Deck 25: Workplace Violence and Incivility

Question 1

Delaney,one of your staff nurses,confides that Marjorie,another nurse,has been actively telling others that you are incompetent and do not know what you are doing in relation to patient care,and that you lie to the staff about attempts to get more staffing.Delaney says that Marjorie is derogatory towards her in front of others and tells her "that she better shape up." Through telephone calls and conversations during breaks,she is recruiting other staff to her position.Delaney confides that most of the staff find you fair,honest,and knowledgeable.Marjorie's behavior can best be characterized as:

A)Political action.
B)Bullying.
C)Building alliances.
D)Disgruntlement.

Answer 1

Bullying.

Question 2

Joe and Carol,two of the RNs on Unit 22,are discussing recent incidents on the unit that have involved patients and visitors uttering threats or making demeaning remarks to staff during evening hours.Joe observes that unless someone shoots at him,he is not concerned because "words can't hurt you." Joe's remarks:

A)Illustrate common misperceptions about the nature of violence.
B)Accurately depict the difference between violence and aggression.
C)Are partially correct because verbal remarks do not cause injury.
D)Reveal possible issues that Joe relates to violence in his personal life.

Answer 2

Illustrate common misperceptions about the nature of violence.

Question 3

While working with an aggressive patient,it is important for the nurse to:

A)Speak firmly.
B)Call the individual by name.
C)Place herself between the patient and the door.
D)Ignore threats against her.

Answer 3

Place herself between the patient and the door.

Question 4

At 3 AM,a man walks into your emergency department.He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife,who is a patient on another floor.He speaks rapidly,his face is flushed,he glances around often,and he keeps his hand in his jacket pocket.A best initial response would be to:

A)Assess your situation and your surroundings.
B)Ask two or three staff to assist in confronting the individual.
C)Ask what floor his wife is on and remind him that visiting hours are closed.
D)Remain calm as there is no potential for violence here.

Question 5

Becky,RN,works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics.Which of these four is most at risk for violence and aggression?

A)Becky
B)Sarah
C)Sharon
D)Donna

Question 6

Which of the following healthcare employees is MOST at risk for violence?

A)Becky, working in a well-lit area with stable psychiatric patients and other staff members nearby.
B)Sarah, who works in a busy emergency room. Access to the emergency patient units is allowed by security staff and alarm systems are in place in patient units.
C)Sharon, who works evening shifts. Workstation is behind a shatterproof glass, and an alarm can be reached easily from her computer.
D)Donna, who works the evening shift, cleans rooms each night in the administrative wing and business offices, which are largely empty. The wing is near an outside access door.

Question 7

You note that Unit 64 has had a high turnover rate of staff during the past year.In investigating this situation,an important source of data might include:

A)Employee evaluations.
B)Level of experience of staff.
C)Exit interviews with staff.
D)Selection processes and decisions.

Question 8

You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization.This team has been established in response to increases in reports of violence and aggression.You begin by:

A)Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations.
B)Offering training sessions in self-defense.
C)Developing a policy that outlines zero tolerance for bullying.
D)Offering education sessions on recognizing behaviors with potential for violence.

Question 9

A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question regarding directions in treatment.When you respond,he moves closer in to you and puts both hands up on either side of your neck.No one else is in the hallway.Your best response at this point is to:

A)Yell at him to stop.
B)Calmly ask the patient to remove his hands.
C)Hit the patient in the midsection.
D)Use pepper spray.

Question 10

During coffee and other breaks,Rosalie,the new RN,is shut out of conversations with the other staff.When she approaches other staff on the unit to ask questions,they turn and walk off in the other direction.The behavior of the staff is characteristic of:

A)Dislike.
B)Lack of trust in Rosalie's abilities.
C)Horizontal violence.
D)Cultural incompetence.

Question 11

Jenny tells you that she is always able to tell when others are about to become violent because they yell.Your response to Jenny is based on your understanding that:

A)Her perception is accurate.
B)Yelling is more likely associated with aggression.
C)Violence is signaled by a variety of behaviors.
D)She is mostly accurate in her thinking.

Question 12

Linda,a staff nurse on nights,yells at Ali,another RN,and tells Ali that she is stupid and can't get anything right.In responding to this situation as head nurse,it is critical that you:

A)Require that Linda attend anger management classes.
B)Investigate to see if Ali did anything to aggravate Linda.
C)Call both immediately into the office to discuss the situation.
D)Respond to Linda in a way that is consistent with organizational processes and with similar situations.

Question 13

In the Emergency Department waiting room,you notice a patient sitting,with his head in his hands,who has been waiting for about 5 hours for relief of his headache.When you approach him to ask him how he is doing,he says,"I can't believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?" Your response to him would be:

A)"It is frustrating to wait when you are in pain and when you are expecting to receive relief right away."
B)"Don't talk to me. If you are going to be rude, then you will not receive treatment here."
C)"We are very busy and don't have enough staff to deal with problems such as yours."
D)"Perhaps you should go elsewhere. We do not have time for you here, as many more sick patients are waiting."

Question 14

Your healthcare organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes.As a unit manager,you thoroughly endorse this direction,and during the selection and hiring of new staff,you consistently:

A)Refuse to hire applicants who are pushy during interviews.
B)Thoroughly follow up with all references before offering a position.
C)Ask applicants during the interview if drug or alcohol abuse is a problem.
D)Refuse to interview applicants with sporadic work histories.

Question 15

Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident.The father screams at her and tells her that she has no right to ask his family to leave,and that if she continues to do so,he will "throw her out of the room." Caroline is shaken and tells her head nurse,who tells her that this kind of thing is just part of the job.The guidance of the head nurse:

A)Is reasonable. No physical violence was involved.
B)Is related to why statistics on violence in health care are likely underreported.
C)Acknowledges the deep distress and fear of the family.
D)Acknowledges the concern of the nurse.

Question 16

Residents in a new long-term care facility attend a large dining hall for meals.In reviewing reports of aggression and violence,you note that behaviors such as hitting,or attempting,to hit staff are increasing.Further investigation suggests that this behavior occurs most often at mealtimes.A possible intervention would be to:

A)Seat residents with the highest potential for violence next to those with the lowest potential for aggression.
B)Feed residents earlier in the day.
C)Restrain residents who are violent or aggressive during mealtimes.
D)Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence.

Question 17

In which of the following situations would you,as the head nurse,be concerned about potential safety issues?

A)Jordan comes to your office to complain about inadequate staffing on the unit. He says that he is concerned because he attributes a recent incident to the staffing levels.
B)Henry, a long-standing RN on the unit, has begun to miss work regularly. He calls in but is vague about his reasons for the absences.
C)Carla, RN, has just ended an abusive relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night.
D)Sarah is very quiet and says almost nothing in team meetings. Lately, she has been much more animated since becoming friendly with a couple of other RNs on the unit.

Question 18

You note that Unit 64 has had a high turnover rate of staff during the past year.In selecting the appropriate action,it is important that:

A)All documentation is reviewed.
B)Usual processes for discipline are followed.
C)Confidentiality is assured.
D)An incident report is filed.

Question 19

You need to terminate Gregory,who has had a long-standing history of conflict with you and the staff,and who recently was charged with theft of patient belongings.You consult Human Resources,and together,you develop a plan,which includes:

A)A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related.
B)Planning an opportunity for Gregory to return and be recognized at a staff farewell.
C)Calling Gregory at home to tell him that he is fired and that his paperwork will be sent to him at a future date.
D)Calling him into a meeting in your office on the ward, where assistance is available, should he become upset or agitated.

Question 20

You note that Unit 64 has had a high turnover rate of staff during the past year.In addressing the staff turnover rate,you are:

A)Confirming the high correlation between managerial incompetence and violence.
B)Demonstrating awareness that workplace violence, if present, has significant costs.
C)Aware that staff and manager experiences contribute to high turnover.
D)Aware that violence is a rare but present factor in the workplace.

Question 21

Which of the following is NOT a factor in patient- and/or family-generated violence in healthcare settings?

A)Feelings of vulnerability
B)Anxiety about treatments or diagnoses
C)Feelings of powerlessness or loss of control
D)Staff rudeness

Question 22

Sarah is involved in intervening when a patient attempts to harm herself on the unit.During the interaction,the patient slaps Sarah across the face.As a head nurse,it is important that you:

A)Offer Sarah immediate education and training in self-defense.
B)Assist with follow-up documentation and offer access to counseling.
C)Provide access to a lawyer.
D)Encourage Sarah to see the incident as a normal part of care.

Question 23

In designing a new healthcare facility,it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.)

A)Emergency
B)Psychiatry
C)Gerontology
D)Maternal-child

Question 24

As a senior manager,you notice that there have been several resignations on a unit where a new charge nurse has been hired.You suspect that the new charge nurse may be demonstrating bullying behaviors,but staff say little about their relationship with the charge nurse.Your decisions about intervention would be based on which assumptions?

A)The staff nurses would tell you if the charge nurse was engaging in relational violence.
B)It would be unusual for leaders to engage in violence and bullying behavior.
C)Bullying is primarily related to feelings of marginalization and jealousy among peers.
D)Initiating confidential exit interviews will assist in determining if leader violence or bullying is occurring.

Question 25

As a nurse manager,you realize that your unit has become a toxic environment in which horizontal violence and incivility has become common.In addressing the problem,you decide to implement which of the following?

A)Increased education in clinical skills
B)Follow-up of all reports of violence
C)Training in conflict resolution and team-building
D)Posting of the institutional policy on violence at the nursing station

Question 26

A safety and security plan is important to a healthcare organization because it:

A)Lays out preventive measures in relation to violence.
B)Provides direction as to changes in facilities that protect staff.
C)Establishes expectations in relation to behavior and tolerance of violence.
D)Establishes policies and practices that guide prevention of violence and expectations in the workplace.