Hey everyone, before we begin today's ACNL in action podcast, we want to share a warning that this episode discusses the topics of gun safety and violence in healthcare settings and may be distressing to some listeners. Please take care of yourself and thank you so much. Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Our guests today are Jessica Cheveri and Mark Reed. Jessica is Director of Clinical Services at TRL Systems, a leading fire and life safety and security systems integrator in Southern California. Jessica is also a member of the ACNL Health Policy Committee and ACNL San Diego Chapter. Mark is Executive Director of Campus Support Operations at City of Hope, responsible for the planning, direction, and coordination of support activities, including security all throughout the hospital campus. Mark is also vice chair on the Council of Guidelines for the International Association of Healthcare Security and Safety. Jessica and Mark co-presented an ACNL webinar on workplace violence and are both uniquely knowledgeable about hospital security operations, making them the perfect subject matter expert duo to talk about the different facets of gun safety in healthcare settings. Welcome, Jessica and Mark, and thank you both so much for being here today.

Thank you for having us.

Yes, it's wonderful to have you both here and to talk about something that is really so significant and it's so important. And this is, you know, really the topic of gun safety and violence in healthcare settings. And Jessica, I want to start with you. You know, your background is in nursing and now in leadership. And so from a nurse leader's perspective, what unique challenges would you say that hospitals and healthcare systems face when managing gun-related violence and injuries in healthcare settings?

I think one of the biggest things is in healthcare organizations that if they do have like a situation, for example, of like an active tutor on site, um, it's always best to be prepared. And uh Mark and I have talked about this significantly. And you really want to have that plan in place. You want to have policies and procedures that are created for the specific unit. And um, Mark and I were discussing an acronym called OODA Loop, and it stands for observe, orient, decision, and act. And I think it's really critical for those units to, like I said, have the leadership conduct drills, um, whether it's a few times a year or monthly, depending on what they decide, and basically um get the staff involved because nothing like having a cardinal event or a situation and people go into panic mode. So it they may still do that, but at least try to help them to prepare as much as possible.

Thank you for sharing that, Jessica. And I agree that the preparation piece is so key and so important. And you know, as nurses, we also love acronyms. So I really appreciate you sharing about the OODA loop. And uh just to reiterate, it stands for observe, orient, decision, and act. Is that right?

Yes, correct.

Yes, so we'll get into more about the preparation details and what nurses and healthcare, you know, settings can do, but um, this is a really good point to start with. And, you know, in terms of not just patient care, but also staff morale, how are gun-related injuries different from, you know, from car accidents or other common causes of injury? What do we mean when we say gun-related injuries?

So in terms of gun-related injuries, um basically when there's a gun-related injury, I was a volunteer EMT when I was in nursing school. And when there's a gun injury, there's an entrance wound, and usually there's an exit wound for those types of injuries. But, you know, in terms of guns, there could be different factors. It could be an accident, it could be deliberation, um, versus like a car accident where you know maybe um somebody wasn't paying attention, or there can be like other environmental factors that could have contributed to that situation. So there's still emotions are still high in both of those situations. But um, you know, our today with our discussion is what to do if if if there is a gun um presented in a situation.

Right. And that is a great distinction to keep in mind as well, because while they both might involve different accidents, they are different injuries and they do require different types of preparation responses. And when it comes to thinking about that from a nurse leader's perspective, what role can nurse leaders really play when it comes to shaping organizational culture around preparedness and safety?

Um, in terms of the organization um preparedness and safety, like I was talking about earlier, is really having that plan in place, um, getting your security within the facility. Um, like for example, I worked on labor and delivery, so we did code pink drills. And I think in terms of um active shooter drills, having those plans in place, having you know, practice drills um on particular units, because every unit is so unique of how the layout is. And by having those drills with security as well, they can kind of take in what's happening, how people reacted, um, what took place. And then what's really critical at the end of those drills is having a debriefing, what worked and then what didn't work, and the takeaway of how to learn from that event. So when it is time, and if it hopefully it doesn't occur, but if it does happen, at least the staff are prepared.

Yes, and that reminds me, that example is a great one because it reminds me of how, you know, how ingrained we have in our healthcare systems about preparing for codes, right? Like code blues, code pinks, and really having that set in stone so that once it happens, everyone knows exactly what to do, what their role is. And then uh, like you said with the debriefing, you can really refine and continue to refine and have those continuous practices. And do you think that's possible too, then, for uh in preparations for these types of um injuries, uh, to have something like a mock code maybe for for these types of situations?

Absolutely. And um, I worked at a military hospital for many years, and we had all kinds of different um mock drills, and we had were worked really closely with the security. Um, there were state police as well on our facility. And um I think it's really good. The other thing to chime in to add to that is having a policy and procedure um for the unit when it comes to active shooters as well. So that way during orientation and um, you know, once a year, that way the staff are constantly reminded about it and what to do. Um, so if a situation occurs, then they're more prepared.

That's great. Having that policy and procedure in place is really helpful because of just like what you said, you can really use it to reiterate the information at the beginning of someone's career in the organization and onboarding, and then during the duration of their time on the unit in the department, where these occurrences might happen, or where the nurse would really need to respond first for that. So that's a really great call-out. And then and then that also even gives the opportunity to keep on refining that policy and procedure, right? Because people will look at it more regularly.

Yeah, that's very true. And it's always important to update that yearly.

Yes, absolutely. And now over to you, Mark. I'm curious about some more of the literature when it comes to these types of events. So, you know, research from a number of gun safety organizations suggests that active shooter drills can sometimes be more damaging or maybe potentially more traumatizing than helpful. And how would you say that healthcare organizations should design and practice their safety drills so that their staff can feel really ready and thoughtfully prepared without feeling overwhelmed or feel fearful, just to add to what Jessica was sharing earlier.

Yeah, I think it's you know, to Jessica's point, it's it's really planning appropriately. Uh far too often, what we see is is you know, they want to have an active shooter program and they immediately go to let's do a full simulation with you know uh loud gunshot sounds and and things like that. And I and I really encourage you know people to be a little more thoughtful around planning for for active shooter drills and and the training that's required, you know, really let's let's crawl, walk, and then run. Um and and I think you know the evidence out there really talks about um you know building a trauma-informed approach, um, prioritizing our physical and psychological safety first, being very clear and specific about when we're running these these scenarios, these drills, what are we testing? What are we looking for? Is it you know um testing the emergency notification, or do the doors lock appropriately, or how do we communicate? Who does what? Um, you know, do you adopt run, hide, fight? And you're really walking the staff through, you know, if this were to happen, what steps should we take? Um, and your unit might be different than your your coworker's unit. Um, and your response might be a little bit different. Um, and really, you know, just from that that aspect, uh, and and I've seen it too many times in our industry where someone has had some well intentions, um, but it caused more harm um than it was trying to solve for by just going in unannounced with a fake firearm and starting to shoot blanks, really traumatizing the staff. And and there's been lawsuits around this. Um, and staff have you know been very uh impacted uh very negatively. So I'd I'd definitely say, you know, and recommend um start out realistically, talk about you know, what is it we're trying to achieve, build a multidisciplinary team, talk about the different areas and challenges and really walk through it before you get to a full-on you know, drill scenario.

Thank you, Mark. There's a lot of really great pieces of information that you shared there. And when it comes to this idea of preparedness and uh really thinking thoughtfully about these situations and how to adequately, adequately respond to them, it really involves a number of different people to come together. It really involves a thoughtful approach to how to make sure that everyone is on the same page when it comes to everyone's roles, different types of mechanisms to ensure that these preparations are actually effective. And so with that said, it sounds like I think that when people think about policies and procedures or when they think about different ways to prepare for these events, they might not think about other parts of the preparation, which could include the equipment, or it could include other things that are kind of, you know, outside of what the person does, but maybe some of the more uh types of things that we might not think about, right? Because there's just so many different aspects that could be involved. Um and what would you say are the key steps that staff should take, you know, in an active shooter situation in a hospital? Uh and how does that differ from other settings?

I mean, I I definitely recommend the run, hide, fight approach. Um, but you know, planning accordingly. Like and I I train staff and we talk about a lot of times, I say, you know, anyone who responds, because that's the the policy, run, hide, fight. But then I ask, well, where are you going to run to? And usually the staff start to, you know, get that look of, well, I never really thought about where I would run to. I just thought about we need to run. You know, are you are you gonna stop just outside the door? Are you gonna run to the local convenience, you know, and call for help? Uh, what does that look like for your location, your area? You know, where are you gonna hide? And I think Charlene, to your point about the healthcare environment, it truly is unique because um, you know, in some areas, you know, like ICU, we have non-ambulatory patients. So what does that mean? Does that mean we're gonna we're going to leave the patient and we're gonna run and hide and save ourselves first? Or are we gonna try to take our ambulatory patients with us? Um, and it's and it's very tough questions to answer because every situation is unique, every environment is unique. And and I always tell staff, you know, do what you think is is best in the in the situation, do what you think is going to hopefully save the most lives. Um, but I can't sit here and tell anybody that yes, you should abandon your patient or you should sacrifice yourself. Uh it's very, it is a very personal choice, and and I'm not gonna be there uh, you know, normally when that happens to tell you what to do. Um so really I just advocate uh, you know, just like we do for earthquake drills, spire drills, code blues, let's not wait until an event happens. Let's let's talk about it, let's plan for it, and let's have those answers as to, you know, in your unit, what is the best place to hide if this if this event happened, you know, where you can, you know, barricade the door. If you had to fight, what what weapons do you have at your disposal to help you? Um, you know, fire extinguishers make a great weapon because you don't have to be very close. It uh it sprays that powder out and can disorient it and make it where people can't breathe or see. And um, I encourage staff, if if you're in a fight for your life, let's never fight fair, let's take every advantage that we can. But it's it's really having those discussions, I think, that are key. Um, and knowing you know what what you would do or what you could do in those in those situations. Because if not, if you don't if you don't plan for it, if you don't talk about it, if you don't discuss it, we're we're more adapted than to freeze when we're presented with that new challenge or that new uh incident. Um and inaction is probably worse than any action and you know, negative action. So really it's it's you know, talking about it, talking about your specific department, your specific unit, and the unique challenges you face from a surgery unit to a to a clinic that's in the community, an outpatient to the ICU, to the labor and delivery or pediatrics. There's not one blanket, you know, this is what works for everybody because every every single department has their own unique challenges, their own unique layouts. Um, and it's you know very personal at that point to make sure that they they do what's best in their area for them.

Thank you for sharing that, Mark. And I I do really appreciate how you pointed out about the importance of the preparation um when it comes to even things like the location, right? Because if we don't know where to go in that first step with run, then you know, how can we be effective in any implementing any of the other steps or supporting ourselves, our colleagues, our patients? Uh and if we're in maybe an anxious state of mind, that would be and and you have this one extra thing to think about that can really be harmful, right, to ourselves when we're trying to respond to the situation. So making maybe making making it so that people have the same thought process, right? Of that, like what you said about earthquake drills or fire drills, you really know where to go. And um, you could talk about that amongst your different teams and departments about what would make sense for that. Um but but I think that that would be uh really helpful for all team members who are involved, whether you're in a clinical position or not.

Agreed.

And you mentioned also about earlier about how even the the act of preparing for these situations could be harmful, right? You gave the example about how some if there's no communication, how some organizations may have done a drill without giving any notice and how traumatizing that can be and how important it is to have trauma-informed care, trauma-informed decisions, and have these all embedded into the preparation. And how would you say that mental health support for staff can be integrated to prepare for these situations?

Well, I think it really goes back to that discussion. So, I mean, everyone should have, you know, an employee assistance program. Um, and we have to be there for each other. Um, and and you know, we all have our own experiences. So uh they might have already dealt with what uh an active shooter situation at their previous you know hospital or they're you know just outside of of their job, um, based on you know where the community that they live and things like that or how they were brought up. And so it's really just going in with that you know intent, knowing it ahead of time before you start just and I just go back to this this video of a state where they they literally just walked in unannounced with fake guns that had blanks and just started shooting up. Um, and nobody knew what was going on, everyone was in fear for their lives at that moment. And I mean, what is what is it we're trying to achieve here? We're trying to make sure our staff are well prepared in the event that they have to face this horrible incident. Um, and really let's just talk with them, you know. They nine times out of ten, the staff have more better ideas than I could ever come as a security professional. And you know, they they share as to what they think or how they think it should play out, and really just walking through that. Um you know, we're not going in there like the goal is to scare people um and get them all worked up to where they can't, you know, now perform their normal job. Um, it is really just to educate and and make sure that they're ready in case something were to happen. And it's no different. I mean, I got kids in school, and unfortunately, you know, my my daughter's elementary school, they do active shooter drills now as well. Um, and she doesn't come home crying and oh my gosh, dad, it's so unsafe. And you know, this could happen. They they they really think through and make sure that people understand why we're doing this and what could happen. And if something were to happen, um, you know, what steps we need to take. Um, and I know I think we can talk about it a little bit later, but being proactive around these these incidents or subjects too. Normally, you know, someone doesn't just wake up and decide, I'm gonna go shoot something up. There's there's what we call pre-incident indicators, you know, they usually have a a beef. There's there's some you know issue that that's gone unresolved. That unfortunately, you know, when we do after actions of these things, it's oh, I knew there was something wrong, or well, they did say this the other day. Well, who did we tell that to? Who did we you know raise this concern with that we might have you know been able to stop it? And far too often, uh, and we know not just with with um active shooter, but workplace violence in general, a lot of this just goes unreported to where we're not able to try to be proactive and prevent incidents and or being more reactive and dealing with the aftermath.

Right. And lots of important points there, and and they do all uh have this kind of full circle back to the importance of of the communication, having everyone involved, uh making sure that uh everyone is able to, you know, at least voice their thoughts, uh voice their ideas, and come up with a plan uh and be able to practice that, have that in place. And, you know, and it and uh going to what you mentioned too about how there's also active shooter preparations outside of hospitals and community settings like schools, I want to talk a little bit more about the community setting and and you know when we think about uh the community setting and firearms in the community settings, for example, for families who own firearms, what practical steps would you say that families can take to reduce risk at home, especially with children present?

Uh I think you know the the key number one, right out the gate, is to properly store your firearms if you have them in the home. Um not only is it a good practice, it's also the law in the state of California that you know firearms need to be properly uh stored. So that children cannot access them inappropriately or without permission. Uh, the state of California actually just passed another new law that goes into effect January 1st that says not only do they have to be properly or securely stored, but they have to be securely stored and kept in any time it's not being carried or under the control of the owner or the authorized user. So not just when it's inside the house, but when it's not actually being carried. And far too often, you know, we hear of, well, I was cleaning the gun, I never thought it was loaded, or things like that. So I would start with making sure that you're properly storing firearms in the house. Um, secondly, I would say make sure that you're educating those in your household um around firearms. Um, you know, we talk about you know you know universal firearm safety rules, such as you know, all guns are always loaded, never cover the muzzle with anything you're not willing to destroy, keep your finger off the trigger, uh, be certain of what your target is and what's beyond it. But you know, teaching children that they should never touch a firearm that they see. If they see a firearm, you know, don't touch it, go and immediately find an adult, find a parent, let them know about it. Um, you know, just reinforcing those messages, just like we would for if there was a fire in the house, if you know how to properly ride your bike crossing the street, and just you know, really removing some of that stigma and the the curiosity that kids could have um through education, I think is is key. Um and then you know, really looking at you know the the opportunities to um talk about safety, talk about you know what guns are for, why do they have them, what are their use. Um and then again, I got I'm just gonna go back to there's there's so many options when it comes to properly securing them with you know uh a trigger lock or a safe, um, you know, lock boxes, biometric, and you know, things of that nature. Just if if we ensure that guns do not fall into the hands of those that should not be using them, we can ensure that we don't have these accidents and things like that. And if we educate people, we remove some of that curiosity or that stigma to where they're not so curious, like, well, I don't know, it's it's a secret, let me go find it now that dad went to the gym and he's not home. Let's go see what that's about. And uh, and then we end up with, you know, an unfortunate accident that you know we can never undo, um, and things like that.

Yes, and it it really sounds like even, you know, in matter of the setting, whether it's in the communities or whether it's in the healthcare organizations or healthcare systems, this theme of education and really having everyone on the same page about uh these different situations, challenges, um uh and safety preparations is really in it's really uh a similar theme, right? No matter the setting. It's it's really making sure that everyone is educated, it sounds like first and foremost. And I think that it's so important too, because when we think about the healthcare setting, um, you know, Jessica, I do want to ask about uh when we think about healthcare professionals engaging families and community leaders in these conversations about gun safety, how can we do so without making them feel judged or maybe defensive about these topics?

I think um it starts as Mark was saying earlier too, about his own children, starting at a really young age. Um, so that way it takes, you know, the curiosity out a little bit of the conversation. And I think part of it is even having um a gun safety, you know, conversation with parents, having the kids present as well and other family members, just in a delicate approach. Um, kids are very intelligent and they ask some very thought-provoking questions. And I think leaving it up to them to be able to ask those questions about guns and um, you know, and answering it in a truthful manner, um, like Mark was saying, like, how do you store a gun and safety, um, and what can happen, you know, if a gun does go off, um, some of the mechanisms of it, but just taking it more of a safety approach um methodology, um, not saying all guns are bad, not taking a stance on it, but just um leaving it up to them to and answering their questions as much as possible and um leaving that communication open. And the other thing too is if a family member, say they are at the hospital and they do have children and they come up to visit, um, being uh mindful and your approach um with them too, because you know, they don't know all the circumstances of their family member that might have been injured in a gun um situation. And so being responsive and um letting them ask as many questions is is really critical, just keeping that communication chain open.

Yes, thank you so much, Jessica. And it really sounds like with these different um groups and um the different people who are having these conversations, you know, whether it's families or healthcare professionals or community leaders, it sounds like the overarching theme for these groups is still the goal of safety, you know, in in all of these settings. And I think that it's a it's a really good it's a really good way to structure the conversation no matter where you're in. It it helps to kind of bring everyone together to have a thoughtful conversation, give a a safe space for people to ask questions, including, you know, younger people who might be in these conversations. So I think that that's a that sounds like it's a really great approach and uh I think it could really help with maybe lowering some of the barriers to these conversations. And I wanted to ask too, because when it comes to nurse leaders, you know, nurses might not maybe talk about these uh these types of topics or challenges uh as much as maybe we should, or maybe there's not an opportunity to as much. And so when it comes to nurse leaders, how would you say, Jessica, that nurse leaders can advocate for stronger safety measures within their organizations and in policy conversations? How can we have more of them involved in these uh types of conversations?

Sure. So in terms of um nurse leaders advocating for stronger safety measures, one of the things is um inviting. And when I say that, like a lot of times units are siloed, they just work within their own department and that's it. And I think inviting different departments um to help out with um gun safety um and workplace violence by including um, you know, maybe for example, it might be a med surge unit, but you also want to include on that unit when you are doing drills, um, people from the safety department. You also want to include people from quality and risk department. Um, you want to include also environmental care because when these interdisciplinary teams work together, um, I think it's really beneficial to help the team um be the best they can in a you know workplace violence situation and that they know that they're not alone um and that there is a stronger plan in place. In terms of um policy, um as you had mentioned earlier, I'm on the ACL policy, healthcare policy committee, and um Mark's gonna get into this in a little while, but um there is a AB 2975 law that is gonna be taking effect at hospitals starting May 2027, and I'll just touch briefly upon it that it's gonna have weapons um detection that's gonna be mandated by the state of California, where they have to have um the weapons detection located in the front of the hospital in the emergency room, and if labor and delivery is a separate unit, and I'll let Mark um speak more on that.

Yeah, I think you know, AB 2975 is like one example of advocating for change. Um and to be honest, workplace violence in healthcare impacts healthcare workers five times more than any other industry out there. Uh, and it's such an unfortunate and and such a horrible statistic to be able to share. Um, because no one comes to work at a hospital setting or a healthcare setting, um, you know, with the idea that we're not there to help people. Uh, and it's unfortunate that as we're trying to help all these people, we're subjected to this abuse on such a regular occurrence. I think statistically, like there's two nurses that'll be assaulted during this podcast. Um, I think you know, cloud closer to 10 healthcare workers during the same period of time. Um, and we know that also for a fact that it's so underreported. So I think you know, when we're talking about advocating, it's really about breaking down those silos that Jessica said, bringing people together. Um, and I and I feel for nurse leaders because they have so much to try to accomplish from fall rates to hospital-acquired infection to now workplace violence and staffing issues. And it's just, you know, they're they're juggling so many different things to try to make sure that they're doing the best they can. Um, and so what we've seen from that now is we have AB 2975, where the legislature for California has passed a law that's not going to require weapons detection devices at hospitals to try and help protect staff even further. A few years back, we passed a law that um went into effect workplace violence and healthcare. Um, it's now Title VIII section 3342 of the California Code. Um, that really helps prevent or try to eliminate healthcare, workplace violence. This now, AB 2975, is hopefully going to you know force hospitals to implement weapons detection devices to prevent weapons from entering the hospital space and further protecting our staff. Um, and so I'd say, you know, we should be working together from a security, quality, risk, nursing, HR, legal, um, EVS, like get all the people in a room together to talk about what are our risks, what are our problems, which devices we think are going to fit our need, where should we put them? Uh, it also requires uh all of these weapons detection devices to be staffed um by a licensed Bureau of uh Security Investigative Services, California State licensed security officer, um, whenever they're in operation, um, and really, you know, trying to eliminate these opportunities from impacting our workforce. And so that's where we're we're seeing, you know, the legislature with different groups. I'm sure ACNL was one of them. I know um California Hospital Association was involved and a few others um really trying to help you know bolster the the law to protect healthcare workers. Another one that we just saw recently passed, you know, it used to be a crime to assault an emergency room nurse or an emergency room doctor. That's now changed to now it's a it's a crime to assault anybody in the emergency department. And we're still advocating to pass that legislation to where it should be a crime to assault any healthcare worker anywhere inside the hospital, you know, similar to flight attendants and other industries that we see. So we're really making it from a from a misdemeanor to an actual felony assault based on you know the job they're doing. Um, and unfortunately, we're gonna change the stigma. I talk to a lot of nurses over time, and there's quite a few that I talk to, like, well, it's just part of my job, you know, and like it's just working in the ER, it's just part of what happens. You get spit on, you get assaulted. Um, and I always talk to them like, oh, hey, show me where your job description says this is part of your job. Like, this is this is an expectation. Um, so we have to change that narrative. It's not an expectation, it's not okay. Let's continue to work together to eliminate this wholeheartedly to where everyone can come to work and help those people that show up at our institutions. Um, because we know no one's really showing up to the hospital because it's a great day. Maybe the labor and delivery departments, right? They're a little bit different. Flaw joy. Everyone else, though, is having a lot of stress, there's a lot of issues. Um, you know, compound that with wait times and everything else. Let's find tools and ways that we can train our staff, educate our patients and visitors to be a little more respectful um and really help solve this problem um and eliminate workplace violence once and for all.

Thank you, Mark. And I appreciate um a lot of the comments you shared. And uh you shared some sobering facts too when it comes to workplace violence in healthcare organizations. Unfortunately, it is fairly commonplace for healthcare workers to experience some form of violence or um some form of challenge when it comes to their safety when they are providing direct patient care. Uh and I want to ask for those to, you know, it is great to see the progress when it comes to different uh things that are in place, including Assembly Bill 2975 and different measures to uh to work towards that goal of eliminating workplace violence once and for all. Uh and what would you say when it comes to healthcare organizations and healthcare professionals who are really early in this journey of achieving that goal, of eliminating workplace violence? Uh, what how do you see these healthcare professionals partnering with their security experts and colleagues and also lawmakers to help create safer environments for both staff and patients?

Yeah, I think it goes back kind of the theme of our discussion today is is really start with education. Um we know it's a problem. Uh I've talked to some healthcare leaders where they they kind of want to put their head in the sand and pretend they don't have a problem. Or, well, we looked at our numbers and it's not really that bad. And really educating leaders, educating, you know, staff, nurses, um, and everyone working collaboratively, like, hey, this is a problem that we all need to focus on. Um, and just like we do, you know, fall committees, um, just like we do infection prevention, you know, and rounding and things like that, get the team together. Let's let's talk about what the problem is. Let's not pretend it's not there. Um, and even if you have low rates, you know, one is still too many. So, what can we do to improve to make it to where we we have zero? Um, and then how do we share those best practices? Um, and I think Jessica mentioned earlier, we we had a lot of silos in healthcare where we're just everyone is so busy and so focused on what they have going that we have to find the time and make the time to really talk with each other. And you know, I've I've been amazed when we've been in these rooms, and I've had a nurse leader from one floor talk about what they implemented, and a nurse leader from a different floor, like, oh my gosh, we're having that problem right now, and we're trending upwards. What did you guys do? Because we want to take that practice and now implement that over here, and hopefully we can fix some of this. Um, and nurse nurses, you know, by default, are there to help. Um, so I don't expect them to have the same view or lens as a security leader when we're rounding on a unit and identifying you know risks or threats or opportunities for improvement. So really partner with each other. Um, because I'll walk on a unit and you know, you go to the nurses' station, and there's always this beautiful, you know, vase with flowers, and it's always like made out of crystal and super heavy, and they're like, Oh, somebody brought flowers for somebody, it's it's awesome. And I always just look at it from a security lens of that's a serious weapon. We need to move that because as soon as someone's not happy, that's gonna go flying through the air and it's gonna hurt somebody pretty bad. Um, and it's just finding that balance and that culture within your organization. So I think you know, when we talk about partnering with with experts and lawmakers, it's really sitting down and having those open conversations and you know, admitting, yes, we do have a problem, it is significant. Um, you know, we could have this conversation about five years ago, uh, before COVID, and we said it was four times more likely than health in healthcare. Now it's five times more likely than healthcare. So we're trending in the wrong direction. So we definitely have to have these conversations and really, you know, everyone come to the table with suggestions and recommendations on what we can do better to stop this from happening.

Thank you for that. And and Jessica, I want to turn it over to you too, because you know, Mark was mentioning about the stigma that exists in healthcare when it comes to these conversations and when it comes to the topic of workplace violence and safety. What are your thoughts on that stigma when it comes to nursing? And do you have any thoughts for how we might go about addressing that stigma or maybe working towards eliminating that stigma?

I think um, as Mark mentioned earlier, that a lot of times workplace violence is very lowly um, you know, reported because, you know, a lot of people and myself included over the years, um, you know, a lot of times it's just part of the job. You know, we all just kind of grew up in that suck it up mentality and just keep going. And, you know, I've been in situations myself. And um I think what's gonna happen is I was talking to some friends that work in the emergency room, and they would, for example, have homeless um sometimes that would come in and and they would, you know, have all their belongings, and sometimes they would have a gun with them entering into the emergency room. So I mean, a lot of times they'll just, you know, say to them, hey, we're gonna give that to security, and then you can check in with them once you get discharged to get it back. And I think in terms of the stigma, I think like today, just having these conversations, discussing safety, discussing um how we can help out um has come a long way. And also, you know, assessing our environment too. Um, when I was an EMT, like they would tell us not to go into um situations, say like a car accident or something, you'd always assess the scene before you did that. And I think in terms of the facility and healthcare facilities, um, I think it's really critical, a takeaway for staff and that stigma is to make sure that they're um addressing scene safety. And when they do see something, say something and report it instead of just saying, well, it's part of the job because that can be the difference for the safety of themselves or other people or patient or a family member at that facility.

Thank you, Jessica. And I want to share there's there's so many important themes that we talked about today during this episode. A lot of it stems on education, really getting everyone involved and having these open conversations so that we have space to prepare and have mechanisms in place to be able to be thoughtful about preparedness and safety measures. And then we also talked about uh looking towards the future, looking towards our goal of safety overall and trending downwards so that we could eliminate workforce uh or eliminate workforce violence and eliminate workplace uh, you know, challenges that are related to violence. And so I wanted to give you both any final words of wisdom or any final insights for our listeners who may be um listening to this today. And I'll start with you, Jessica.

Um so I think in terms of final words, um, first of all, thank you for this opportunity of having us today. And um I would say be kind to one another, um, be safe, have a plan in place as not just one person, but as a team so that way you can help each other. And I think in terms of um practicing and having um drills on units, and then it's really critical to um debrief that team and see what worked and what didn't work so that you can work on process improvement from there.

Great, thank you so much, Jessica. And then over to you, Mark. Any final words of wisdom for our listeners today?

Yeah, I always say just you know, have these conversations. Let's not wait until an event happens. Let's try to plan and prepare the best we can. Um, the more we we plan and prepare today, the the better off we'll be during that event. Whether it's it's a fire, it's an earthquake, it's an active shooter, it's a code blue, it's a it's a slip and fall. No matter what it is, the the more we plan and prepare today, the better off we're gonna be uh when that unfortunate incident, if it does happen. Uh, we already know what to do, we already know what how we're gonna do it, when we're gonna do it, and making sure we're gonna save the most people the best we can.

Great. Thank you so much, Jessica. Thank you so much, Mark, for this conversation today, for sharing your expertise with us and with our listeners, and for having these important open conversations. Thank you, Charlene, for having us. We appreciate it.

Yeah, thank you so much.

Thank you. And our guests today were Jessica Cheveri, Director of Clinical Services at TRL Systems, and Mark Reed, Executive Director of Campus Support Operations at City of Hope. We'd love to hear your feedback. Email us at social media at acnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.