Seattle Children’s nurses say workplace violence a symptom of a broken pediatric mental health system

44 nurses signed letter to hospital leadership asking for more resources

This story was published in the Winter 2024 issue of The Washington Nurse.

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Nurses on the Seattle Children’s Psychiatry and Behavioral Medicine Unit were dealing with escalating violence without proper resources, so they decided to take action.

On Nov. 17, 44 nurses — almost every nurse on the unit, not including those who were on a leave of absence due to injuries sustained while at work — signed a letter to Seattle Children’s management urging help on the unit.

WSNA spoke to a dozen nurses about the situation, and the nurses were clear that it’s not the children to blame. They said the pediatric mental health system is broken.

When hospital leadership declined an urgent meeting with nurses in November, WSNA sent a release to the media. This story hit a nerve and received widespread media attention, including national news.

The nurses handled a media firestorm with grace. They kept their messaging on lack of resources in the unit and not enough long-term beds for children in the state.

These kids are broken, and they are lost, and they have nowhere else to go…we need something to change from leadership because I don’t want to just abandon ship.”
— Natasha Vederoff, registered nurse, Seattle Children's

“These kids are broken, and they are lost, and they have nowhere else to go, so we need change to happen,” Natasha Vederoff, a nurse on the unit, told NBC affiliate KING-TV. “I want to stick through and see change happen because I care about these kids, we care about these patients, and we need something to change from leadership because I don’t want to just abandon ship.”

More than 150 people attended a candlelight vigil Dec. 12 organized by WSNA. The vigil allowed seven nurses on the unit, state legislators (Sen. Javier Valdez, Rep. Gerry Pollet, and Rep. Nicole Macri), and WSNA leadership (President Justin Gill and Executive Director David Keepnews) to speak out. Their message was covered by the local TV affiliates for NBC, ABC, FOX, CBS, as well as the NPR affiliate, and others.

The vigil was held the night before the regularly scheduled Nurse Conference Committee with WSNA and hospital leadership.

The two-hour conference committee meeting resulted in some major changes.

The hospital agreed to permanent 24-hour security on the unit with significant increases in travel nurses and behavioral techs. The hospital said it will be hiring seven travel nurses — six to start on Jan. 8 and one to start on Jan. 22. The hospital will also be hiring 20 travel behavioral techs — 13 to start on Jan. 8 and seven to start on Jan. 22. Behavioral techs work as coaches with the patients as they carry out therapy and other skills. The hospital also approved a recreational therapist and an occupational therapist based on nurses’ feedback. And they agreed on an expedited construction schedule on the unit by May 8.

While more needs to be done, these measures will likely increase safety on the unit and improve the quality of care provided to patients.

When nurses stand together, change can happen in healthcare.

Thank you to the local unit at Seattle Children’s who worked on this crisis, the more than dozen nurses who shared their stories with the media, WSNA’s nurse representative and organizers, state legislators, reporters who covered this story, and the many people who helped bring light to this issue.

Psych Nurses Sound the Alarm on Patient Violence at Pediatric Hospital
Seattle Children’s PBMU staff “work in a persistent state of fear,” says state nurses union
by Shannon Firth, Washington Correspondent
MedPage Today, Dec. 4, 2023

Incidents at Seattle Children’s Psychiatry and Behavioral Medicine Unit

The Washington State Department of Labor and Industries (L&I) inspected Seattle Children’s Psychiatry and Behavioral Medicine Unit on June 22, 2023, and issued a report on July 10, 2023. While L&I did not cite violations or assess penalties, inspectors offered three recommendations:

Work with the hospital’s Safety Committee and affected employees to set quantifiable goals to reduce workplace violence.

Have management audit reporting of all workplace violence-related threats, injuries, and attempted assaults against employees for record keeping and review.

Improve management’s follow-up with employees who are affected, including notifying them of corrective actions, coping resources, and a recommended timeline for follow-up.

Since those recommendations were issued, the volume and severity of safety incidents increased. Below are some examples as of press time:

11/25/23 - Nine staff were mandated to stay after their day shift was done due to short staffing; three of those received injuries on the job due to various patient escalations during the evening. These three staff should have been able to leave the floor immediately due to their injuries, but due to the lack of available staff on the night shift, they could not leave until around 10:30 p.m. One of the barriers preventing the injured staff from leaving the floor was a serious safety issue involving two patients. (One was holding a sharp, large, broken piece of a thick plastic soup bowl and was making verbal threats and threatening gestures to stab another patient.)

11/25/23 - A patient engaged in self-injurious behavior by repeatedly slapping themselves in the forehead. Staff attempted to put the patient’s helmet on and in the process one of them got bitten... The bite broke skin and led to significant bruising and pain.

11/25/23 - A patient pushed over a meal cart, attempting to break the cart into weapons.

11/17/23 - When I came to the unit, two patients were throwing ceiling tiles at staff and broke computers. There were not enough staff to help intervene. Safety support was called, and eventually, the police were called. A few staff members were hit that evening.

11/16/23 - A suicide-watch patient assaulted a staff member by punching her on the right side of her face and hitting her on top of her head. The patient got very combative with the staff on the unit and was threatening to hurt more staff and other patients on the unit. The patient had already injured a few staff members in the past and talks about continuing to do so.

11/13/23 - One patient broke a meal lid into multiple pieces. One piece was sharpened to a point. The patient made multiple motions mimicking stabbing someone and verbally threatened to stab staff. One patient assaulted multiple staff. Four staff were injured at work. A nurse was charged and hit in the head with a closed fist.

11/13/23 - One of the patients had soiled themselves, and three of us were attempting to change the patient. While attempting to change the patient, the patient became agitated and began engaging in self-injurious behavior. As per the patient’s plan, this requires arm splints to be applied to the patient to prevent further injury to the patient’s head. The patient also began attempting to physically assault staff members, and we went into a physical hold to prevent them from doing so. I had placed the patient in a standing physical hold with another staff and then transitioned to the supine position. During the transition, the patient extricated their legs from the hold and kicked me in the head seven times.

11/7/23 - Numerous staff were sent to the emergency department with injuries from patients overturning carts, swinging a metal pole, and putting a nurse in a chokehold.

10/29/2023 - Multiple staff were injured and had to leave. One staff member was bit. Several staff were kicked in the head and the body by several patients. We had around 20 callouts throughout the day due (most likely) to the unit’s acuity.

At one point, we had four violent restraints going on at the same time… We did not have enough staff to place the patients kicking staff actively involved in violent restraints, so staff were intermittently getting kicked all over their bodies.

10/22/2023 - We were short a primary nurse resulting in me having a 13-patient assignment and a charge nurse taking patient assignments.

I have sustained more serious injuries in the past year than in my first six years of working on the floor.

The PBMU is broken and is simply put, dysfunctional. We cannot keep admitting patients because the rest of the house needs us to. Once these patients are on our unit they are out of sight and out of mind by the institution.