By Jennifer Thew, RN
Sadly, nurses are more than familiar with being hit, kicked, sworn at, or threatened as they try to deliver care. According to a 2014 study in the Journal of Emergency Nursing, three in four nurses experienced verbal or physical abuse from patients and visitors.
As a result, nurse leaders are grappling with the issue of how to protect staff against workplace violence.
But, as Ronell Myburgh, RN, MBA, MHA, manager for certifications and program development at the accrediting organization DNV GL, says, C-suite leaders may be overlooking another type of violence that can affect employees and healthcare organizations—domestic violence.
"Nurses are being exposed to so much violence that we sometimes become so numb to some of these personal things," she says.
Myburgh speaks from her experience in a previous position as a hospital CEO.
"In 2011, my administrative assistant, who was near and dear to my heart, died at the hands of her husband because of domestic violence," she says. "It was devastating to me as her supervisor, but also to our whole organization, to deal with that feeling of guilt about, 'Why did I not know?' "
Myburgh began to engage in self-reflection and encourages other nurse leaders to ask the question:
"How do you protect your employees when they carry that burden [of domestic abuse]?" she says.
Here are five of her insights that could serve as a model to others:
1. Understand the scope of the problem
While the incident involving Myburgh's assistant did not occur on the hospital campus, incidents of domestic violence can, and do, occur in the work environment.
According to numbers from the Bureau of Labor Statistics, 40% of women who died because of workplace violence in 2016 did so at the hands of domestic partners or relatives.
In November 2018, Tamara O’Neal, MD, an emergency department physician at Chicago's Mercy Hospital & Medical Center, was shot and killed by her former fiancé on the organizations' campus. The gunman also killed himself, a pharmacy technician, and a police officer who responded to the incident.
However, incidents like this often are not classified as domestic violence, which may conceal the enormity of the problem.
"Typically, when the police are involved, it's not recorded as a domestic violence event. It was recorded as a homicide," she explains. "So [in our incident] it was one more homicide in the City of Orange instead of adding to the statistic for domestic violence."
2. Reassess your policies and annual training
Myburgh's organization already provided annual training on domestic violence, but after the death of her assistant, they sought out ways to make the training more authentic and applicable to real life.
"A lot of times [training] material is developed by legal organizations and the material is really just to be compliant with your state's requirements on domestic violence," she says. "We revisited the materials and selected some different videos."
Additionally, they added time after the videos for authentic conversations and to discuss what to do if one employee becomes aware that another employee is struggling. They developed processes to handle situations, for example if a spouse were to call to talk with an employee, how to let them know the employee couldn't talk while avoiding triggering an event.
3. Understand the signs
When asked about the signs of domestic abuse, many would say that an employee might come to work with unexplained bruises or injuries. But the signs can be often be less overt.
"What's more prevalent is the psychological abuse," Myburgh says. "When I reflected on what happened…I would hear her talk about her husband and how he was difficult. [She would say] that he was extremely jealous, that she had to tell him she's going to work, that she needs to call him to say she's leaving work."
As Myburgh explains, the victim maintains a pattern of allowing the spouse to be in control most of the time.
"When the victim decides to draw a line in the sand and say, 'I'm no longer going to be controlled by this pattern of behavior,' that's when it can escalate to either physical abuse or something more serious like homicide," she says.
4. Make authentic connections with staff
Myburgh encourages leaders to make authentic connections with staff members.
"Make every effort to get to know employees personally, and know them by name if at all possible," she says, "because, when you do that, you break a barrier and [they might] come to you if they had trouble."
However, Myburgh acknowledges that domestic violence victims may hold back on talking about their situations.
"There's the guilt, there's shame, and sometimes it's they would rather not share because work is their free-zone," she says.
In Myburgh's case, she did not know her assistant was a victim of domestic violence until she told her at the end of the workday she would be late coming the next morning because she had to let her child's school know she took out a restraining order against her husband. That was the last conversation they had.
5. Create support structures
Myburgh says that during the many conversations that took place after her assistant's death, she learned that other employees were experiencing domestic violence.
The organization created a support group, and participants were encouraged to have a "go bag" they could leave with a friend so if they needed to leave their domestic situation, they would not jeopardize their safety by returning home to get clothes or personal items.
They also provided additional training about the organization's anonymous domestic abuse hotline.
Myburgh would like to leave leaders with one parting piece of wisdom:
"We need to move away from statistics and talk about feelings," she says. "We need to take away the shame of talking with your coworkers about it. If we can transition from the less emotional to the more emotional and talking about emotional issues, the environment will become more transparent."
Editor's Note: If you or someone know needs help or resources regarding domestic violence, call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).