Back in 2016, the New England Journal of Medicine published an article referring to violence in healthcare settings as “ubiquitous” (Phillips, 2016).

In 2018, healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence, more than prison staff, police officers, and other occupations that may typically be considered more “dangerous” (USBLS, 2018).

A 2022 study noted that healthcare professionals who had experienced workplace violence suffered such problems as demoralization, depression, loss of self-esteem, feelings of ineptitude, problems sleeping, irritability, difficulty concentrating, reliving of trauma, and feeling emotionally upset. There were also effects in the workplace, which were noted to be a decline in the quality of care delivered, increased absenteeism, and health workers’ decisions to leave the field (Lim, et al. 2022).

Physicians are not responsible for the violence perpetrated against them. 

But having no responsibility does not mean having no power. 

And one of the powerful ways to reduce the risk of violence is to practice situational awareness.

You may be used to hearing the term in the context of clinical care. Here, it refers more broadly to being aware of the situation in which you find yourself.  It means not being oblivious to what is occurring around you, but it also means not ignoring certain aspects of the situation while paying attention to others. 

Though situational awareness is important, it can be difficult. There are four main categories of barriers that impede it: environmental distractions, physical needs, emotional needs, and personal trauma history.

As the name suggests, environmental distractions are those distractions that occur in the environment. The jackhammer outside your window that keeps you from hearing the person entering your office, the overcrowded hallways that prevent you from noticing suspicious activity, your own workload and efforts to divide your attention among multiple pressing tasks. 

Your personal physical state can take your attention away from your environment.  If you’re tired, hungry, or thirsty, your situational awareness is likely to be lessened. At its most basic, there is nothing wrong with this. We are primed to attend to our physical needs and this can take precedence when we don’t perceive immediate threat.

Along with physical needs, we are also primed to attend to our emotional needs. But when our emotional state is really elevated, our attention to it can blot out our ability to pay attention to situational cues and risk. 

The last category of barriers to situational awareness is personal trauma history. A history of trauma may make us overly attuned to some cues but inattentive or unresponsive to others.

Imagine someone who has been involved in a serious MVA. Then they are at work and they hear the squeal of brakes outside. This cue is likely to be far more significant to them than it is to others who don’t share that trauma history. But they can become so attentive to that cue, which is very unlikely to pose actual risk to them at that time, that they miss other cues in their immediate environment. And those cues might actually indicate risk. 

Despite these barriers, there are things you can do to improve your situational awareness.

One way is to push yourself to practice the skill. Make a habit of asking yourself questions such as:

• How many men were in the elevator with you?
• How many people were sitting in parked cars in the parking garage on your way in?
• How many people have you seen today who were wearing glasses?

You can also practice the SLAM technique, which is four steps: stop, look, assess, manage.

1. Stop – Pause whatever else you are doing and bring your full attention to your environment.
2. Look – Truly look at what’s around you, paying attention to everything that you can see. 
3. Assess – What do you notice that might be a threat to you? How could you react if something happens? Do you have access to any resources to help you? 
4. Manage – Take action. Address the situation if you can or find someone who can help you address the situation. 

You did not sign up to be abused.

Violence is not “just part of the job.”

Though you are not responsible for the actions of others, you do have the power to take steps to reduce your risk. Practicing situational awareness can be an effective way to do so.

References:

Lim, M. C., Jeffree, M. S., Saupin, S. S., Giloi, N., & Lukman, K. A. (2022). Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures. Annals of Medicine and Surgery, 78. https://doi.org/10.1016/j.amsu.2022.103727

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374(17), 1661–1669. https://doi.org/10.1056/nejmra1501998

U.S. Bureau of Labor Statistics. (2018). Workplace violence in healthcare. Retrieved from https://www.bls.gov/iif/oshwc/cfoi/workplace-violence-healthcare-2018.html