Thank you everybody, thank you for coming today. It's a little bit of coordination, my dog Freya is here with me, so if you see some movement, that's just Freya. But I'm very honored to be here. I do, just disclosure, I work for Vistler, it is a workplace violence prevention company that focuses on education in the healthcare realm. So I'm going to skip the activity just for time's sake, 15 minutes, just to let you know, I could probably talk about this all day long. And 15 minutes is going to be like fast and furious, but we're going to get through it. So I'm going to use Reason's Swiss cheese model, and probably a lot of you are used to this model, I've seen it a lot. But why I really like this is because we're talking about harm here. And the red arrows really indicate that harm. The cheese itself are those safeguards, the things that act as barriers for us to make sure that harm isn't ever reaching, in my case, the employee. And then those holes, what are those holes? That's really the systematic failures, those gaps that we see, not only in our organization, but within our healthcare systems. So a little bit about my background, I come from a long line of military. When I was in high school, my mom was deployed, and she is a critical care nurse, and she was deployed to Iraq and Afghanistan. And I got to talk to my mom almost every day. And I got to hear about her stories, helping the population, helping other service members. And it really just cemented for me wanting to go into the healthcare profession, and wanting to be a nurse. I knew right away that's what I wanted to do. I commissioned directly into the U.S. Army from school, and the reality of clinical practice was so different from what you learn in academia, right? You go to school, and you have these expectations, and you're bright-eyed and bushy-tailed, and you hit the floor, no matter what your profession is, and you're like, that's not what I learned in school. That, no, no, let me go back. I still have the book and the highlighter and all the tabs, right? And it was just so different. And one of those holes that I really identified for me was that in nursing school, at least when I went through, and I'm a little aged now, but there was no discussion about workplace violence, whether that be worker-on-worker, patient-on-worker, those family members, domestic violence, there was just no discussion. It was like you were going into this perfect profession where nothing ever wrong happened. And I think looking back at everything, we need to change that. That is a huge gap that we currently have. The education that we could be providing healthcare professionals to prime them for what they are going to, and I say going to, because if you look at the prevalence of workplace violence, we know they are going to be exposed to workplace violence. And so I look at that, and I look at the expectations I had for healthcare, and I think about how education can really play a key role in not only changing the culture of what is expected, because some of this is the expectation you go in and your lead nurse or your head nurse says, well, that's just how it is, and you're on the floor now, and you have to deal with it. But also the priming, and why priming is so important is because literature tells us it helps with resiliency. It helps us not to just take no as an answer, but to push and question and to help ourselves overcome some of these barriers. A year and a half into being a nurse, I was promoted and I was made a supervisor. At this point, I had six individuals under me. I moved across the country to Fort Leavenworth, Kansas, and again, the expectation versus reality. Nursing school had never set me up. My time on the clinical setting had never really set me up to be a strong leader. I didn't understand some of those administrative, some of those technical pieces that could really help me thrive in this position. Not only that, it lacked the mentorship. When I went to fellow nurses, people that I knew that had been in leadership positions and asked them some of these questions, they were just kind of winging it too. And they said, well, have you talked to HR? Have you talked to these folks? And when they didn't have an answer, it was this circle of not knowing and the blind leading the blind. And so I really lack this strong mentorship piece. First day on the job, I get in bright-eyed, bushy-tailed, ready to take on the world. I'm now pregnant with my second child, and I'm going through this experience and they say, hey, we have to talk to you about one of the people that you will now be supervising. And they tell me that this person, this individual, has a long history of not only performance, but behavioral issues. And as you can see here, these are some of the things on the bottom that I dealt with. On the top, that's the intended pathway, the pathway to intended violence. And as I'm telling you this story, I want you to kind of look at this and to think to yourself, did this individual follow this pathway? So they're talking to me about all the things historically that had happened with this individual. And then they tell me, this individual had not met accreditation standards for their organization. And my job not only is to now be a supervisor, but I have to write the ship. And now, right? Because it's never like, we're gonna give you resources and help you. It's, we want it done now and we want to pass this accreditation. So I get into this position and I'm starting to talk to this individual. And right away, it becomes this bullying type of situation where I'm a very young white female. This individual feels that I am way too young to be his supervisor. He's 30 years my senior and he's been there a lot longer than me. And so he starts to make comments, starts to gossip about me to my peers and starts to say things derogatory in nature. And this starts to escalate into, he starts to yell and scream at me, tell me that I'm the problem. I would ask him, hey, this Excel spreadsheet or something, this report wasn't done correctly. Can we work together and get this straightened out? And instead of working with me, I was the problem. And so as I continued down this pathway with him, I was informed to start a performance improvement plan. Has anybody here have any experience with a performance improvement plan? It is painful, painful, right? And there are so many things that you have to do and you really have to work really closely with your HR. As I go down that and start to feel physically unsafe because this person is now cornering me, yelling, screaming, belligerent in my face, making threats that he's going to quote, take care of me, that I'm no longer going to be a problem for him. I go to my supervisor and I tell them all of this and I document it. And my supervisor tells me, well, you're just a new supervisor. You're a female, you're kind of emotional. It's just how it is. You just need to get over it and continue. And not only do you need to continue, you're part of this performance improvement plan. So you have to continue because otherwise we're going to have to start afresh, right? And so these are all the barriers I'm working with with this person. And little did I know this person was Googling at that time, how to kill me, how to cut my carotid. What's the most painful way for somebody to die? He was Googling this on his work computer. But yet when I asked my supervisors, my hospital commanders, and I said, hey, these are all the red flags. This is exactly what's going on. Can you please monitor what is happening on his computer? Can we take away access? Because another thing he was doing was he was staying late and I would be alone in the building and have to ask him to leave. And he wouldn't leave and I wouldn't have anybody with me to ask him to leave. So he was starting to breach. How long can I stay? Who's going to be around if I stay after hours? The other thing that was happening is, is that though I was doing all of these write-ups and I was going to HR and I was asking for disciplinary action, there was no feedback loop, right? HR was just, would say, well, it takes time. Yeah, we're working on that. When you're in a life or death situation, and I really felt that I was at that point, you don't have months. Every time that that person was allowed to take an action, that action escalated the next day and the next day because he could, right? There was no repercussions for any of his actions. So the day of the attack, and this is just some of the quotes, and I really wanted to highlight some of the things that I was being said to me. The day of the attack, this individual had asked me earlier to come into his office and I had denied. I said, no, I don't want to be alone with you. I had asked my hospital chain of command several times to always have somebody with me if I had to interact with this individual, not only for my safety, but because of the things that were being said at the time. And that request was denied. And so I said, no, I'm sorry, I'm not able to, if you can work in here, I have somebody in my office and we can work together. And he wouldn't, and he was very insistent on it, and it just didn't sit right with me. And so he was very upset, stormed off, and I had gotten an email then that had come at midnight the night before, and it was in third person, and it was sent from him, and it was talking about how I was trying to take his job and just all of these really bizarre things, and it wasn't very coherent. And I had taken that information and him wanting me to go to his office to my direct supervisor, and it said, this is what's going on. I don't feel right about it. I had already been to the hospital commander, please help me. It's not a matter of if, it's a matter of when. Again, I was told, come to me with facts, not emotions. That day, that individual, after hours, stopped in front of my door, doused a bottle of gasoline on me as I sat at my office computer and struck two matches and lit me on fire. I suffer from 30% total body surface area burns. I only survived that day because two individuals, both providers, were there with their doors closed, so he didn't know they were still there. They heroically came out, not only put the flames out on me, but stopped that individual from coming back with a straight blade and trying to finish to attack and kill me. Both of those individuals were harmed in this altercation. And I tell you this because, going back to reason switches cheese, how many times have you seen threats, violence, shrugged off as that person would never do that? It's not that serious. It's just part of the job. I tell you today, this is not part of the job, and it can never be part of our job. This is the true cost of those holes. And it's not just that 30% burns, but it is the ongoing six years and lifetime sentence of laser, z-plasties, ongoing medical care, and not to mention the emotional tax that it just puts on me, but my family. So I think about all of these things, and I tell my story because we can change, we can grow, and we can do better. It doesn't matter if you are the CEO of an organization, a floor nurse, an LPN, that front desk help, it doesn't matter what position you have in that healthcare setting. We can all be a voice of change. I ask all of you to be an upstander, not a bystander. And what does that mean? That means not to tolerate, not to look past, not to just shrug it off and say, somebody else will deal with it. I think about my story and how many times somebody could have intervened in this position and said, this isn't okay, I don't feel safe, we need to get help. What about a threat assessment team? What about a safety plan? We need something for this individual. But nobody felt safe to do that. Nobody knew to do that. Nobody had that safety. The other thing that I ask you is, what are we doing within our organizations to really combat workplace violence? It has to be more than that placard on, you know, when you go into the ED and it says, we don't tolerate violence there. But do you really? Because I see people yelling and screaming and getting belligerent. And instead of understanding and giving that, you know, healthcare professional resources or changing things within the hospital, we ask that healthcare professional, well, don't call the police, don't press charges because it looks bad on the hospital. I hear that over and over again. And it breaks my heart. We need more than the placard. We need robust education. Not only education, but training. We need to put people through some of these simulations, give them not only verbal deescalation, but those physical skills to protect themselves when this happens, because it will happen. And that is the unfortunate truth. The last thing that I ask, and you know, is that we can all make a change. Start talking to your local governments and communities about the federal legislation that is pending, the state legislation that is oftentimes pending. We can make a huge difference with requiring hospitals to have robust workplace violence prevention plans. I look at this, and I look at an opportunity for growth. I think together we are stronger and our voices need to be heard. Thank you.

workplace violence

healthcare safety

violence prevention

legislative advocacy

upstander culture