Dr. Marc Harrison: So, today I'm with Josh Layne who's a charge nurse in the emergency department at Intermountain Medical Center. Josh, please tell us a little bit about yourself and then we'd love to hear what's on your mind today

Josh Layne: So, thanks for letting me be here and talk to you about this. I've been with Intermountain since 2007, I've been at IMC in the emergency department for almost five years, and like you said, I charge there. And I'm very lucky to work with such an amazing group of medical professionals and I do love my job and I love my co-workers, and that's why these questions and this topic is very, very important to me.

Dr. Marc Harrison: How long have you been a charge nurse, Josh?

Josh Layne: I've been charging six months, so not as long as some of the other-

Dr. Marc Harrison: So you still have fresh eyes.

Josh Layne: Yes.

Dr. Marc Harrison: Well, first of all, thank you for your service to our community, to our patients, to Intermountain, you guys do great work. That's true across the enterprise, [00:02:00] our daughter came through your emergency department after a knee injury, she got great care and-

Josh Layne: Good, good.

Dr. Marc Harrison: ... I hear and I've experienced, as I've rounded in your emergency department, terrific things.

Josh Layne: Yeah. So, both as a witness and a victim of patient violence, I'm consistently concerned for the safety of myself and my co-workers. If I can give you an example, we had a lady who came into the emergency department who was very nice, very polite, kind. Her son wasn't as nice and he started throwing things around the room, he actually pushed the bed and pushed it up against the counter, started throwing things. Security was called, our police officer was called, but before security and police got there, he actually turned at me, I got hit multiple times, and I was the one who ultimately took him to the ground before security arrived, before P.D. arrived.

And that's just one of many, many issues. I guess what I'm asking is what is your stance on caregiver safety when it comes to patients and patients' family members that are violent and aggressive to our staff?

Dr. Marc Harrison: So, let me say I'm really sorry that happened and that is completely unacceptable and I'm open to suggestions, both from you ... But this is something we're actively talking with our security team about, is what does our stance need to look like, how do we need to staff different parts of the organization, what level of response do we expect from our security and from police officers, et cetera.

So, I aim to stamp this out the same way we're going to stamp out other safety and quality concerns for our patients.

Unfortunately, violence against caregivers and caregiver safety is a big problem. We are doing a great job on working on the none-violence associated caregiver safety and starting to see ... and I'm sure you experience this in your emergency department, paying ever more attention to splashes, falls, back injuries, needle sticks, et cetera.

The area that's growing out of proportion is this violence issue and violence against caregivers. It does on rare occasions happen from caregiver to caregiver, but it's usually patient or family member against one of our caregivers.

This is something I think about all the time. As you know, I care immensely about patient, safety, quality, experience, I care just as much about our caregivers. What you will see is an emphasis over the coming months, and years, this is not going go away, it's going require focus and attention, an incorporation of safety for caregivers into our zero-harm approach. So there will be explicit training about how we keep people safe.

There's a responsibility that our caregivers have to be fully engaged in this and to not assume that this kind of stuff just happens, because it doesn't have to just happen. So that's going to require situational awareness, it's going to require training, it's going require support, it's going to require reporting. And in the same way that, if we harm a patient we swarm and try and understand what happened so it'll never happen again, we need to take that same approach for our caregivers as well.

The question is, do we have the resolve to go ahead, both institutionally, but also individually and as leaders, to take this on. And I guess a question I'd have for you is do you think we do?

Josh Layne: I think we do, I think, like you said, it's going to be a long process, it isn't going to be a quick process of hopefully changing ... Well, hopefully it is a quick process of changing the safety of our staff.

And just going off that, it happens often, which is too bad and it's kind of scary, but what advice do you have for me and all of my co-workers and all of the emergency departments that are dealing with this? Do you have anything to say on keeping myself safe, or my co-workers safe?

Dr. Marc Harrison: I think using active situational awareness, what are the risk factors? Just like emergency responders do, before they address a scene out in the field, they look for safety issues, not only for the victim, but also for their teammates to make sure that they stay safe.

Josh Layne: Yeah, absolutely.

Dr. Marc Harrison: And I think as a charge nurse in particular, your antennae need to be way up and work with your staff to try and proactively identify risky situations, and then get whatever resources we need to mitigate them.

Josh Layne: Okay.

Dr. Marc Harrison: And when somebody gets hurt, if somebody gets hurt, to try and get to the root cause and pull all resources forward to understand what could have been done differently. Just like if somebody had done a wrong procedure in the emergency department, did a thoracentesis on the wrong side, for instance.

Josh Layne: Absolutely, yeah.

Dr. Marc Harrison: If that happened, you guys would try and figure out "Did they read the x-ray wrong, was there poor communication, what was the hand-off like, how could they have double checked?" I think we need to take the same approach when a caregiver is harmed. And this is a high priority and something that we're going to really take on. So thank [00:08:30] you, again, for your service, but asking such a hard and pertinent question.

Josh Layne: Thank you very much.

Dr. Marc Harrison: You're welcome. Anything else you want to share?

Josh Layne: No, I don't think so. I could go on with stories, plenty of them, but no-

Dr. Marc Harrison: I'm glad you love your job.

Josh Layne: Yeah. No, I do, I absolutely love it and I love the people that I work with and I think that's why this topic is just very important to me.

Dr. Marc Harrison: I think a lot of this is fueled by substances and behavioral health issues, I'm sure that's what you-

Josh Layne: Absolutely.

Dr. Marc Harrison: And hopefully, as we begin to address some of those issues at Intermountain, whether it's through Zero Suicide, or our efforts around opioid prescription reduction, mental health integration, opening access centers, I hope that'll help you. But I think we need to take other kinds of security interventions to keep you guys safe too.

Josh Layne: Yeah, take those interventions [00:09:30] and have those procedures or policies in place while we progress and move forward to hopefully getting that substance abuse down and the suicide issue down. But I appreciate it, thank you so much for talking with me.

Dr. Marc Harrison: Thanks Josh. My pleasure, thank you very much.