trail. Also photocopy/take notes and keep in your records. If the manager refuses to take action( such as have security assigned to the unit ) even after you tell the manager that all this will be noted , then CALL THE POLICE. At this point , your safety, your co-workers safety and your patients safety becomes urgent.

---if however there was no indication of violence go to next step.

---after your traumatic violent incident you will need to deal with not only what happened to you

on a personal level( includes emotional, physical and psychological)but also will have to deal with what happens afterwards in a more practical , rational way which will protect you from further "victimization" by other systems.

---get support!!! and do it immediately. You have been traumatized and should report to emergency and get staffing to replace you---this also includes violent incidents were you are not physically harmed but have been threatened, confined and or abused. You will be in no shape to continue your shift and make quick rational decisions. Protect yourself and your patients by admitting how shaken up you are---this is not a sign of weakness!! but in actual fact it is telling the truth. By not seeking immediate support you are downplaying or minimizing or trying to deny what has just occurred. By going to emerg. you have a better chance of getting immediate crisis debriefing which you need so that you can begin to talk about the experience. For other geographical areas the process may be different(you may already have a crisis team on call and can call them directly if no physical injury has occurred. Find out before hand!!--you need to know your available resources before you become a survivor of violence).

---now you will have to deal with the paperwork. If you are not physically injured , try and concentrate on the process such as charting the incident and filling out such as in my case a "critical incident report". By not doing the paperwork it is as if nothing has happened!! Also photocopy all that you have written so that you can refer back to it if needed. However, realize it is illegal to take photocopied material from a patients chart so take notes. Each country will have a different process to access compensation. Again, I urge you to inquire beforehand about the process involved so that in a crisis it is one more piece of knowledge that you have. For example, in British Columbia, Canada, the Workmen's Compensation Board requires you to fill out its forms as soon as possible after injury---do not leave work without doing this or if you are traumatized and can't think coherently, take the paper work home but submit it ASAP.

---How you fill out your compensation form and the procedure to follow is crucial to whether you will get benefits or not---I contacted my union to have the steward go over my forms and also included a 5 page summary( a professional responsibility form which I also filed with my union) of what happened to me with the forms when I handed them in to WCB. Get someone from your union or nursing association to go over this with you---one of your first phone calls should be to a nursing rep. You will need their support. REALIZE THAT EMPLOYERS CAN GAIN ACCESS TO YOUR WCB FILE . FIND OUT IF THIS IS TRUE IN OTHER COUNTRIES/PROVINCES. If part of your assessment includes a psychiatrists report ask the psychiatrist to send a letter to WCB and a complete report to your physician. In this way you can protect your privacy. Also, before signing any forms for WCB that you do not understand ask to speak to a WCB lawyer who will clarify what you are signing---however this may hold up your claim.

---Next, do not talk on the phone with management. Screen all your calls and get or request everything to be in writing. It is important to have this documentation because what is said on the phone can be open for misinterpretation.

---during this time you may want to proceed with reporting and then laying charges against the predator. In British Columbia , you can go to the RCMP or local police force and make a report.

Take a support person with you, preferably a nursing colleague who will back you up and clarify to the police that this is not part of your job!!---A report is separate than laying charges. Laying charges and going through with prosecution is individual choice. BEFORE LAYING A CHARGE SEEK LEGAL ADVICE---IN FACT, SEEK LEGAL ADVICE IF A VIOLENT INCIDENT HAS HAPPENED TO YOU AND THE ACCUSED HAD A HISTORY OF VIOLENCE IN YOUR WORKPLACE---THERE MAY BE LEGAL  RAMIFICATIONS FOR EMPLOYERS WHO DO NOT ACT ON THIS INFORMATION---REMEMBER , MANAGEMENT WILL BE CONSULTING WITH THEIR LAWYERS--YOU NEED

LEGAL SUPPORT (AND THIS INCLUDES SEEKING COMPENSATION FOR TRAUMA)---AND DO NOT TELL YOUR EMPLOYER THAT YOU ARE SEEKING LEGAL ADVICE!!! NOTHING MAKES THEM BRING OUT THE BIG GUNS FASTER!! IF YOU DECIDE TO RETAIN A LAWYER LET THE LAWYER DO ALL CONTACTS WITH MANAGEMENT. 

For those of you in British Columbia there is a hotline number for lawyer referral service: 1-800-663-1919. They will help you find a lawyer for your situation when you don't know where to look. There is a nominal fee involved ( I paid $10 for a supposed 30 mins but spent well over an hour with the lawyer for no additional fee). Also, be careful of your personal file---gain access to it if you can before you start making waves---get your union to help or nursing association. Its important to have regular job evaluations that you have copies of so that if you suddenly become less of a valuable employee you have previous documents that prove otherwise.

---I will now write this in large block letters because as nurses or health care workers we were taught to be caring and this will come as the worst shock but it is reality!!   HEALTH CARE IS A BIG MONEY MAKING BUSINESS NO MATTER WHAT COUNTRY YOU WORK IN. MANAGEMENT TREATS YOUR PLACE AS A BUSINESS AND THE BOTTOM LINE IS SAVING MONEY. YOU ARE EXPENDABLE SO YOU NEED TO WATCH OUT FOR

YOURSELF. Once you are clear on this nothing that management does should come as a surprise or shock---they will do an internal investigation and will try to shift the blame on to you. DO NOT ACCEPT THIS ATTEMPT TO BLAME YOU THE SURVIVOR. IT IS ONLY SO THEY CAN SAVE MONEY BY NOT ACTING ON WHAT HAPPENED.

*****This next step is very important and I would say it is above all else the most crucial. To

work on you own healing is one of the best gifts you can give yourself---find counseling support---there may be employee assistance programs through your workplace, or counseling at a women's center, or even here in BC some police detachments have a victim service unit. You need to talk about this over and over so that you don't internalize it. I won't go into post traumatic stress on this hand out but it does happen and you need to be aware that there is help for you. Family and friends who support you may not fully understand the impact this has on you so be kind to yourself and realize that as you are learning how to cope they also will need information on how to cope with the changes they see in you.

---Now, lets blow away the myths that come with nursing---counseling does not make you "weak" or "not able to take it". Also, don't let yourself or others take you down the road to "self-blame" by stating "if only I/you had done this!!..." Violence means you were at the wrong place at the wrong time---whether you were working as a nurse or just walking down the street!! De-escalation does not always work!!!  You survived!!! That is what matters!! 

---Be aware of the above pervasive and insidious points I have made about nursing in general---you may be supported by your colleagues but you may not and will have to deal with the personal challenges this represents( since I received no validation from co-workers of my trauma I felt my self-confidence plummet in my ability to carry on being a nurse ). Even your own local union/nursing reps may not see this as an important issue. If that is the case, bypass the local union/nursing association and get in touch with the head office. For the BCNU( British  Columbia Nurses Union ) contact the Occupational, Health and Safety Division, 4060 Regent St. Burnaby BC V5C-6P5. PH. 1-604-433-2268 (general number, ask for OHS division)

---be aware that what has happened to you may evoke some particularly strong emotions : denial, rage, grief , sadness, increased anxiety, nightmares and obsessional thoughts by replaying the incident repeatedly to the point were you lose track of time and place, and thoughts of suicide. Physical symptoms may include: sleeplessness, decreased appetite, diarrhea/constipation, hypervigilance, and extreme fatigue. Be kind to yourself. Some suggestions are: eat well, try and get adequate rest, walk , journalize , continue to seek support from individuals who have shown empathy( don't isolate yourself) and in general, nurture yourself!!!

---note that on working on your traumatic incident by refusing to accept management's version of what happened takes time---months or maybe even years. You need to work on your healing and getting on with your life. If you decide to NOT take on management because you need the work, for lack of support or whatever reason, DO NOT FEEL GUILTY!!!!  You need to concentrate on your healing and whatever advice anyone gives you may not be what works for you. Take back the control and your own personal power by choosing what is best for you!!!  And try and continue to find a safe place and way to vent your feelings so that ultimately you come away with more self-confidence, inner power and peace.

---resources for your own area will be different. Phone your local crisis line and get information as to were you can find support in your area. Always remember that you are not alone!--others have been through it and survived!!  

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