One in every four nurses reports experiencing an assault while performing their job and it is likely that 20-60% of victims are under-reporting. This disconcerting reality directly affects Care Team’s ability to provide fully-focused, patient-centered care. In this episode of “& so much more,” our host Cami Smith speaks with Tiffany Lyttle, Patient Education Coordinator, Nurse Wellness Coordinator, Admissions, Discharge, Transfer Team (ADT) Director, and Wren Roberts, Senior Director of Support Services regarding Workplace Violence (WPV).
Their conversation defines WPV, emphasizing the importance of strategic safety measures and the robust Caregiver and community education needed to provide Caregivers and patients with the safe space required to provide fully-focused care. Join us to learn more about Centra’s current initiatives designed to combat WPV through a continuum of mitigation, preparedness, response and recovery.
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Transcript
Cami Smith:
Hi, and welcome to & So Much More. My name is Cami Smith, and I am here with two very special, very important guests, today on our podcast. I have Tiffany Lyttle, and I've written down their titles because they both cover so many different important things. So Tiffany Lyttle is the Patient Education, Nurse Wellness Coordinator, as well as Admission Discharge Transfer Team Director, ADT Director. So there's a lot of acronyms and things that float around. We call it alphabet soup.
Wren Roberts:
Oh, yes.
Cami Smith:
So I always tell myself it's okay to ask what that means because there are so many. And we also have Wren Roberts, who is the Senior Director of Support Services. And so what are support services? Because that's a very encapsulated title.
Wren Roberts:
It's everything no one wants to do.
Cami Smith:
Oh, okay.
Wren Roberts:
No, it is a pretty large scope. Everything from food service, housekeeping, environmental services security, and the Dawson Inn, which is our central hotel.
Cami Smith:
Yes. That is a lot.
Wren Roberts:
It is a lot.
Cami Smith:
And it's a lot of different locations too. So you're probably on the go often.
Wren Roberts:
All the time. Yeah. We've got 99 buildings throughout the central campus.
Cami Smith:
Oh my goodness.
Wren Roberts:
And so the majority of my time is within the hospitals and those campuses. But it could be anywhere. It could be in Danville or Amherst or any of those areas.
Cami Smith:
Okay. Very cool. Well, before we jump into exactly what we're going to be talking about today, I would love to give you guys the opportunity to share just a little bit about yourself, what brought you to Centra, so that our listeners can just get acquainted. So Wren, we can start with you.
Wren Roberts:
Okay. All right. Well, it's been a 31-year journey. So I've been in healthcare leadership roles since 1992. I grew up in Lynchburg. And so after graduating from Virginia Tech, I spent time in healthcare systems in Florida on the eastern shore of Maryland. I was at VCU Health in Richmond for a while. Finished my master's degree there. And then after a wife and three children, it looked really attractive to come back home where I so desperately wanted to get away from all those years prior. It looked really great, and the Lord blessed us with coming back to Lynchburg and having an opportunity here at Centra. So I came back as the Food Service Director for the system. And at the time, it was really just the two hospitals, and it's grown and evolved, and my role has evolved since then. Added on housekeeping EVS, and then picked up security about two years ago. And so here we are. And it's flown by. It has absolutely flown by. I cannot believe I've gone from 1992 to 2023. It's crazy.
Cami Smith:
My goodness. Well, and that's encouraging to hear because they often say that time flies when you're having fun. Time doesn't typically fly when you're not having fun. So that's encouraging.
Wren Roberts:
The days are long, but the years are short.
Cami Smith:
That is true.
Wren Roberts:
In our business, we have long days, but I'm looking back going, where did the 31 years go? So I'm just blessed to be here though. And you take each moment as that opportunity.
Cami Smith:
Yeah. Well, I'm thankful to have you here today as well.
Wren Roberts:
I'm thankful to be here.
Cami Smith:
And Tiffany, why don't you tell us a little bit about yourself?
Tiffany Lyttle:
Actually, I'm a transplant to Lynchburg, Virginia. I came from the border of Mexico. I grew up in South Texas. And when I came up here, I was not originally a nurse. That's a second career. I was a mental health counselor here at Centra. Went to nursing school, went to Carilion, and came back in 2017.
Cami Smith:
Okay. And so when you first came back, I mean, these are many titles under here. So when you first came back, what brought you back?
Tiffany Lyttle:
So I really wanted to be closer to home. My children are here and it was quite a bit of a drive, and I always loved Centra. They gave me a little bit of opportunity at Carilion, which is why I went in the first place. But then I found out that there actually was fantastic opportunities here. So I came back in 2017 as a resource nurse, became one of the house supervisors and resource nurse. And then partway through one of our COVID surges, the need became apparent that our healthcare teams really needed that support system too. So that's when I took on the role of the Nurse Wellness Office.
Cami Smith:
Which I've heard wonderful things about. We'll have to have you back on here to talk a little bit about some of the nurse wellness initiatives. So today we are coming under a little bit of more sobering circumstances because we're talking about workplace violence. And it's something that is happening nationwide. It's something that's escalating nationwide, and is of course happening right here in our own hospital systems. And I have some statistics here, which were shocking to me. And you guys have been doing this work for a while now. And so you are probably very aware of these. But I wanted to read these to our listeners because it really opened my eyes to what our caregivers are experiencing on a daily basis, which blew my mind a little bit. So one in four nurses are assaulted in our healthcare nationwide system. I'm curious what that statistic may be here at Centra, but we can talk about that.
Healthcare and social assistant workers are five times more likely to experience workplace violence. 20 to 60% of victims are under reporting, particularly when the victim is a minority or a female. And then verbal abuse and bullying, put the nurses, patients and the system at risk of harm and is a contributor to burnout and the nurse shortage, which really directly correlates with the nurse resiliency work that you're doing. And so these are statistics, I think, someone in our office, as we were talking about this yesterday, they all they could say is, "That's not okay." You want to just, that is your immediate response. Because no one should have to experience this to this level or really at all. So there's been a lot of work done and I'm curious how that work began. But first, how would you define or how do we define for clarification, workplace violence here at Centra?
Wren Roberts:
That's a great starting point, I think. Again, we look at a lot of sources of truth being in a highly regulated industry. OSHA has been managing this for decades. And so with the changes we're seeing in society, we're seeing this increased focus on workplace violence. But it's really been there and been part of our continuum for a while. But I think part of what's different is that we're now starting to understand and have more awareness that it's not just about acts of violence, it's threats. It's acts and threats. So when we look at our workplace violence definition, it includes both of those. And that could take many forms. And you mentioned some just earlier: bullying, just threats, that could be an expressed threat, an implied threat, or a conditional threat. And in the past, those probably were not reported. Maybe we just said, "Yeah, it's just part of our job."
They're going through a lot. It's a high stakes, high emotion environment, but we're beyond that now. We can't allow that to just be swept away or here in the south, "Oh, bless your heart, it's just Wren, it's just Tiffany." Those days are gone. We have to take each one seriously. So it's not just about the acts. It is the threats. And I think that's one of the biggest learning moments and pieces that as we educate and make our staff more aware, getting their mind wrapped around that and taking the education and creating habits here at work, that when you experience that, how do you deal with that? What do you do? What are the steps you take? So training our staff that you've got to report that, I don't care how benign you think it was, you got to report it. So let your supervisor know. If you can't find them, let security know. Let our Director of Emergency Management know. Let someone know so we can start the process.
Cami Smith:
And so that really speaks to this zero tolerance policy, which was really my next question because I've heard we now have a zero tolerance policy. And you even talk about that cultural impression here in the South where things are dismissed, things, it's like, let it roll. It's just who they are. So was there a catalyst for that change? For that shift in perspective?
Tiffany Lyttle:
There has been a change in the legislation because we are facing a healthcare worker shortage. The workforce shortage is being influenced by workplace violence. And-
Wren Roberts:
That's a good point.
Tiffany Lyttle:
... Statistics that you pointed out with women and minorities under reporting, is demonstrating that we do have vulnerable populations. We have populations that may not report, and it may be something that they hold to themselves, or it could also be that sometimes it's a disease process and not the person, in which case as healthcare teams, you never want to report someone with a dementing illness that maybe strikes out at you. Of course they're scared, of course they're fearful, being in the hospital system where there's probably a lot of lights and bells and whistles going off, that is very startling. And so we understand, but we also know that our healthcare teams are leaving with that residue still on them.
I have a nurse that has told the story that even though she was attacked by a patient with dementing illness, completely understood the circumstances, understood. We almost come into it with a tacit expectation that these things will happen. Even though she understood it, she was still having nightmares about the incident and had trouble coming back to work and focusing. And that can be dangerous for our patients and for our healthcare team. So us bringing this to light is also creating a safer area for our community come because our healthcare teams are safe and able to operate in a safe place, but it's also a safer place for our healthcare teams because they can be safe and protected and fully focused in on the patients that they're caring for.
Cami Smith:
And I love hearing, I shouldn't say hearing, so I don't love hearing it, but I love sharing these personal stories because I think sometimes when you hear workplace violence or when you hear statistics, they're numbers, they're not faces. And stories come with faces and come with very personal experiences, which can make this real to our community and to our caregivers, which is exactly what needs to happen. So it's encouraging to hear that. What type of initiatives have been put in place as a part of the workplace violence initiative process?
Wren Roberts:
Several things. Let's see, where do we want to start? If we look at the continuum of mitigation, preparedness, response and recovery, there's a lot of different components in it. And I know Tiffany has a great component around recovery and things like that, and I'm going to let you unpack that. But I think from a mitigation standpoint, oh, you can chime in and help me too. That's fine, because it is a team effort. I think from a mitigation and preparedness, first off, we recognized we had to have an interdepartmental committee, a steering committee, to where we could say, okay, we got to have a baseline. Let's make sure we understand the entire scope and how comprehensive is this. So I think that's how it started. And from that, we created some subcommittees. So within those subcommittees, we're looking at the physical environment, we're looking at caregiver education and deescalation.
We're looking at data collection and reporting. And then talking about, we have a committee about communication, signage, all those pieces. So those levels of subcommittees are doing specific targeted work that roll up to a comprehensive package. So some examples, so if we take our Physical Environment Subcommittee, so we're thinking about things like badge readers at entrances, video surveillance, not even in the building, but exterior, maybe a parking lot, a call box in the parking lot for caregivers if they're walking a distance to get into the hospital. So those are some examples. And I mentioned earlier we've got 99 buildings. So how do you get your arms around that level of investment and commitment? It takes a team and that's not a six-month process. This takes several years to build and grow. And so we've been doing work in those areas, good methodical work, for really the last 24 months and still have a ways to go. But we're doing a lot with that. So badge access, video surveillance, panic buttons, those are some physical environmental examples.
So when we look at that level of a subcommittee, there's a couple of components. So with education, I mean, it's a critical part. So with education that helps promote the awareness. So we partner with our corporate director of emergency management, Joe [inaudible 00:12:58] and his fabulous team, to help do education around active threat and putting together level of detail up to and including things like "Wren, where in your office, where you work every day, what's going to be your safe space?"
Tiffany Lyttle:
I love that.
Cami Smith:
That. Oh, that is so important.
Wren Roberts:
So we want that level of detail as we educate and make someone aware, because what we don't want to happen, is you hear that announcement and it's a deer in the headlights moment. We've seen that. And in the industry, that's a lot of times what we hear about. So we are committed to doing a deep, deep dive to where that level of education awareness can't be done by just the Corporate Director of Emergency Management. That's true. Or Cami or Wren or Tiffany. So as we educate our leadership, we're expecting them to take that and incorporate that into their monthly huddles, their weekly huddles, talk at that level. So another example of that. Another component is CPI, Crisis Prevention Institute. We're partnering with them on training and educating our high risk caregivers. And we've categorized all of our caregivers into those different categories.
So with our high risk, we're primarily focusing on our ED staff, emergency department staff, our behavioral health staff, our security staff, nursing supervision, those where we've seen the data that shows the highest propensity for a threat or an act. And so with that, they go through online module training, which it doesn't stop there. This is not one of those things, Cami, where you can watch a video and say, check box, we're done, we're good, we're safe, we're good. They then have to take that knowledge and go through classroom training up to and including knowing how to deal with nonverbal intervention.
Cami Smith:
That is incredible because I've watched the videos, I've taken the surveys, I've watched the videos where you answer the multiple choice questions afterwards, and it is helpful because the questions help you step into a perspective switch. But gosh, to be doing that level of interaction as well, that's really cool.
Wren Roberts:
And it's a big lift.
Cami Smith:
Yeah, I'm sure.
Wren Roberts:
I mentioned earlier one person can't do this. So we have trained and had certified Centra caregivers to become CPI instructors. As a matter of fact, we have 10 additional ones that are going through training, August 8th, 9th and 10th, right here on campus. So it demonstrates that continued investment from our senior team that they take this seriously, they support the work because again, talk is cheap. It is. And so we've got to be able to demonstrate how we are evolving as an organization, and it's exciting to watch us grow and learn through that. And it's not easy. Like I said earlier, take a little bit each day, one step, one foot in front of the other to do that. And so I mentioned earlier that high risk bucket of caregivers, we still have a moderate risk, a low risk. There's components to that we'll be rolling out in the future for them as well. So those are such just some examples of some of the tangible things that we're helping steer and talk about at that workplace violence committee level.
Cami Smith:
Yes. Well, and it's so important to hear what is being done, even on that granular level because you hear these statistics and they're so shocking. And immediately your thought is what is being done, what can be done? And it's not an easy X, Y, Z. It's not a quick-
Wren Roberts:
[inaudible 00:16:27]. It's just not.
Cami Smith:
There's so much. And I think it helps to build people's understanding of the level, how many facilities we have, how many caregivers we have. It's just an enormous responsibility and an enormous cultural change as well that involves a community as well as caregivers.
Wren Roberts:
If you think about all of those campuses that we have, not every campus has onsite security. So think about our CMG sites and they do great work. So we have to build and craft plans that still work with the resources we have. There is a paradigm, I call it a legacy paradigm, where there's an expectation that I need to have a security guard in line of sight at all time. It's not reality.
Tiffany Lyttle:
Yeah, it's not.
Wren Roberts:
It's not. And so that's why we have to be able to unpack all this and make sure we build a robust education process that we can then evaluate continuously to make sure it's effective.
Tiffany Lyttle:
And having that plan is so empowering too, because-
Wren Roberts:
That's very true.
Tiffany Lyttle:
... There are steps I can take to get to a place of safety and to take care of myself and my community and my patients.
Wren Roberts:
Agreed.
Cami Smith:
So you mentioned a recovery. And so Tiffany, I would love for you to elaborate a little bit more, and I'm assuming, I hope I'm not speaking ignorantly, but I'm assuming that's for those who have reported or those who are suspected of maybe experiencing and not reported, because that's such a huge number we're seeing.
Tiffany Lyttle:
It is. And the reason that that span is so big, 20 to 60% are expected to have under-reported, it's because we really don't know. We don't know who's staying silent. And like I said, healthcare workers come into the workforce with that kind of tacit expectation that something will happen, that we will be hurt. And the thing is that most other careers, people don't go into it with that expectation. If I decided to have become a, say real estate agent or an attorney or someone who ran a bakery, I would not go in with the expectation that I would somehow be abused, bullied, or threatened. Healthcare workers are a little different breed. We come in here knowing that we're dealing with people in pain and fearful, and sometimes with neurodivergence that will create situations where they become fearful and strike out. So in the event that something does occur, and I have so much faith in what Wren and Joe are doing, I just really do feel so much safer in knowing that they have taken over these reins and are just doing phenomenal things within our organization.
My year working with nurse wellness, what we have discovered is that it's very difficult to find a place of higher health. And to say probably Maslow's hierarchy of needs is really the visual picture I have in my head, where we start in one place and as we are able to address our needs for food, safety or shelter, water, hydration, our biological needs are met, we move up to that next level. So when I do rounds, a lot of the times our healthcare teams talk to me and they tell me, I'm fearful, or this happened, or I was punched today because I could not give an order for something because that's outside of my scope. I can't give those orders. And I realized that we really needed something for taking care of our teams if they experienced that violence, because we can't expect them to get to that level of self-actualization if they're still living in fear.
So remove the fear and bring back that health and wellness and that approachable health and wellness. I looked out there for any models for this, and there really aren't. What I did find was through the FBI, they had a mass casualty situation with a recovery method for that, and that really wasn't fit for what we were doing. So we here at Centra just came up with one. It is a toolkit response for any healthcare team and leadership because the leadership is also integral in being able to walk our teams through those steps of not only reporting, speaking up, because as we speak up and we normalize the reporting process, we create a band of safety, we identify those potential barriers for the next person that might walk in the room. So I might know that so-and-so gets very agitated with this certain noise, or if I do this, but the next person to walk in after me may not.
And we need to be just as protective of our whole team and not just the next person we're handing off report to. So we identify those barriers and normalize the reporting experience because we all deserve to be healthy and safe. The second part of that is leading them through the process of identifying what's happened. Sometimes we just need that space. We need to call our loved one and go through our mental cues. Am I okay? Am hurting anywhere? Am I feeling okay? How do I really feel about what just happened? Can I shake it off? Do I need a minute? So giving them them that space. And then of course, those additional resources, and we all have it through a QR code. It can be printed on any facility, at any time. QR codes for resources for now, or resources for later, and resources within Centra, resources at a state level.
And also additional information from our chaplaincy because they're well loved and trusted. And Darren's team just does a phenomenal job of taking care of our teams. And our health works, of course, because they're phenomenal too. And Dee Rainey has done amazing work with our teams. And then even further on beyond that, our national hotlines for crisis intervention or suicide hotlines, having those sorts of resources as well, just in the event that we need help. But we've also included in this packet, because we did realize that a lot of times it is disease process and not person. We wanted to make sure that there were different areas to glean information from. So the National Institutes for Health or NIH, provides a lot of great information about how to take care of someone with maybe a dementing illness or a neurodivergence and how to keep the stimulation levels at a minimum. So we do have that included in the packet too, just in case.
Cami Smith:
That's incredible. I think that you think about the people who fall through the cracks and they are so often the unseen pain that can have an outburst or a situation that puts other people at harm intentionally or unintentionally. And so I think seeing how Centra is going out of their way to take care of both sides of the situation is so encouraging, because there are two sides to the situation. Doesn't make either okay. But that that's the reality of workplace violence is that you don't expect it and you probably hope that it won't happen, but to know that there are people ready and waiting with proven techniques to help you. Have you had any instances even recently where this has been put into place and how has that gone? Because we've gone from things like that not being available, and we've talked about resiliency and retention, and so having these in place, have you seen an impact?
Tiffany Lyttle:
We have, and I won't identify the groups that have called for them, but we have actually started integrating them into our Code Lavender response carts, which is probably a whole other podcast. But yes, it is the response carts for our teams when they're in distress so that they have, I was talking about Maslow's hierarchy, we make sure that they have snacks, they have hydration, they have resources for now and later. Sometimes we just need some space and to be able take that eight minutes away, but we wanted to make sure that those were integrated onto the carts and they have been utilized. In fact, we've had team members that have reached out to the local resources afterwards too, to make sure that they had follow through and that someone had called them and made sure that they were okay. And that's an important part of being not just healthcare givers, but also receivers, and making sure that we're healthy enough to take care of the people in our community.
Cami Smith:
The cart, I think, is especially important because you are more able to assess your own needs and even what you may have just experienced; if you're in a better mental place. And so to get them into a better mental place, so that should something happen that could jolt them, they can take appropriate actions, which is what I wanted to talk about specifically for those who are listening. How do you report if this has happened to you? So I mean, with all the work that has been done, this may be really well known, but in case there are those who are not sure, you've had an experience where there's been some level of violence, some level of assault, whether bullying or more extreme, what do you do? Where do you go?
Wren Roberts:
So let me start off by saying when you verbalize, you mobilize, and so you have to speak up. So we want them to go to that immediate supervisor. I could be on the 7P to 7A shift. So it may be a charge nurse. That's where we start. Again, find someone to report it. So there's some immediate things that way. So verbalize means to mobilize. So that gets it started. We have a wonderful platform that the organization has in place called RL6. And so we document, and that's part of our data collection, which is one of our subcommittees. So that's how we get the robust data. So everything that's reported would be funneled into RL6, and that's the repository for next steps.
Tiffany Lyttle:
No, that's fantastic. The only other part of the response toolkit is that we do have that leadership infographic that helps our leaders be able to walk their team members through it. Just because being a brand new leader sometimes can be intimidating. So to know, like lead your team member to the RL6, make sure they've had an opportunity to take care of their physical wounds or emotional ones. Let them talk to their person.
Cami Smith:
Yeah, that is very good to know. And for those listening, to verbalize, to speak it out loud, acknowledge that something that is not okay is not okay. Is there any other aspect that you think would be important for our listeners to know?
Wren Roberts:
I Would say, I'll jump into the pool on that one. 8,000 caregivers here at Centra, we are part of this community.
Cami Smith:
So we are the community, right?
Wren Roberts:
So we are and so we want this community to be the safest community possible. And so all of this work has a purpose and we take it very seriously. And we're not perfect. We're going to continue to pursue safety and excellence. And I'm excited about the journey that we're on and the progress we've already made.
Tiffany Lyttle:
That's right.
Cami Smith:
I did want to share because I think that this is really incredible, so the legislation that you briefly mentioned earlier, that was passed just the beginning of this month on July 1. So back in 2019, the Virginia Assembly, it strengthened the protections for healthcare workers by making it a class one misdemeanor to threaten, kill or harm any healthcare workers while they are rendering care in a hospital, emergency department or clinical facility. And then just recently at the beginning of July, they extended that protection to providers rendering care in all healthcare settings. And so I think that's really pivotal for our healthcare workers and also one of the reasons that we want to help push this into the spotlight, the initiatives, the care, but also the fact that we see them, we see you, we see that this is a thing and we're doing something about it.
I would love to also encourage those of you who are listening, we have shared some of these statistics as well as the legislation and even some of the things that Centra is doing to care for our caregivers as well as our community, on our social channels, on our newsletter Centra Today. We have actually have a nurse sharing her personal story. And I encourage you to go check that out on our website. There's so much to this. This is just such a scratch on the surface. But I love that we get to talk about it even a little bit. So thank you guys so much for coming in, and thank you all for listening today on &So Much More.