Saskatoon health workers ride the WAVE on violence prevention

A registered nurse and a former security officer have teamed up to develop a new occupational health and safety program for the Saskatoon Health Region (SHR) that aims to educate workers on preventing workplace violence.

The SHR’s new Workplace Assessment and Violence Education (WAVE) is the result of collaboration between two veteran health care employees: Anne Parker, a critical care nurse and clinical nurse educator with SHR, and Tony Elliott, former manager of security services and now safety consultant for the health region. With a combined experience of 55 years in their respective fields, Parker and Elliott spent more than a year designing a “stay safe 24/7” program that is 90 per cent preventative and 10 per cent reactive.

The development of the WAVE program was in line with the SHR’s commitment to preventing workplace injuries. In 2010, the health region signed a provincial charter committing to Mission Zero — with the goal of having zero workplace injuries by March 31, 2017.  It is programs like WAVE that have assisted in moving in this direction.

The SHR has more than 13,000 employees. These employees come together to provide care and support for thousands of patients and their family members. In some instances the situations are highly stress-filled.

In developing the WAVE program, Parker drew on her experience as a nurse to describe health care situations where employees need hands-on, practical violence prevention techniques. For each clinical situation she cited, Elliott drew on his security training background to design methods to keep employees safe without hurting the patients, family members and/or colleagues.

Parker estimates that most nurses during their careers will have encountered a violent episode, whether physical or verbal. She has been witness to or involved with spitting, hair pulling, pinching, grabbing and kicking in her work environment. Elliott, on the other hand, has faced patients or family members with guns, knives and numerous other makeshift weapons. They both know how fast tensions can build.

Health care employees work with patients and their families who may be confused, frightened, angry or under the influence of drugs or alcohol. Recognizing the danger signs to watch for when approaching a patient is critical to employee safety.

Elliott says the WAVE training is very basic, “We tell you what could happen, what are the possible signs, and practice getting out of that situation by not even getting into it.”

Parker knows that health care employees need hands-on techniques that are easy to learn and remember such as:

• How to get out of being pinched
• How to get out of being grabbed
• How to get out of having your hair pulled
• How to safely approach a person whether they are standing, sitting or lying in a in a bed or stretcher
• How to redirect hitting and punches

WAVE training involves up to eight hours of theory, role-playing, acting out scenarios and practicing self-defence moves. Parker and Elliott give staff tools to do a proper assessment and how to keep a proper distance from the patient while approaching.

Using the traffic light concept, they teach green, yellow and red zones for determining safe distance strategies and how to read facial, physical or verbal cues for warning signs of possible violence occurring.

During the training session employees are taught to evaluate what state the patient is in, what caused it or what may have triggered it. They learn to assess quickly, defend themselves and get help as fast as possible. The course is tailored to deal with real life clinical situations using these tools:

• Coming to work with the right attitude
• Being aware of your surroundings
• The importance of proper communication
• Planning for violence and gaining confidence
• Being aware of your safety zones
• Treating patients, family members and colleagues safely with respect and dignity
• Proper hands-on techniques

Parker and Elliott visit different clinical units, such as physical therapy, acute care nursing, mental health and long-term care. They observe employees in other hospital areas like food services and housekeeping. They shadow employees and then apply the principles of WAVE to adapt training to the type of work within each health care setting, establishing safe positioning for their tasks. Based on risk assessments and acknowledging unit-specific challenges and concerns, training may be adapted and adjusted for specific departmental situations.

The WAVE program was piloted at a medicine unit at St. Paul’s Hospital in Saskatoon in November 2010. Saskatchewan Labour — the health region’s governing body for legislated training — approved the program in December 2010.

Program evaluation feedback from SHR managers and employees has been enthusiastic and positive.

Nancy Glover, a manager at St. Paul’s Hospital, sums up the positive feedback from her employees: “Everyone found the hands-on practical sessions to be the most valuable. All gained a new sense of awareness for multiple situations including self-awareness; they appreciated that the region was sensitive to their safety issues both inside and outside work; and you did it all (and I quote) ‘in a fun, informative atmosphere while building camaraderie with fellow employees. I hope I will never have to use these techniques, but I now feel more confident in defending myself if I had to.’”

More than 3,000 SHR employees have completed the WAVE training.

Diane Haugrud, a manager at Saskatoon’s Royal University Hospital echoes many of the evaluation comments in her enthusiastic ‘thank you’ to Parker and Elliot:  “It was one of the best educational hands-on sessions that I have ever participated in, and I've been with SHR for over 30 years.  It was great to join my staff in the learning and really work as a team.  The class also promoted process improvement and standardized work and approach, which we constantly are striving for.  Did I mention that it was a lot of fun as well?” 

Due to the high demand for violence prevention training within the health region, Parker and Elliott are currently developing a Train the Trainer program for WAVE.

Laureen Gatin is a writer and consultant with the Saskatoon Health Region. Laureen acknowledges the following SHR staff for contributing to the article: Bonnie Blakley vice-president, people and partnerships; Carleen Sutherland, manager, OHS; Anne Parker, OHS clinical nurse educator; Tony Elliot, OHS consultant.