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Fostering Mental Well-Being Amongst Emergency Department Staff

October 17, 2022
October 17, 2022

This blog is taken from a recent HealthStream webinar entitled Fostering Mental Wellbeing Amongst Your Emergency Department Staff. The webinar was moderated by Chris McElvogue, BSN, RN, CHSE, HealthStream’s Director of Product Management, Clinical Programs and featured Jennifer Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC, Board President, Emergency Nurses Association (ENA), Marjorie Morrison, MFT, LPC, CEO and Co-Founder of Psych Hub and Chelsea Woodruff, MA Vice President of Clinical Sales, Psych Hub.

Even while demand for emergency department (ED) services appears to be on the rise, ED nurses are increasingly facing threats that include verbal and physical attacks while providing care in an already-stressful setting. As the threat of those attacks increases, there are corresponding concerns about the mental wellbeing of ED nurses and their patients. The increase in these threats means that EDs need strategies to support the mental wellbeing of ED nurses and the patients in their care.

How Big is the Problem?

The short answer is that the problem is large enough that in 2019, the Joint Commission announced a major initiative to address increasing rates of crime committed in hospitals and specifically noted that the ED was the clinical setting where clinicians were most at risk from workplace violence.

McElvogue went on to share some alarming statistics from a recent New England Journal of Medicine study:

  • 82.1% of ED nurses have reported physical assault
  • 100% of ED nurses have reported verbal assault
  • Healthcare workers are 4 times more likely to experience workplace violence than other jobs

She went on to point out that the physical and verbal assaults have resulted in ED staff having to be in a constant state of vigilance which can adversely impact mental health and may also impact patient safety and the quality of patient care. The problems are so prevalent that OSHA has also set some new standards in regards to workplace violence.

Safety Concerns and Mental Health in the ED

The stressful nature of the ED combined with traumatic events and violence is a combination that can threaten the mental health of providers in this setting. There are numerous statistics that point to higher levels of depression, anxiety, substance abuse, work-related injuries and absenteeism among providers in this setting. Morrison talked about the importance of teaching providers how to recognize when their own symptoms rise to the level of needing intervention.

Morrison acknowledged that the ED is stressful for patients as well. “We have to think about giving patients the kind of information that will help them understand what is happening to them and why,” said Morrison.

Tools and Strategies to Promote Mental Health in the ED

McElvogue asked the panelists to address strategies that will support ED clinicians’ physical and mental wellbeing while promoting professional development. Schmitz began the discussion about how to address the issue by stressing the importance of awareness – and not just among healthcare staff. “Increasing awareness is really the first step. Making sure that the public understands that this happens to providers in the ED is important in addition to the mitigation strategies,” said Schmitz.

Schmitz recommended a three-pronged strategy to address the issue.

  • Advocacy and awareness: to educate staff and the community about the issue and to advocate for solutions and protections for staff.
  • Departmental leadership support: leaders that recognize the issue and support measures to address it.
  • Building resilience: helping nurses to be aware of their own mental health and build support for awareness and self-care.

Schmitz also talked about the importance of equipping nurses and other ED providers with a basic understanding of mental health in order to be able to navigate a patient’s mental health event, de-escalate that event, and recognize the early warning signs that might indicate that physical violence may be imminent.

Schmitz also shared some courseware from ENA that provide an excellent foundational knowledge of mental health issues.

  • Emergency Severity Index (ESI) – ESI is core triage courseware that helps providers triage patients and identify any red flags that might indicate that the patient could become verbally or physically abusive.
  • Geriatric Emergency Nursing Education (GENE) – GENE helps providers understand the specific risks associated with this patient population.
  • Introduction to Trauma – This course focuses on a broad range of topics including risk factors for violence when treating trauma patients.

Morrison also shared that the Mental Health Ally courseware provided by Psych Hub includes a series of ten different courses covering everything from what mental illness is and how to recognize it to appropriate interventions and treatment. Mental Health Ally topics include:

  • Mental Health Foundations
  • Substance Use
  • Motivational Interviewing
  • Diversity and Bias
  • Suicide Prevention
  • Fostering Resilience
  • Helping in a Mental Health Crisis
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