Employee turnover is high, and the rise in verbal escalations is not helping. 

Verbal abuse is the most common type of abuse toward nurses in the healthcare setting.   

Verbal abuse is three times more likely to occur there than physical abuse—and swearing and shouting are the most common types, says Shawna Grissom, MS, CCLS, CEIM, CPXP, Director of Family Services at Children’s Hospital Colorado, speaking at the recent NRC Health Pediatric Collaborative. 

“The perceived reasons for these types of calls with verbal abuse is that families are frustrated, and they might be anxious,” Grissom says.  

“In our internal surveys, we found declining data around resiliency, morale, and retention, which impacts a team member’s ability to respond empathetically to patients and their families.” 

Children’s Hospital Colorado’s leaders understand that higher levels of engagement, such as pride, intent to stay, and intrinsic motivation, demonstrate higher PFX scores.  

They also know that the employee experience centers around leadership, a culture of safety, and valuing employees—all of which are no easy feat to maintain. 

“The difficulty lies in a family member showing up who may not be acting as their best self,” Grissom says. “You may not respond in your best manner as a team member, and there lies the crossroads.” 

Want to learn more from the team at the Children’s Hospital Colorado? Check out their presentation from the 2024 Pediatric Collaborative.  

Children’s Colorado has a baseline tool to communicate expectations on their Safe and Healing Environments flyer, to help eliminate poor behavior from families.  

Over time, they’ve learned it’s best used for resetting expectations because families can be overwhelmed upon admission, and they may have skipped it. 

They launched a new documentation tool because they didn’t have a consistent place to document the de-escalation interactions that were taking place.  

This de-escalation navigator tool lives within Epic and was designed to address bias through various aspects. It includes identified triggers, underlying causes, and debriefing to better support patients and familiesin the future.  

Children’s Colorado also created computer-based training modules that are now mandatory for staff.  

The goal was to build staff de-escalation skills during quarterly online training. Staff members who may work in behavioral health or interact with behavioral health patients get more in-depth training.

Shelby Chapman, MA, Director of Patient-Family Experience at Children’s Colorado, says one of the things that they were finding is that a lot of that intervention focused on in-person escalation—particularly physical escalations.  

She said leaders were reaching out and saying those tools were great, but they didn’t quite fit the escalations they saw. They said they were seeing a lot of verbal abuse online or over the phone, and some of the tools and resources that the organization had in place weren’t quite meeting those needs.  

“They said, ‘We have schedulers who don’t want to work in this department anymore,” she recalls. “‘Our nurses feel it, and we’re unsure what to do.’” 

When over-the-phone escalations began taking a toll, Children’s Colorado started making moral distress rounds and identifying ideas from teams that would be meaningful.  

They also instituted a tip sheet with six de-escalation strategies to reinforce online learning that is easily accessible with helpful phrases, which included: 

• Breathe
• Be an active listener
• Use the power of empathy
• Find solutions together
• Ask for help when you need it
• Take care of yourself 

“Asking for help when you need it is giving people explicit permission that if you are being verbally abused, if you’ve tried all of these methods and they’re still yelling and using demeaning language, you can end the call,” Chapman says.  

“So that was really important, and there’s some language to approach ending those conversations.” 

Children’s Colorado tried a phone-recording pilot where they combined marketing, an IT infrastructure team, schedulers, nurses, a patient/family-experience team, and a music therapist to update the on-hold music and messaging and record new on-hold messages.  

They got creative with their messaging using patients and doctors, with the intention of reminding callers that they are humans caring for humans.  

They are still collecting data to see if these small changes are curbing escalations, but one of the procedural changes made was that team members now fill out a form if they’ve had an escalation and want resources and support from their leaders.  

Leaders get an alert to follow up, and they can collect data on escalations that haven’t happened before. 

“I think the first thing I want to say is that these are big, hard, challenging problems in healthcare, and there isn’t, I don’t think, going to be one solution,” says Grissom.  

“I think it’s important that they’re multifaceted and iterative. We’re figuring this out as we go.  

So we’re trying things, getting feedback from our families and our team members on what’s working and what’s not, and making changes along the way. We know that when we do these things all together and work together, we will create better experiences for our patients and our families.” 

Click here to view the entire presentation, including advice for emergency department and urgent care centers and team-member responses from the NRC Health 2024 Pediatric Conference.