Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Assembly Bill 977 and Assembly Bill 2975 are two recently signed bills that address the problem of workplace violence in hospitals. The ACNL Health Policy Committee has been following these bills closely, and we wanted to bring this topic to our podcast to inform our audience. To discuss this topic further, our guest today is Marla Postin, Director of Patient Care Services at Sharp Healthcare. Marla is here to talk about the current state of workplace violence and what changes these new bills will bring. Before we get started, just a quick reminder that if you like today's episode, please remember to share it with a colleague or drop a review on Apple Podcasts. It really helps us out and it helps other nurses find our show. And with that, welcome Marla. Thank you so much for joining us.

Hey Charlene, thanks so much for the invite. I'm glad to be here.

We're so excited to have you here and to discuss these two assembly bills and uh really um getting ready to dive into that.

Yeah, me too.

Yeah, and I wanted to start first with just the foundation of understanding these assembly bills a little bit more. So these two assembly bills introduce new requirements and penalties designed to address the current state of workplace violence in hospitals. But as the starting point, can you describe the current state of workplace violence in hospitals?

Yeah, I think if you ask anyone who works in healthcare, they can clearly state the difference that they've noticed in healthcare violence since the pandemic. That was a very pivotal moment that really shifted some of the operations with healthcare. It's really changed a lot. We've seen a large increase in healthcare workplace violence across the nation, significant concern and a very big growing problem where a lot of these events are happening in the emergency department setting.

Yes, and I I definitely resonate with what you've been sharing because there is, it seems, a noticeable increase in workplace violence in these healthcare settings. And who would you say are the primary perpetrators of violence in hospitals? Would you say it's mainly patients, or do we see violence that's stemming from other groups as well?

I think patients account for a large majority of those, but some people may not consider families. I've worked in an EG setting for a very long time, and I've had a lot of events that were involving family members, whether it's, you know, after getting news that they didn't want to hear, um maybe a traumatic event that happened, sometimes long waits, just that stressful environment really does trigger violence from both patients and families.

Yes, and that might be something that people don't expect, right? Uh when they come into the hospital and there's a lot of emotions and there could be some unexpected reactions from both the patient groups and the family groups. And, you know, given your expertise in the emergency department, I'm sure you've seen um changes throughout your career. And and speaking to that, can you talk a little bit more about these recent trends? You know, are things really getting any better now or are they getting worse?

Yeah, you know, I think um before today and really thinking about this in a larger scale, I did a little bit of research to see what those numbers really look like, right? And so um I looked at many different groups that are advocating for um for for these bills, and in particularly um one group said that 97% of nurses surveyed witnessed some form of workplace violence over the past two years. 97%, that's the entire workforce there. Um a huge increase in number of reports of workplace violence, over a hundred percent increase. Um American College of Emergency Physicians is someone who's really looking at these bills and really a big advocate. A lot of surveys have been distributed in the physician setting, and um, one said that 85% of emergency physicians believed um workplace violence has increased significantly over the past five years. But I think what's even bigger and more important than this is um this is just what's being reported. So, what are people not reporting, right? So um they have they've surveyed that too, how many people are actually reporting what's happening, the real the real state of this issue. And um, only about 50% of people are saying that they would, in fact, take the time to make these reports. So um, really concerning. And then another statistic that I looked at said um more than half of nurses surveyed have seriously considered leaving their positions or exiting the nursing profession altogether due to the violet safe experience. So, what a big growing concern as our nursing shortage is just expected to get worse, you know, over the next five years. So very concerning trends.

Yes, those are pretty significant numbers. I mean, 97%, and that's just among the people who have reported these incidents that they're facing. And we know that that the that not the majority of the staff are reporting, but even if they are, it is a very, very drastic number, I would say, and very significant to see only in the last five years. And I, you know, I think for those who are listening and who might not be familiar with AB977 or AB2975, would you be able to share just a brief summary of what those two assembly bills are?

Sure, yeah. So AB 977 was introduced by um Freddie Rodriguez. It would extend certain penalties for violence committed against first responders to include all healthcare workers who provide services within any emergency department in the state. Um, the bill would also authorize the health facility or hospital to post a notice in the emergency department stating that an assault or battery against staff is a is a crime and may result in conviction. Um so this would be a big change in the state of California as this has gone through legislation many times before without the approvals to pass and move through the process. So many people ask, why is this only in the emergency department setting? And I think the strategy behind that. So they felt that it was um going to be a little bit more you know, starting small might might be a better way to start. You know, first responders already have that level of protection. So next, the emergency department, one of the largest points of entry into the healthcare system, and then a future state to expand to include and really, you know, focus on all healthcare workers, everybody providing care in that setting. Um, and then for uh our next bill, um AB2975, um, this bill is providing very prescriptive rules that hospitals will have to um take into consideration, including adding metal detectors to all um points of entry into a hospital and to create processes and education plans to um effectively screen everybody that goes into that setting.

Yes, and you know, coming from myself a nurse who has been in healthcare for my entire career, I know that these are big changes in the healthcare settings and the emergency departments and in these different points of entry. And for those who might not be in the healthcare space, could you share a brief overview of what current protections actually are?

Yeah, so I think as far as current protections, right, we definitely have some accrediting bodies that really support, you know, workplace violence and creating processes in place. The Joint Commission has has regulations around that. Um But I think most of that is that health systems are the ones responsible for doing the right thing, you know, creating those processes, policies, reporting mandates, and and many have those in place, but these bills would mandate it and really not give a hospital the choice to to comply with with them, right?

Right, exactly. And and so these two bills would be changing changing the requirements quite a bit so that there are you know there are some levels of standards to be upheld in these different settings. And I'm curious with these in place, what what do you think are those most significant gaps in this current, you know, in the current workplace violence prevention measures that these bills are specifically aiming to address?

Um, you know, I think uh will these bills really create change in the space? You know, I really hope it does. And I think at the end of the day, could it help, right? Um when I think about complex issues like workplace violence, um, I think about like what are the needs, and they're complex, right? So creating a toolbox with lots of different options, you know. These these laws would help provide one additional tool, another layer of support, if you will, to create a safe workspace for employees and keep them safe while they're at work and you know, retain them. And and I think um lots of hospitals have made progress in this space, but um these these bills will certainly continue to support that work.

Right. It really is another tool in the toolkit to add a layer of support and protections for healthcare workers against workplace violence, and you know, another step in the right direction in terms of uh having uh some more of these standards in place. And speaking about Assembly Bill 977, you know, it has a provision that allows hospitals to post notices about criminal consequences, uh, as you were mentioning. And based on your expertise, I'm curious if you can share other similar penalty-focused approaches that you might have been familiar with in other states or other healthcare contexts.

You know, um, good question. I don't know that you can necessarily attribute, you know, reduced instances of workplace violence to any sort of bill or to even assign, right? Um also like a metal detector won't necessarily prevent some other type of violence, right? Whether it's verbal or physical, it could prevent someone from being bringing contrabandage, which is great, but not necessarily going to be the line for prevention, right? Um I personally think that posting notices about the criminal consequences could be an effective approach and deterring any act of violence, right? Um, but I think the overall effectiveness of these approaches can vary. And I think it depends on how how well the policies are enforced by the administration and by the teams, right? Um I have worked in other states. You know, I um started my career in North Carolina in a very large um busy emergency department, and um I had a lot of coworkers, turned friends that um experienced workplace violence. I've had, you know, a coworker who got punched. I had one that got bit and had a had a lot of uh downstream complications with that. And they did go through that process and press charges. And I think being able to do that is just one of those strategies implement in the toolbox, right? Um we need that comprehensive approach and we need to make sure that that we're supporting our teams and and a lot of times reporting um those events are, you know, that it really does help, you know, even with the closure piece from the healthcare worker. So so I really do hope that um these can help create some change.

Yes, and I think that having this notice available can also equip healthcare professionals just with that added piece of information so that they know what can happen, right, when when these incidents occur. Because I think historically, nurses and healthcare professionals might not actually know if there were consequences when these incidents do happen, but having it posted and it it pretty much uh helps to formalize that. And it could give healthcare professionals more of this ability to say, you know, there are consequences to these incidents that occur.

Right.

And I'm curious as well about Assembly Bill 2975, as it is more focused on weapon screening. And, you know, I think that when we talk about weapon screening in the healthcare setting, a lot of people are typically familiar with metal detectors, but what exactly would that mean for hospitals? Would it mean that we would see even more metal detectors in every hospital? Or, you know, what options are available with with this assembly bill in place?

Yeah, so the bill is very um prescriptive on the requirements for it. And it's it it states that metal detectors would need to be available at every point of entry into a facility. Um it specifically notates the main the main entrance, the emergency department, and also labor and delivery if there is if they have a separate entrance to that that a level of care. It requires that you create a process to get contraband from people. Um it requires you to create a protocol for alternative search and screening for patients who may refuse to undergo the metal detector screening, and also a requirement for hospitals to adopt protocols for the storage of any property that could be used as a weapon. So a lot of details there.

Yes, absolutely. And I know that these changes are pretty different from what we have seen in the workplace before and different things to implement and consider. And with that in mind, I wonder about the deadlines to implement these different policies and changes. Uh, could you tell us about what those current deadlines are to implement these screening policies and then any challenges that you anticipate hospitals facing in meeting these timelines?

Yeah, sure. As far as deadlines, um, 2027 is the the time listed on that bill for these to get all into place. As far as challenges, a lot of challenges to consider. This is a very large impact on any hospital system, right? And I really I think about those small facilities that may be independent hospitals. Um you have to think each metal detector requires somebody to run it all the time. So some smaller facilities may not have that personnel readily available. So it's really um there's staffing implications, there's costs, there's cost considerations. Um and I think um that's something that we have to be really, you know, considerate of. We don't want to pull all of our security to a metal detector when we need that in the hospital. So creating the funding and sourcing um of all of the technology needs with the metal detectors is a very expensive undertaking. And then you know, the right parties to create those processes. And I think um, you know, when you create a process, you have to include everyone. Will this work? Will what are the downstream effects of this? You know, we can't let the screening impede patient flow, especially for someone trying to seek emergency care. So a lot of really big considerations and challenges that hospitals will um will have to really work through to be compliant with this.

Right, exactly, because you know, we can we can say that there are these requirements that are included in these assembly bills, and actually implementing those requirements and recommendations is is a whole other thing to consider because of the implications for staffing, right? It is a lot of change management discussions, it's a lot of operational discussions, staffing discussions, uh just as you were mentioning, and then supply challenges as well, and ensuring that everyone is aligned with these different policies that come into play and how it how it becomes into effect. So quite a bit of change, it sounds like.

Yeah, absolutely.

And you know, in terms of the expected impact and what we could hope to see, what do you expect the largest impact of these two bills will be on hospital operations, uh, particularly in terms of cost, staffing, and logistics? I know you spoke to it a little bit, but what might be the largest impact?

Well, I think for AB977, um the Emergency Violence Acts, right? Um, I don't see a huge impact, you know, or resource need for this one, fortunately. And I think um, you know, I keep mentioning the toolbox. I think it's just um is what we want as healthcare providers, right? You know, we want this support. We want to create a toolbox with a lot of different resources that we can take advantage of, and and the bill really supports hospital administration creating signage. You know, I know my health system is is working on that right now so that we can get it posted as soon as possible. Um, it feels like a really easy, um, easy task to accomplish. So lots of support groups have actually created signage already. So um I think this one is is fairly straightforward. Um, hospitals will need to, you know, develop a procedure to make sure that their staff are aware and you know what is that process, right? How would we report that? Um, but it doesn't feel super resource intensive, which you know feels like quite a win. Um, it's not normally the case when you have new um new legislation that you have to take into consideration when you're working on processes, so that feels like quite a win. But I think AB2975, um the impact on that is so large that it there's a lot of work to do there, you know. Since that that bill is so um prescriptive, you know, hospitals number one, I think cost is a big one there, you know, to secure funding for the actual medical, medical the metal detectors, also um for the staffing, creating a model that's going to support a safe space in the hospital while um being able to provide those tasks with the screening. Um and I mentioned, you know, not delaying access to care. I think that's super important. Um, my my hospital has fortunately already um executed metal detectors at our emergency department entrance. And it took a significant amount of time and work to you know really go through our roadblocks to help create structures that actually work and um even just finding a location for metal detectors, right? Um my my facility is quite small. So when you have limited space, um where do you put this big device to push people through? And um I know that there are a lot of smaller hospitals that will have a lot of considerations from that cost space logistic perspective to look to look at as they um they you know work on this.

Absolutely. And thank you for sharing that. I do agree with uh we you know with Assembly Bill 977, there is that there is that win in terms of the the relative ease in terms of implementation and potential for still having quite a bit of impact uh in that regard with the signage and utilizing the tools and resources that are already in place to have that happen and have that in operations pretty quickly. And then with 2975, definitely can see how that could be a significant impact in terms of all of the ways that you've mentioned with cost, with operation staffing, and really making sure that it's operational and that there are specs as well, because that's another challenge that we see in healthcare settings quite often. So, so definitely some considerations to to have, and and uh definitely great to see that there are already preparations in place within your your um healthcare system to get this started. Really great to plan ahead and get started as soon as possible, especially for Assembly Bill 2975 with the potential impacts and uh that it can have and the costs that it can have as well. And I am curious about feedback that you might have heard from nurses and healthcare professionals regarding these assembly bills. You know, what have you heard in terms of feedback from staff, whether positive or you know, more negative? Are people feeling hopeful? Are there lingering concerns?

You know, I think locally the feedback's been overwhelmingly positive. Um, you know, working in healthcare is rough. It's hard. It's a hard job. And I think working in an ED is super tough, um, especially over the last couple of years. It definitely hasn't gone easier, it's gotten harder, it's gotten busier, it's gotten much more complex. And I think that um as a frontline healthcare worker, um it feels really nice to feel the support that came with this bill, you know. Um while in the legislative process, I I did review quite a few position statements from multiple organizations and and read that more than 400 hospitals and health systems were really proud to co-sponsor 977 in particularly, um, in addition to lots of other really large advocacy groups, the Emergency Nurses Association, Emergency Nurses Association, um, the American College of Emergency Physicians. And you know, I think that's the biggest piece, having a community that that backs you, that um values your work and your safety, and who takes the time to do this important work, it feels really nice. And you know. Just provides one of one additional layer of support for our teams. I think locally at my hospital, at my organization, we have a workplace violence and security committee within our emergency department, a small task force that we have created to try to make sure policies and processes around screening and management of violent patients and visitors is really robust. And we we have a really nice forum where employees get to voice their concerns and really help us. And we've gotten a lot of really great feedback and a greater sense of security since implementation of a lot of these initiatives. So really, really great feedback thus far.

Thank you so much for sharing that, Marla. And it is a great opportunity to include nurses, to include frontline staff to be able to share their ideas, their concerns, and then be able to share how this can all work in support of the staff who are in the front lines and who might be facing a lot of the workplace violence in the first place. So really great to hear the support from so many organizations on these assembly bills. And I wanted to, you know, as we wrap up our conversation today, I wanted to give you an opportunity to share any final comments or any final words that you'd like to say to our audience in terms of, you know, either the assembly bills or workplace violence in general. Any final words that you'd like to share?

Yeah, you know, um, before you know joining you today, I was able to kind of think about the bigger picture of this. And, you know, healthcare is so important as far as you know, it's it's everywhere in the media. Um, lots and lots of um legislation that affects healthcare and affects every day for us, right? You know, our nurses, our entire teams. And I think making sure our teams are informed and engaged in that conversation and you know, able to provide the right feedback to really help get the right initiatives moved across is so important, you know. Um I'm super excited that we have you know the support for them. And you know, workplace violence is such a challenging topic to really overcome and to prevent. So um it's really nice to have these bills to support our teams, but I think um the call to action for myself and I think for my teams is you know, how do we make sure we stay in the know? Um, how do we know what's going on, what's what's occurred, and how can we support the right things to get them across? So um tons of healthcare workers across the country and our state just remember to um use your voice to the best of your ability and really um see the value you bring to the table, right? It feels very intimidating when you think about something outside of your comfort zone. You know, I'm a nurse, I have no business, you know, advocating for these bills and whatnot, but I actually do, and I'm the right person to do it. So I really encourage all nurses to really um take that stance and take that that opportunity to speak up.

Yes, thank you so much, Marla. It it is so important for nurses when they use their voice and acknowledge the voice and the expertise that they have to be able to make significant and lasting impacts to their healthcare settings, just as we see with these initiatives for workplace violence reduction in the workplace. And thank you so much for sharing your expertise with us today and with our audience, and we really appreciate all that you're doing.

Yeah, thanks so much for having me. It was it was great.

Our guest today was Marla Ploston, Director of Patient Care Services at Sharp Healthcare. We'd love to hear your feedback. Email us at socialmedia 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.