Is Zero Tolerance Against Our Code of Ethics?

The first time I really delved into Zero Tolerance was at the request of one of my colleagues from the IAHSS. He was being pressured by a board to adopt this policy since the hospital next door had done so. As many experienced security professionals have stated, the policy just does not make sense from a Healthcare Security perspective and really negates the principles of prevention. He needed support to intelligently oppose the board and present a better option. Even I was shocked at the amount of evidence I was able to find to negate it.

I looked to the foundations of Nursing Theory and referred to the American Nurses Enterprise 's Code of Ethics as a foundation to begin. The more I looked at the Code of Ethics, I could see that these policies were impractical and potentially unethical. I really had to look no further. After a small 30 minute conversation, the board was convinced and we came up with a better, more sustainable option.

Here is a little insight into that journey, I hope it helps you to make an informed decision.

Our Nursing Code of Ethics is a compilation of principles that emphasizes the duty of care, respect for the dignity of all individuals, and the importance of addressing the underlying causes of disorganized behaviors. Read them here.

We will begin with Provision 1: Respect for Human Dignity.

1. Provision 1: Respect for Human Dignity:

The ANA Code of Ethics states that nurses must practice with “compassion and respect for the inherent dignity, worth, and unique attributes of every person” (Provision 1). This includes patients who may exhibit violent or aggressive behaviors due to medical or psychological conditions. Zero tolerance policies can lead to the refusal of care for these patients, which contradicts the ethical obligation to treat all patients with dignity and respect.

With a lack of seasoned nurses at the bedside, it is becoming increasingly difficult for nurses to see what respect and professionalism really looks like when we are providing care to patients with disorganized behaviors. When most bedside nurses are in the Novice stage of the nursing career, and with little to no tenured bedside leadership left, it is not hard to see how respectful care lags.

As nurses we have a duty to uphold the values of caring for a patient, while still trying to get them to participate in care. This lack of skill is directly causing an increase in violence. Patients are afraid, new nurses are afraid, and now we have issues with trust.

Learning how to get the patient to assist in their own compliance is a skill that takes time, practice and knowledge to be able to perfect. When we are no longer able to see it exemplified, it makes it very challenging to develop these skills.?

“The fundamental problem is that people focus on risk and choose control rather than establishing relationships and trust.”?- Melanie Marshall - Author of TRUST Read Melanie’s book Trust here.

When we look at trying to put into place rigid workplace violence policies like Zero Tolerance we are reducing the opportunity to connect to our patients. It is IMPOSSIBLE to have no instances of violence when we are caring for humans, in a human condition and still have EMTALA in place. So evidence shows that policies like these leave the patient, the family and the employee feeling confused about what the true meaning of the policy is and how it will be enforced, if at all.

This lack of clarity on enforcement erodes trust in an already "trustless" environment, making healthcare workers a target for increased frustration and violence as they are no longer seen as authority figures.

With violent crimes steadily increasing in this country, the chance that you could be in a negotiation for your life involving a weapon at any moment is very real. This should dictate the way that we are addressing complaints and/or grievances every day. When I am teaching nurses, I tell them that while being voted the most trusted profession is something to be proud of, it may also save your life.?

"The most dangerous negotiation is the one you didn't know you were in."?- Christopher Voss This Is How I Build Trust In ANY Negotiation! | Chris Voss

The three top principles of trust as stated by Chris Voss that I think most apply to clinical settings are listed below. You will also see case studies of how I have seen them playing out in clinical practice in part two of my ebook A Nurses Guide to Healing Workplace Violence in Healthcare. Purchase Part 1 Here.

1. If someone doesn’t trust you, they won’t disclose important information.?There are many times when a patient will tell me something they will withhold from family or the physician for fear of "being bad" or looked at negativity. Sometimes that's the missing piece of the puzzle when it comes to care, other times they are letting me know they are in danger in some way.

1. If someone doesn’t trust you they are more prone to being skeptical about your motives. This is especially true with mental health patients who struggle with paranoia as part of their diagnosis or those with elements of severe trauma.

1. If someone doesn't trust you, they are less likely to make a deal with you. The majority of the art of negotiation depends on getting someone to do something they don't want to do. Being an active participant and compliant with care is sometimes challenging with certain populations. The nurses role is to help them organize disorganized behaviors with skill and tact through compassion and understanding.

How many times has a patient progressed to yelling while you are resolving a complaint? People only yell when they don’t feel like they are being heard. When you have a Zero Tolerance policy, sometimes this further escalates the interaction between caregiver and patient/family members because it feels very dismissive when we head strait to policy. We are now entering a continuum of violence that could easily been avoided by taking a connection approach.?

For more information or to work with Mel in creating profitable, sustainable solutions to workplace violence and other care issues in your organization book a FREE consult here.