Countdown to OR Manager Conference: Protect your workplace from violence—How to build a safe environment

Editor's Note

Beth Chrismer, MSN, RN, CPHRM, former director of clinical excellence at CHRISTUS Good Shepherd Health System, shared insights into a tragic workplace violence incident that occurred in 2013 at a Texas ambulatory surgery center (ASC) at last year’s OR Manager Conference. Chrismer was risk manager at the time when a patient’s son, who had accompanied his mother for a GI procedure, fatally stabbed a visitor and a nurse and injured two others in a span of 30 seconds.

The attacker, with no prior signs of violent intent, unleashed chaos in the ASC, beginning in the waiting room and moving into the preoperative area. The visitor, a father waiting for his son to finish a colonoscopy, was killed instantly, and the nurse victim was fatally wounded while trying to de-escalate the situation.

During her engaging presentation, Chrismer emphasized the shock of this incident, which shattered the perceived safety of the ASC, a typically close-knit environment where staff and patients feel familiar and secure. In response to the tragedy, ASC leadership implemented significant changes, including enhanced security measures like RFID access, panic buttons, and identifying safe rooms for staff and patients. New protocols were put in place, such as restricting access to certain areas and upgrading security features, including camera monitoring and security patrols.

Chrismer also discussed the importance of emergency preparedness and regular staff training. Despite being an unpredictable and quick event, the ASC staff managed to react swiftly, pulling patients into safe areas and calling for help within minutes. However, she acknowledged that more could have been done proactively, highlighting the necessity of routine risk assessments, comprehensive security audits, and ensuring that all staff are familiar with de-escalation techniques and emergency protocols.

Chrismer's presentation shed light on the broader issue of workplace violence in healthcare—per the literature, healthcare workers are far more likely to experience violence than those in other sectors. In the 2013 incident, the attacker showed no visible warning signs, which shows the need for ongoing vigilance and preparedness. Chrismer recommended that facilities adopt resources from organizations like OSHA and The Joint Commission to perform risk assessments and improve safety. She also encouraged the use of tools provided by the American Society for Healthcare Risk Management and FEMA's "Run, Hide, Fight" guidelines for active shooter situations.

Ten years after the attack, Chrismer reflected on the lasting impact of the incident on the facility’s staff and community. The nurse who was fatally wounded during the attack, she said, remains a symbol of dedication and courage, and her memory is honored annually at the ASC. Chrismer urged other healthcare facilities to take proactive steps to protect their staff and patients, emphasizing that no environment is immune to the threat of violence. Her final message was clear: "Take care of the [staff] in your facility" by being prepared and vigilant to prevent similar tragedies.