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The cost & courage of caring - stories that spark resilience.
Welcome to today's episode of the caregivers podcast today We're joined by Kelsey Springer
otherwise known as the no violence nurse a critical care nurse and Montana State
University nursing instructor Kelsey turned her own brutal ICU assault and recovery into a
national call to action for caregiver safety She embodies the frontline caregiver who
refuses to normalize harm her lens is nursing but her message is universal
Caregivers cannot thrive if their workplaces are violent, be it physically, emotionally,
or organizationally.
Kelsey, welcome to the show.
Kelsey, welcome and let's get right into it.
Yeah, thank you, Mark.
So tell us a little bit, what did it feel like when you went from a nurse who heals to a
nurse who was harmed?
Tell us about that impact on you and where it took you.
Yeah, so it's been a long process.
I think, you know, in the initial moment of it, I couldn't believe it, and I don't know
that I even let myself believe it.
And over the last few years, it's been just over four years now since I was assaulted, and
that...
shift in my identity and who I am, you know, as an individual and as a nurse has really
changed a lot.
um And not necessarily in a, you know, overall negative way, but just my perception of
what I am as a nurse um has really, really changed.
almost sense that there's some new boundaries established around you in moving forward.
Can you share some of those?
I think one of the biggest things, and I think this is kind of a phrase that has been
coined by many different people in many different um things, the thought of I am a human
first and a nurse second, um or potentially even a nurse third, fourth, fifth, with some
other identities kind of coming into play.
um I don't think I ever really.
recognized that I was putting myself as a nurse first.
That was fully my identity and kind of my entire life revolved around that.
And now I have really just learned the importance of kind of being me first as a human and
um kind of separating some of those things because as soon as I lost what I had felt my
identity was,
in being a nurse, kind of lost a little bit of myself just in that initial moment.
So was a really big eye-opener.
think that happens to caregivers a lot where we're not used to creating that room, you
know, affords space for self safety and self care and other things that we identify so
much in our caregiving roles.
For someone who's never worked in providing care for the sick in a hospital, when we talk
about workplace violence, what does that actually look like on a normal everyday shift?
Is it always looming or is...
Are these one-offs that are just kind of like earthquakes and then in between it's sort of
calm or is there a new awareness?
You know, that's a great question.
I think that's something that is so important, especially for people who don't work in it
to understand.
I think there are elements of it that are always looming.
ah And then there are the extremes that are kind of, I don't want to necessarily
categorize them as one-offs because we have seen in data and research that these big
events aren't necessarily one-offs, ah but they're not happening as frequently.
I think the potential and the, what I kind of like to categorize as the near misses, those
are happening all the time.
And the kind of more low level violence that doesn't necessarily create a significant
injury in the moment that's going to be life altering in that moment, those aren't
necessarily happening every day.
But the things that are building and progressing and ultimately still are life altering,
but almost in a little bit more of a sneaky way, those are absolutely happening every day
in some areas more than others.
But I think just when you're taking care of humans in general, um there is a lot of risk
and a lot of things that are happening that we just don't recognize.
There a lot of things unpack there, but you speak of these chronic little micro hits that
sort of amass and potentially sort of form uh once enough of them ah occur, sort of a new
weight on your shoulders.
So maybe we'll be able to get into that a little bit further.
Because what I'm hearing is that there's always that sort of looming sense or looming
awareness, which um is not something that's intuitive.
And certainly from the pure caregiving point of view, it's not how
caregivers think.
It's framed in the, in sort of the wholeness of the approach to caregiving that we are
drawn to, whether we're physicians, whether we're nurses, whether we're social workers, I
healthcare providers and social workers uh come right after law enforcement officers in
terms of the frequency of workplace violence.
So it's real and it's looming.
So you survived this event in the ICU and it certainly changed your body and your work and
your life.
But in the days that followed and the weeks that followed after that, what were the
emotional and sort of psychological
events that followed.
must have been um something that really sort of made you second guess perhaps your
vocation or just how you've been doing it all along.
Yeah, and it's interesting because I have historically always worked in really high stress
environments.
So working in the ICU, working, I was a flight nurse on a helicopter for a while.
I have always kind of gravitated towards these environments that require you to kind of
push some of your own personal feelings aside to be able to.
stayed vigilant in those areas.
And so I think initially I, and also, you know, this was in the height of the pandemic.
So was 2021, mid-summer 2021.
So I was already, you know, in the throes of kind of that emotional weight.
So initially I don't know that I...
really had or even started to have my emotional response um until probably about a year
later ah for a couple of reasons.
I think that self-protective um thing just naturally came about because I was used to
that.
um I was already pretty emotionally burnt out and exhausted from the pandemic, so I didn't
really allow myself to have any more weight of that.
But also I was in the midst of finding
how to treat my physical injury.
Because one of the things I discovered from this was I ended up having a very...
um
I don't wanna say unique, but an injury that required me to actually seek care across the
other end of the United States.
I'm based out of Montana and I had to have surgery in Florida um because I had such a
significant injury to such a sensitive part of the body that there's not a lot of surgeons
who want to um do surgery on your jaw joints unless they highly, highly specialize in it,
cause it's such a high risk thing.
uh Ultimately, it took me almost a year to find the right treatment uh provider.
That was really exhausting.
Being the patient really took priority of my physical injury versus that emotional injury.
Then once I really had my treatment team nailed down a plan and uh had my jaw surgery,
that was really when the emotional stuff started to unpack.
think because I could put
my energy um towards that, because I had a treatment team I trusted to take care of the
physical part.
um And then that got really, really intense for me.
But the one thing I did do right away was seek out therapy, because I knew that I would
have a pretty big emotional response to this at some point, and knew that I needed to have
um the right ah treatment team for that as well.
That's an important message to share with our listeners because the physical injuries are
often obvious from the beginning, but then the emotional wounds sort of multiply and then
eventually emerge and they could really catch us off guard and they can sort of spill out
in multiples and overwhelm our ready tax coping mechanisms.
Before this all happened, and I mean, I think we don't think of ICU assaults as being as
common.
always think of the hustle and bustle of an emergency room.
um or some other uh large volume encounter with different individuals from the public who
might come in with in different conditions, which predispose to risk for assault or injury
or violence.
But the ICU is certainly different.
But when you look back, where there's sort of distant early warning signs from others'
experience or moments in the ICU when you realize that violence was becoming more and more
part of the job, even though it really shouldn't be.
Was there a storyline that was kind of emerging over time that we were like, what's going
on here?
This isn't supposed to be this way, but it's happening.
Yeah, so it's interesting because looking back and honestly reflecting back on my entire
career and that started when I was 16 years old working as a CNA in a nursing home.
um It was probably within the first month of working as a CNA in a nursing home at 16 that
I experienced my first violent event um as a healthcare provider.
But until I had the event that absolutely changed my entire life,
I don't think I recognize the gravity of what could happen.
And so I think this is for so many of us out there, we do accept certain levels of being
yelled at, being grabbed, being not necessarily the physical punching bag, but sometimes,
but being kind of that emotional punching bag for our patients because we know, and
especially in the ICU,
we know that our patients are typically having some of the worst times of their life.
No one's really having a good day in the ICU unless you're getting out of the ICU.
ah But even then, you've probably just gone through something pretty traumatic.
so I think we have certain levels of, I absolutely understand when my patients are having
a really bad time.
They're grieving, they're stressed out, they have no idea how they're gonna handle what's
in front of them.
So there's certain levels of
you know, just being present for some of those moments.
But then I think it naturally just bleeds over into this world of, now our patient, their
family, friends, they're no longer just having a bad time around us.
They're having a bad time and taking it out on us.
And I think the line is totally blurred from when they go to having that bad time and
we're just present for it to us being the receiving end of that.
And I think that is something that we just take on day after day after day and we learn to
absorb it.
But we don't necessarily learn where that boundary is of, you know, I'm OK if you're going
to, you know, cuss and swear in the room and have all these, you know, just really
colorful moments, but don't take it out on me.
Don't direct that at me.
um But we're not necessarily
trained on how to understand where that boundary is or to recognize when it's escalating
to the point of, okay, we're no longer just grappling with this horrible diagnosis we just
got, and internally handling it.
Now we're to the point where we're ready to be external and start taking it out on people.
And us as care providers, we're not necessarily trained on how to recognize when that
shifts or what those signs are.
and when we need to really clue into setting those boundaries and how do we do that safely
and appropriately.
um So I think the ICU is a prime example of somewhere where we don't necessarily think our
patients are going to be high risk for violence, but it's probably one of the most high
risk places because we have such high levels of distress and altered mental status.
grief and all these various things that are absolutely risk factors for violence.
You know, a lot of listeners won't recognize the fact that even someone who's in the ICU
who's quite frail appearing when they're delirious, it's amazing how much physical
strength in a moment can be released in a state of delirium.
And the impact can be huge.
Patients are strong.
Even frail elderly can be very strong when delirious.
it's probably underappreciated actually.
But can you tell us a little bit
about um what you experienced and how these things unfolded and looking back, are you able
to sort of tell us what could have been the moment where you could have stepped back now
that you know everything you know?
Yeah, so when I was working in the ICU at this time, I was the charge nurse in the unit.
So was there to kind of direct the team, support the team.
And I was working with a great crew of nurses that day.
We had a normal mix of patients on our unit, normal, pretty typical diagnoses that we see
in our unit.
So really nothing out of the blue in that regard.
We had a particular patient who um was experiencing a form of delirium.
So, you know, they were not aware of, you know, where they were, what was going on.
um And ultimately they were scared um as many of our patients are.
You're in this, you know, environment where there's all this equipment, all these noises
and people that, you know, may seem as a threat to you.
And that's exactly, you know, we were the perceived
perceived threat for this person.
And they were defending themselves from what they perceived as threat to them.
And ultimately um what ended up happening was this patient did um strike me in the face.
So they uppercut me with their forearm and hit me in just a manner that had enough
strength um to dislocate my jaw.
um And it took
that year long process ah of finding the right care team, getting the right imaging and
all these things to really learn just how badly I was injured.
I think the adrenaline in the moment and again, the ah reality of I never in my wildest
dream could have imagined that I could have been hurt like that on the job.
So until I truly had the imaging and the diagnoses and all these things.
I didn't believe, even though I had the physical feelings and inability to chew, I had
constant jaw dislocations after this.
I knew I was hurt, but I just couldn't conceptualize and put those together.
um So I had severely damaged my jaw joints to the point that they needed to be
reconstructed just from that one moment right there.
And I...
I will say one of the biggest things that I have done therapeutically is not to
necessarily look back and tell myself if I would have done this, none of this would have
happened um because I just don't think that's beneficial for um me and my healing.
um But I've learned a ton from that incident and doing my own research and various things
that I know
things that I would advocate for and do differently um if I was put into a similar
situation again.
um And I think one of the biggest things, and this is something that I encourage, um you
know, I have kind of a list of questions that I commonly tell people to bring to their
employers, whether it's in a job interview or they're starting a new job or starting a new
unit, or if they just never address these things when people ask me like, what can I even
do?
And one of the big things is ask your leader, what are the expectations of me if I'm in a
situation where it becomes violent?
Am I supposed to stay in the room?
Is the patient's safety coming first?
Is my safety coming first?
And how do I differentiate when?
you know, where that line is.
um And I think, and I'd have to look um up the specific provision, but in the um ANA code
of ethics, you know, for nurses that we all follow, um there is a provision that
explicitly states that, we need to put our safety first and not before, you know, putting
ourselves in harm's way.
And having worked in um some forms of EMS, you know,
and even just taking a BLS, a basic life support CPR class, the number one first rule is
scene safety.
If it's not safe, don't go help.
ah But for us working in the hospital setting and especially in the ICU, it's typically
not that our scene isn't safe so we don't go help, it becomes unsafe when we're in the
middle of patient care.
And so how do we handle that situation where
by us leaving, our patient could potentially end up getting hurt.
And that's a huge ethical moral dilemma for us, especially because we don't typically have
these conversations before something happens.
We have the conversation afterwards.
um So that's one of the biggest things that I just want to encourage is have these
conversations before, because it is inevitable, not necessarily that my exact situation,
but it's inevitable that something is going to happen.
Maybe not to you, but something on the unit.
So let's have these conversations early instead of retroactively.
other learnable skill sets, right?
And I think a lot of these questions that are starting to arise in modern healthcare
probably merit some representation at undergrad, even post-grad curricula, whether it's in
nursing, uh medical school, other schools of healthcare, school of social work, even
probably PT and OT, because you're in close contact with patients recovering from harm,
trauma, and other things.
um And I would suspect that in these cases, and I mean,
Our listeners probably won't all be able to appreciate what it's like when things go awry
in the ICU and someone's sick and there's lots of different things going wrong.
But I think that image of the calm healthcare provider who's overseeing a crisis situation
stands out in people's mind that people are trained and trainable to become those kind of
leaders in the environment.
And I think at the bedside,
Nurses and care providers can be trained or equipped with a tool set, as you mentioned,
and those tool sets are informed by the same suggestions that you suggested would be very
suitable questions to ask of your employer.
And um those build the prefrontal cortex of the moment that allows you actually to think
while your reptilian brain is kind of in overdrive in the acute setting of whether it's
trauma or a very unwell delirious patient with all the alarms going off.
It allows you to take a step back and then also find some cognitive space for, I safe in
this environment?
But until we practice doing that, it's not obvious.
Absolutely, and I really equate it to, you know, the thought process of universal
precautions.
When we think about taking care of patients who potentially have some kind of infectious
disease and, you know, being around patients and bodily fluids.
And it really does...
go towards all of those care providers that you were just talking about.
So anyone that is going to interact with patients is trained on these basic universal
precautions of hand hygiene, wearing gloves, various things like that.
Having this basic assumption that every single person we come in contact with could have
something that could be harmful to us.
So let's do these very basic, very easy rudimentary things to prevent the spread of these
things.
And that wasn't always the case.
I don't know exactly when universal precautions really became adopted, but before we
really had this process, there were a lot of these diseases and things that we were really
afraid of.
And so we just didn't touch patients or we kind of categorized certain patients as being
unwanted or just less than because they could have something.
so we.
know, our care was really poor to those patient populations.
But then we learned, hey, if we just adopt these very basic set of protocols and
procedures that we do, we can safely care for all of these patients.
We don't need to be afraid of them.
We don't need to be afraid of what we don't know with them.
We can just universally keep ourselves safe.
And I think this is the exact thing that could really be taken care of with a similar
approach, you know.
And I think that's where we're really at this standstill of we don't necessarily want to
talk about it ah because we don't want to deter people from going into healthcare because
it's scary.
And that's one of the things that I've grappled with at times of sharing my story.
And I do teach at the university level in a nursing program.
And one of the things that I've learned is when I share my story, initially people are
like, my gosh.
m
and you're still a nurse?
And I'm like, yeah, absolutely.
Because I've learned a lot from it.
And there's a lot of things we can do to prevent this.
But we need to talk about it.
And then we need to develop that standard universal approach to it.
And then we all are equipped with these tools to just basically keep ourselves safe in any
situation.
It's not about the resilience.
keeps coming up with more and more people that I meet and speak with as the resilience is
there.
And it's not like you need to teach individuals to be more resilient as you need to build
the framework around them to make that resilience sustainable and safe.
spoke about fear and other things.
mean, events like this are obvious, but along with those same questions, you'd advise a
young nurse to ask of their employer in terms of, you know, the hows and whens and how do
whys.
about certain scenarios as they arrive when there's risk of harm.
But the other issue is always, well, what do I do if smaller harms occur?
Who do I turn to?
How is it reported and how is it acted on?
So, you know, often staff just sort of stay silent and when they're scared or harmed and
don't do anything, but what would be your advice or what do you see as being the ultimate
framework to have operating for healthcare?
providers facing this.
Yeah, and I think that is probably one of the first things we really need to get ah nailed
down in terms of what we're doing consistently is that reporting.
Because, um you know, one of the phrases that we have in nursing is, if you didn't chart
it, you didn't do it or it didn't happen.
So if you don't report it, it didn't happen, not, you know, to you.
but nobody else has any reason to think that there is a problem if they don't know about
the problem.
And going as far as having that formal reporting system keeps everyone accountable.
um So it is one thing to go and report something to someone and just make a quick
unofficial verbal report.
But if that's not done in an official manner that is going to be taken up
to the right people and documented and kept for kind of reflective action, then it's not
necessarily going to do anything.
ah But it's a really multifaceted problem when it comes to reporting that I found in
multiple different kind of studies that there's a lot of reasons why nurses aren't
reporting.
And one of the biggest things is that they don't feel like anything is happening once they
report.
that may or may not be that something isn't happening, but they're not hearing about it.
And I think that's one of the biggest things that leaders can really do to not only make
sure that things are being reported, but to actually really engage with their teams and
show that they do care is by just following up and letting them know, hey, you're probably
not gonna hear the ultimate outcome of this, but.
this did go to our quality and safety team, or this did get documented in our formal
register of these events that we plan to look at at the year end every year and report off
to whatever entities.
Whatever it is to know that, this report didn't just make it to my inbox and then that was
it, it went to that next step.
I think that's one of the biggest things.
to encourage and keep people reporting is knowing that something, you know, it is going
somewhere and it doesn't just feel like they're kind of crying wolf.
Because the other part is um nurses do a lot of documenting, a lot of charting.
And the last thing we wanna do after a 12 hour shift or in the middle of a 12 hour shift
is do a whole nother set of documenting and charting.
um And depending on what that reporting system is, it might be really easy to use, really
quick to put in kind of the objective facts.
or it might be really cumbersome.
So if you're never gonna hear an outcome, why would you subject yourself to taking more
time to doing all that if you don't think it's going anywhere?
And then that also goes to touch on, you know, one of the other big things is how easy is
your reporting system?
And is it really built for these types of reports?
Because we have, everywhere that I've worked has had some kind of a reporting system for
safety events.
whether that's with patients or patient errors or near misses or maybe an equipment issue
or something like that.
But a lot of them aren't necessarily built for these types of reports.
So it can feel really clunky to try to put in this report.
And you're like, well, many of these questions actually ask the right question for what
was going on or give me the right space to put this into a report.
And the other part of this that I think is really, really huge is there's no national
requirement here in the US for reporting these events.
So there is no reason for organizations to encourage this reporting from a national
standpoint.
So organizations really need to have a reason themselves.
um So whether it is following up on nurse satisfaction and all these different things, um
But I think that's a really big barrier.
And there's some individual states here who do have reporting requirements.
But those all vary as well in terms of what would be considered reportable.
So there's a lot of work that really needs to be done.
And when it comes to making national standards and things like that, I think there's a lot
uh of gray area.
ah But I do think just requiring reporting of these safety events um
is a really big first step to me.
I've recognized the importance of the debrief from uh the one ups, the managers involved
in the unit or what have you.
you know, being a manager doesn't mean you're a leader.
It's the debrief, it's the checking in, it's the accountability and the follow up that
makes leadership because that applies to every person on the team thereafter.
And that's where leaders shine.
um
I suspect that there are a lot of these sort of invisible hits along the way that may also
never get reported, but also sort of amass and result in extra weight on the shoulders of
nurses or healthcare providers in different arenas.
And those are probably things that the public really don't understand.
What do you think are some of those invisible hits and the subtle hits of even violence
that...
don't really sort of look mainstream, but you just kind of still experience them.
Absolutely.
I think, and these are some of the things that have, that really lead to the burnout and
the moral distress.
And that's what's really destroying.
That's the normalization of violence,
Absolutely.
And that's what's destroying our workforce.
know, in, you know, here in the US, we talk about having this nursing shortage.
And I think when they, when they talk about this, it's not that we don't have enough
people trained to be nurses.
We don't have enough nurses who still want to work in nursing.
these things, yeah, yeah, globally.
mean, I think it's, you know, it's a humanity thing.
And I think when we look at this,
These invisible hits are what drive a lot of that.
We just looking back, you know, throughout my career and the different things, there are
so many instances I've had with patients that um my mom is a nurse and so I can talk to
her and she understands, uh but I have many other family members that aren't in healthcare
at all.
And it would be so hard to even tell them like what patients have called me, things they
have threatened me with, threats that I've gotten from family members, ah friends of
patients, um things that are just said in the moment that you're like, you know, I
understand this is probably just very much driven by the fact that you just got a terminal
diagnosis.
And deep down,
probably know that you don't mean whatever that is to me, ah but you're still saying it
anyways.
And I'm still going home at the end of my shift, just having been berated my entire shift.
And those are the things that we're not trained to recognize that that actually, even
though consciously we know that it's probably, you know, we know it's not true and we know
this patient doesn't, you know, we're a total stranger to them.
So.
They don't know our background.
They're not making any truthful comments to us, but they still build up over time.
And we're not trained to recognize how our outer shell just gets broken down and broken
down over time to the point that now we are really burnt out.
We have major compassion fatigue and these things now are taking it home with us.
um And these are still violent things.
Physical violence is not the only form of violence, but I think we're so stuck on that
that we don't see the emotional toll that it's taking on us.
And then we're less able to really tune into understanding when things are truly
escalating because we're so used to hearing all this stuff all day long or having these
patient interactions go a certain way that we don't, you we just normalize it.
So then we don't really clue into, gosh.
about 20 minutes ago, things actually really shifted.
We're no longer just having this, I'm kind of, you know, taking some of my anger out on
you verbally.
Now I'm actually really getting ramped up and now there's, you that line has been totally
crossed and we just don't recognize it.
No, you're absolutely right.
And I think that can also be taught and there can be a lot of very important contributions
from maybe more advanced level teaching.
mean, you sound or the environment that you sometimes face is one where
Navy SEAL or Marine needs to show the same self-discipline and discipline to the mission,
so to speak.
And if healthcare providers, when faced with situations like that, could be trained with
some of the skill sets that are afforded to some of our lead individuals that we count on,
ah I think a hybrid version could really pass on some important skills for individuals to
cope with those situations.
I mean, those are not...
acts of physical violence, but they're violent interactions.
And those violent interactions verbally or emotionally uh need to be parceled and dealt
with.
Otherwise the PTSD, the anxiety, the sleepless nights, it all sort of factors in.
Switching gears a little bit, um because there's also that sort of background which,
depending on how cohesive the team is, and again, going back to what is considered
fair game on the team and what's not and how much leadership is involved.
But um I've never thought of it in the ICU as much.
I've had very positive experiences as a resident and staff in the ICU.
I've always felt that sort of team element.
But once there are shortages of personnel and your patient's nurse ratios go awry and
everybody's got that next layer of stress,
How does bullying or incivility between ICU nurses, does that ever creep into the
equation?
It absolutely does because when we start treating each other as colleagues poorly, we, you
know, there's really no limit to what we'll accept from our patients and family members
too.
And we set that tone of what is really expected um for just general treatment across the
board.
um
But also when we bring in those thoughts of that bullying and incivility, and especially
with our new colleagues who are new to our unit or maybe new to healthcare altogether, or
maybe colleagues from around the hospitals, parts of our interdisciplinary team, when they
come in knowing that this unit, hey, they're kind of known for having this bullying
mentality.
Toxic, yeah.
Yeah, we're already breaking down these barriers.
So then,
when we do have a critical event happen, we're already not communicating well just at the
baseline.
And then a critical event happens and communication is one of the most important things
when it comes to handling critical events.
So our communication is broken down because we're just not being nice to each other.
This critical event is happening and maybe it's a code or our patient's not doing well.
or it's a violent event.
So now we've got this patient, family member, whatever it might be, that is now a threat
to us and we're all not communicating well.
So everything's just already broken down before we even get into the scenario.
um But we're also afraid to bring up when we need help, we're afraid to say, hey, I've got
a patient that I'm a little concerned about for whatever it might be because we can't.
safely go to our colleagues because we're not treating each other well.
So the risks just kind of exponentiate for these violent events and patient safety events.
um We know that uh studies have shown that our nurses are higher risk of making mistakes,
especially our newer nurses, when they don't feel confident asking a question because they
feel like they're embarrassed that it might be ah
something that they should know and so they don't want to ask the question and then a
patient gets harmed because of that.
um Or they feel like they should have to be able to handle a situation themselves and
they're going to be seen as weak if they do ask for help.
ah So when we start letting this kind of interprofessional violence to occur by ways of
bullying and that incivility, then we really reduce our chances of being able to handle
any of these situations well.
and especially being able to prevent these situations from happening.
You know, the idea just came to me listening to you.
hear the circulating nurse in the operating room who sort of runs the show and speaking
with Darlene Jackson, the head of the Manitoba Nurses Union a couple of weeks ago, she
spoke of having nurse mentors on units who are not involved and charged with patient care,
but are there to help in those exact scenarios.
And they can be navigating across the different parts of the unit to just make sure those
young individuals have.
resource who's not already overstrapped and maybe burnt out to turn to so that there's a
really harmonious encounter to pass on that new knowledge so that that young learner, that
young nurse uh who's just starting, maybe empowered earlier on without the hacking away
from just negative ah sentiment or negative experiences or feeling faulted for asking.
And I think that applies across all healthcare learners.
whether you're the new medical student, the new resident, the new nurse, the apprentice,
whatever.
What do you think about that?
Yeah, I I think that's a great, great concept.
And I think that's something that we have seen.
I've been a nurse for 10 years and worked in healthcare since I was 16.
And one thing I have seen a big shift in is breaking down that kind of hierarchy structure
of having, whether it is provider to nurse or senior nurse to younger nurse, whatever it
is, really breaking down that negative
interaction just because you have a quote unquote higher title or more experience.
And that concept of nurses eating their young has really gone by the wayside.
And I think it's really important that we do foster from the very beginning.
And I've seen this a lot in our new to practice nurse programs of actually creating these
processes of, hey,
We know, you know, for those first six months to a year, you're gonna continually be
having all these questions and all these things come up.
So how do we create a program to support you from the very beginning so that you know
exactly who to turn to and that you're surrounded by your colleagues who are also in the
same boat um and don't feel isolated?
I think that, and that's inspired leadership that makes those programs come to life.
And we would hope that, know, organizationally that would be bought into across the
nation, right?
I mean, that's, you'd want your company to be run that way.
Why would you not want your hospital to be run that way?
So, or I think you hit the nail on the head of organizational responsibility is so
intrinsic at different levels of leadership all along.
And it's not just a question of the individual's resilience
the junior person's resilience and that's not the common denominator.
Asking for help is not a sign that you're not resilient.
I always told medical students as they were finishing saying, you know, what will keep you
as safe?
The young doctor or young resident is knowing what your limits are and knowing when to ask
for help.
And what a shame to not be able to feel that you're being judged for asking for help in
those scenarios that you alluded to.
Yeah.
So if you were advising,
hospital leadership tomorrow, what would be the sort of the, I don't know, three concrete
changes you'd insist on to reduce workplace violence and just improving the overall safety
in reporting and safety in the moment?
Yeah, I would say the number one thing would be a comprehensive, kind of all-inclusive
de-escalation program.
And when I say comprehensive and all-inclusive, I mean not just for your direct staff that
are always working bedside, but for all staff that are gonna be in patient care areas.
Because we know when these events happen, you're not necessarily gonna have that response
team all readily available right in that moment.
So you need whoever is around you to be able to help support that violent event.
And having it be comprehensive means looking at the physical aspect of it.
We do need to know self-defense.
It's scary to have to think about that.
But if we're never trained and trained in ways that keep our patients safe as well, um
we're not gonna be able to have a good outcome.
ah But also that de-escalation piece
that comes from how do we build that rapport with our patients?
How are we interacting with patients?
And how do we learn not to escalate the situation ourselves?
That is one of the biggest things that I've learned from taking a few different
de-escalation courses was how to not actually myself escalate the situation, um which I
thought I knew how to do that, ah but I do not have a...
significant background in psych or really understanding the psych aspect of nursing and
not just talking psychiatric nursing, but just that emotional kind of piece of it.
So learning how to understand myself so that when I'm in those events that I recognize
where I'm being getting heightened and how that's maybe not helping my patient.
So I think that's probably one of the biggest things.
And then I think the second thing would be having that reporting system and having a
a very objective understanding of what is to be reported and have it be very broad.
Everything should be reported.
If you think you were having, you you were part of a violent event or an event that made
you feel uncomfortable, then it should be reported and having follow-up that automatically
goes with it.
And whether it's not, you know, that you're going to be clued into what that root cause
analysis that was done, you know, you as a bedside nurse might not need to be privy to all
of that.
But just having that follow-up of, I received your report, um and this is where it's
going.
ah And then the third thing would be how we're supporting our staff after an event
happens.
And so that follows right into that reporting.
And like you mentioned earlier, debriefing.
ah So having a comprehensive way and having the right people doing that work.
Not all organizations can afford to have
people that are trained in, you know, it'd be great to have like a staff therapist that
had the understanding of healthcare, but also was trained in, you know, being able to
truly debrief these events.
But making sure that whoever we put into that position, a lot of hospital chaplains do
this, whether, and maybe it's leadership that's doing this, having them have formal
debriefing training.
And there's a lot of different options out there that are even just like a,
a single day class on how to debrief, but making sure that we're not just saying, hey, we
debriefed because we just chatted about this, but making sure that people know how to ask
the right questions and to clue in to whether or not our staff are okay afterwards and to
get them the support and help that they need so that they don't crumble later on.
maybe there need to be some new non-negotiable budget items that just never make it to the
chopping block, right?
If you think people first over profits, whether you're in a fully profit-based system or
even a nonprofit, um there's certain things that really shouldn't be negotiable.
And I think when those reports are taken seriously, that's where you witness the culture
shift, which is...
self-awareness and investment of self in the group and in the performance and the pride
and the quality of the healthcare provided.
It's in listening to your story and just hearing your comments, I get the feeling that
you've been in a pretty positive environment overall, but yet we hear stories of, how come
that only happens to you?
It doesn't happen to anybody else.
Or, you how come you're always the one reporting all these things, but no one else is or.
sort of gaslighting from leadership, from institutional leadership that can occur and it's
been brought up before in discussions and ah have you witnessed that as well or uh is that
a test to the variability and some places are better leaders than others?
I think it's definitely a test of the variability.
It's because I have experienced great leaders throughout my career, and I continue to work
with great leaders.
And I think that's why I have chosen to...
take what happened to me and not just try to put it all behind me, but to really move
forward with advocacy, to show what can be done when we take these things seriously and to
show how we can support and heal our health care providers.
uh We're never gonna be able to prevent every single bad event from happening, but there's
a lot of things that we can do to equip our teams to prevent things from getting severe.
um
And there's a lot of things we can do after an event happens to really not only make sure
that we look into what happened and see if there's anything we can do to prevent it, but
to support those team members.
I, you know, as I started to share my experience, I have heard so many stories from people
that are afraid to speak out for whatever reason, or just have nothing left in them to...
move forward with trying to be on an advocacy journey because they are so burnt and so
burdened by everything that has happened to them and had no support along the way that
they couldn't even imagine trying to make it a bigger part of their life.
They're just trying to survive because they've had such a lack of support.
And I think that's, unfortunately, I'm very thankful that my experience, I
I think I've had some of the leaders and experience, know, the experiences that I've had
throughout my healing journey have been really positive considering how horrible the thing
I went through.
And it's absolutely heartbreaking to know that this is not the norm.
You know, this is the exception.
And I, you know, it's part of my journey, a part of my, you know, passion to really push
this forward to
hopefully make this the norm, make the support that I got and the reflection and
everything, make that the normal.
Because I think that's where we really move the needle on outcomes uh overall.
management does not equal leadership nor does seniority leading to a rise in managerial
position equate with leadership or I suspect often leadership skills are not necessarily
considered in that decision making but you know it's huge.
ah
without leadership management, think, flounders especially, and maybe there needs to be
more leadership growing as you make way up the ranks in healthcare leadership and
organizations.
I would love to interview uh leadership at healthcare organizations to find out what
successful programs can be implemented universally uh in an organization to make sure
leadership in nursing and healthcare departments, et cetera,
the best chance of having successful outcomes.
mean, it's screaming everywhere, whether again, whether it's the NHS in the UK, whether
it's in the US and Canada, and I'm sure places elsewhere, it's going to be leadership
that's going to shift the curve, I think, in terms of people walking away from their jobs
in healthcare and their commitments in healthcare or feeling like there's no way out or
burning out or even worse.
we've heard stories of uh
will feel life's not worth living anymore.
What about under resource settings?
We've touched on this a little bit and my bias is that if you're invested in your people,
there are certain things that are not considered on the chopping block and cannot be
rationalized in terms of resources towards whether it's training or support or what have
you.
But for the under resource settings that really can't afford that same major security
upgrades and metal detectors and a whole lot of paraphernalia, but what are some of the
sort of lower
workflow changes that you might envision or would say could still make a meaningful
difference in, whether it's in the ICU or in the emergency room, which has certain
parallels, but though they're certainly not identical.
Yeah, so, and this is something that I think about a lot living here in Montana, because
we have a lot of rural hospitals and these rural hospitals have maybe a two or three bed
emergency department and maybe have a five bed inpatient area.
So you just naturally, you you don't have a lot of staff in those areas and they might be
so rural that, you know, the
the sheriff that covers your area, your law enforcement might be in a 50 mile plus radius
at any given time.
So the emergency response from law enforcement might be really uh delayed depending on
what's going on.
So I think again, that deescalation training, um I think there's uh many different levels
of programs and there's also some different free resources depending on where you live.
um I think those are great investments em
just to help teach your staff some of those basic skills.
But also doing that environmental assessment.
This is something that I really learned in my grad program, taking a healthcare design
class, which was actually thinking about what is our built environment?
Do we have our computer placed in the corner of the room where our patient now is blocking
our exit?
Or do we have our computer placed near the exit so our patient is not going to be able to
block us?
Do we have a lot of different things in the room that could easily be used as weapons
against us?
Or how can we secure things down better?
Or do we need to store all this stuff in the patient room versus having it in a cabinet
outside the room?
Different things like that, just thinking about our built environment and how do we lock
down?
How do we keep ourselves safe?
if we do need to escape, where do we go?
Do we have an area that's close by?
Do we practice this?
Do we know where our close by areas are?
um Or are we finding it out when the event is actually happening?
So really just having that forethought of trying to think about, what are some different
things that could potentially happen?
And are we prepared to respond to that with the staff that we do have?
And this is also where
thinking about working in these really tiny areas where you might not have a security
team.
So who do you have on site?
And are we training all of them in this de-escalation?
I think it's absolutely appropriate to be thinking about our environmental services, the
folks that are helping clean our rooms and keep things tidy.
Are they trained on it?
They might be one of the four people that is on staff in that hospital that night.
um So just really being creative with
what resources we do have and being thoughtful about that, I think can go a really long
way, but it means that we need to think about these events before they happen.
And we need to understand that statistically it is going to happen.
ah So let's not ignore it anymore.
and potentially minimize the impact.
Sure.
It just seems like healthcare workers safety at a much more granular level than the
calling of different codes you may hear on the overhead when there's a spill or a
wandering patient or um toxic exposure or violent patient.
mean, that's sort of big scale, but it's, as you say, in those moments, having a skillset
that's common, shared among all workers in the environment.
So that I would think that that's achievable with the right with the right curriculum and
very focused learning of high impact skills and definitely within the range of the
achievable.
What do you think?
I think it's absolutely achievable.
I think we just need to, I think we're at this stage where we see such a big problem and
so many different things that contribute to it that we're almost kind of, you know, we're
shocked by it all.
And so we don't know where to start.
And I think just starting anywhere is the right answer.
And I think it's absolutely achievable.
And it doesn't have to be those big grand things like putting in the metal detectors and.
tripling your security staff and having all these major shifts happen, there's a lot of
low-hanging fruit that can really make a big difference.
really love the lens through which you're looking at this.
It feels tangible and it feels achievable and I think this conversation needs to carry
forward many places.
From the perspective of a bedside nurse who's feeling really burned out and scared with
lots of things they've been going through, what would be one high impact safety practice
that you could point them towards and they could start using tomorrow before the system
has had a chance to change?
Yeah, so...
I think.
One of the biggest things that I always tell people is look towards your professional
organizations.
So for the ICU, have here in the US, we have the American Association of Critical Care
Nurses.
And they, know, we have professional organizations for all different types of nursing
areas.
And they typically have kind of highlights on these are the types of environments you work
in.
And here's some things that you can do to keep yourself safe for that specific environment
because it is highly individual in the environment you work at.
I always, that's probably one of the biggest things that I recommend is just looking
towards your professional organization because not only do they have resources for
prevention, but also resources for that burnout.
it just, you know, recognizing I am exhausted, I am not well.
and I just need some support and where can I go for that?
um Because I think overall, you know, we can't pour from an empty cup.
You know, we can't do a lot of things if we're just not well to begin with.
And I think that's a really, really important place to start.
spoke earlier about sort of the lateral violence and toxic bullying that can occur among
members of a team.
And we can't forget how that culture spills over to caregivers who are there trying to
advocate for their loved ones who are sick and who are going through a lot themselves and
how it creates yet another layer of a very challenging dynamic.
But caregivers also are at the bedside.
They're there as advocates.
whether it's in an inpatient ICU, whether it's in an emergency room, whether it's at an
outpatient clinic.
From your experiences, are there any practical prevention skills that you would advise
caregivers to be informed about so that they can approach situations in a positive way
that can help deescalate as well?
I mean, we all know that someone who looks to escalate something's probably going to
succeed because that's what they have in mind, but...
There are a lot of people who might say, I never expected it to amount to that, but
somehow it did.
Are there practical skills that caregivers can use to improve de-escalation and
communication?
Is there just a level of understanding that everyone needs to have?
think one of the biggest things, and this is something that I have learned a lot in my
current role as an ICU nurse educator, is just going into every situation with a genuine
curiosity.
So kind of checking our own preconceived notions at the door.
And I think that really applies to every
So whether you're the nurse walking in the room, whether you're the patient's loved one,
whether you're the patient, we can all, I think, bring a lot of these things down to a
working level.
And we're just genuinely curious about what each other are approaching the situation,
know, what the angle we're approaching from.
just walking in and asking more questions and being
genuinely willing to hear what the other person has to say and trying to understand where
they're coming from.
And I think this is something that is so hard to do, especially if you've been in
healthcare for a long time or even being a patient, being a chronic, you know, a patient
who's been in the system for a long time.
It can be really hard to walk into a room with that genuine curiosity to every situation.
but the more that we're open to truly understanding what is happening in that current
moment versus what's happening in the bigger situation, I think really helps make our
interactions a lot more cohesive and a lot less um of that breakdown in our relationship.
Absolutely.
And I think what I'm hearing from you is that we just need to acknowledge each other's
humanity.
Humanity between the patient, the caregiver and the healthcare provider.
And that's sort of the first step that we all bring something to the encounter and we're
not just individuals in a vacuum.
If you could speak directly, Kelsey, to a leader who still has this mindset that violence
is unavoidable.
It's just part of the job.
uh
What would you love them to understand from the human and financial costs associated with
violence in the workplace?
Oh gosh.
I would, I have two parts of my brain that want to answer this question, but I'm going to
go into- want to answer them.
So, well, I'll, from my more kind of direct side of my brain, I would say there is no
excuse to not acknowledge this because we have seen absolute
I mean, we've seen life lost.
We have seen lives completely changed to the point where it's just unfathomable.
um And for myself, my life has completely changed and hundreds of thousands of dollars
have already been spent uh to take care of my injury.
And it is going to be a lifelong injury.
I will never get the full function of my job back.
um
no one should have to go through that.
But especially knowing that these things happen, there's no excuse to not address it and
to learn more about it if you have never uh made any changes to what your program might be
or if you don't have a program.
Now, the other side of my brain is coming from that approaching that with curiosity and
asking that leader a little bit more about, you know,
What is your understanding of what your organization is doing?
And do you have reporting?
Do you actually know what is truly happening with your teams?
And do you know that your increase in loss of nurses or turnover has nothing to do with
this?
Do you have the evidence and proof to say, nope, absolutely no one is leaving because they
don't feel safe?
great, if you can tell me all of that, then wonderful, you're doing a great job.
But out of curiosity, I would like to know where you're coming from in this and approach
it from that angle.
ah Because we're seeing more and more and there needs to be so much more research done.
But if you truly look at what's out there, we have the numbers, we have the evidence to
show that this is a significant problem and
We don't have enough energy going towards mitigating this problem, but there's probably a
lot of other problems that we could take care of just by addressing this.
I more if you had a chance to sort of give a final message to caregivers, be they
professional or non-professional everywhere, a final message to sort of point out what
they need to remember about their right to safety in the workplace.
What would be your parting words for them?
My message would be that this is not part of the job and that most of our institutions
have this concept of a zero tolerance policy.
But that starts with us at the bedside.
If these things are happening to us and we say nothing about it, then we are not adhering
to that zero tolerance policy ourselves.
We are tolerating it.
So my message would be, do not tolerate it.
Report, make sure that you're having these conversations with your leaders, and be part of
that shift as well.
Figure out not only to not tolerate it, but figure out what you can do to get involved and
engage and just help promote that healthy work environment.
Zero tolerance is at multiple levels.
You can't just have the poster up on the wall and not have follow-up, not have the
debriefs, not have the accountability from leadership to the worker.
All of those elements are part of zero tolerance.
It's not just, I have an idea, let's put a poster up on the wall.
That'll solve everything because people will read it and it'll have uh teeth.
It's been wonderful getting to know your story and getting to know more about your mission
today, Kelsey.
I think it's honorable and it's devoted to the greater good.
facing what you faced and to be able to rise, so to speak, uh with such strong intention,
I think is an example for us all.
And I wish you well in pursuing your mission.
And it's certainly one that I've learned from today.
And I think all of our listeners will really consider you a champion and look forward to
hearing any updates from your successes on your journey, perhaps in another visit sometime
down the road.
Yeah, well, thank you so much, Mark.
I really appreciate you taking the time to put your focus on this, because this truly is
what helps make that change happen.
Change is meant to occur everywhere.
Kelsey, I wanted to thank you for bringing your honesty, your clarity, and your advocacy
to this conversation today.
Caregivers everywhere, not just nurses, needed to hear this.
You've shown us that naming harm is not weakness, it's actually leadership in itself.
And reclaiming safety is not a rebellion, it's how caregivers survive long enough to keep
caring and not walk away.
For everyone listening, if you're working in a system that asks you to absorb violence,
be it emotional or physical, you're not alone and you're not imagining it either.
Your experience is real.
Our hope today is that you walk away with language, with boundaries and a new
understanding that your wellbeing is not negotiable.
Thank you for listening to the Caregivers podcast with me, Dr.
Mark.
Take care of yourselves and take care of each other and we'll see you again next week.
Before we wrap up, I wanted to remind you of something important.
Conversations you hear on this podcast are here to inform, to support, to spark
reflection.
You're not a substitute for professional medical advice, care, therapy, or crisis
services.
Listening to this podcast does not create a doctor-patient or caregiver-client
relationship between us.
If you're facing a medical concern, health challenge, a mental health challenge, or a
caregiving situation that needs guidance, I encourage you to reach out to a qualified
professional who knows your story.
If you're ever in crisis, please don't wait.
Call your local emergency number or recognize Crisis Hotline right away.
You deserve real-time help and support.
The views you hear on this show, whether from me or my guests, are our own.
They don't necessarily reflect any organizations we work with, or are part of, or have
worked with, or been part of in the past.
This podcast is an independent production.
It's not tied to any hospital, university, or healthcare system.
Thank you for being here, for listening, and most of all, for taking the time to care for
yourself while you continue to care for others.
I look forward to hearing from you.