Mel:

Hey, thank you so much. I'm excited to be here. It's nice to catch up with you.

Dan:

Yeah, so we've been chatting a lot about this, and you have some amazing stuff that we'll dig into around how do you prevent and protect nurses in different ways. But one of the things that I'd like to just jump into right away is what was your career path? I mean, you've been an ICU nurse for a long time and very good at it all the way through COVID. But you have this itch to be an entrepreneur at the same time, so talk to me about sort of that career progression and what really drove home the need to build something related to supporting nurses.

Mel:

Well, what do they say, climate breeds success. Basically what happened was I went through COVID as an ICU nurse, so anybody who experienced that from our standpoint, that's enough to really change your world, change your perspective. I saw the profession that I loved ... I'm not one of those people that became a nurse because they really wanted to be a nurse. I wanted to be a marine biologist. My dad was like, "No, I'm not helping you pay for that, so here's Forbes' top up-and-coming jobs." That was back in the early 2000s. I said, "Okay, nursing, I like science," I chose that and ended up being what I absolutely loved. Then I saw my profession turn into something that was unrecognizable, and I realized that there couldn't just be me suffering. I went to school in Baltimore, so I got to see a lot of really awesome places As part of my clinicals. I remember doing psych training at Sheppard Pratt, doing peds clinical at Children's in DC. We did get this high caliber of training, and then I ended up traveling around the country and seeing that that wasn't the case everywhere.

During the pandemic, I went to Massachusetts General and had probably one of the best assignments that I ever had even though it was very traumatic. I thought that the way that they were able to function in that environment was astounding. I was really encouraged by that. I came home, took some time off, and I said, "What if we could make this happen everywhere? What are the hiccups?" That's kind of where my LinkedIn journey started. I really got on LinkedIn, started looking at nursing, academia and the administration world. I thought I wanted to be a CNO. Then I realized that the system itself was not going to allow a non-yes person, a Baltimore ICU nurse to elevate that way.

I said, "Well, let me ask my colleagues what they're struggling with." That's kind of where we started getting a lot of research. I think Trusted was really pivotal in doing a lot of the mental health assessments and kind of surveys, and they've been really outspoken about the way that they move forward and how we can, I guess, create something positive out of this tragedy that's really happened to our profession. That's where I got the idea, looking at surveys and trying to understand why nurses were leaving. I knew why I wanted to leave. It was just crazy, and it wasn't anything that I recognized. I started looking at these young nurses and saying to them, "I'll be back. I promise you, I'll be back. We have to create a solution to fixing things."

The top priority that I was seeing on a lot of the surveys was that nurses didn't feel safe in their environment. If you look at an abusive relationship, someone that's being traumatized, you can't really start healing the trauma until you remove them from the trauma itself. We know that violence isn't going anywhere. I think there's a lot of tiptoeing around the subject because who wants to be the one that says, "Yes, you're going to get assaulted at work at some point."

But there is some truth to be had in acknowledging the issue so that we can start moving through it. Our company was really borne out of that space of being a resource to nurses. It's called Cortex because we believe that the cortex in the brain is the largest site of neuronal integration. That's where everything happens. Everything fires and everything connects there. We wanted to be that connection piece for nurses. We are an initiative-based company, so that means we find something that needs to be fixed and we put all of our resources and time and attention into that, and right now it's the safety and security of our frontline staff.

Dan:

Yeah. That's awesome. I love how you've taken the passion of the frontline experience. A lot of our colleagues are going on social media complaining about it, making fun of it, and there's truth to that. But I love that you turned it not only into a platform, but also a tangible thing that's actually going out and addressing the issue too.

Mel:

Yeah. It's easy to sit back and kick your feet up and kind of look at these memes. I think I posted one on LinkedIn yesterday. It was a picture of Squidward on a hospital bed watching your psych patient get wrangled by security or something. It's true, and it is therapeutic. I think some of them are kind of humorous, but Cortex initially was Cortex: A Light and Love Company. What we meant by that was being able to believe in alchemy. Taking something that's really dark and transforming it into something that can move and to mitigate the violence that we're seeing. If you're in a dark room and you strike a match, that little bit of light might not be a lot when the sun's out, but when it's really dark, that little bit of light will lead you kind of in the way that you need to go to get out.

Dan:

Yeah. I love that message. I love the focus on nurse safety. I was just at Marquette University working with their Master's certificate program in leadership, and they had a design challenge. How could you eliminate or reduce violence in the ER? They had some good ideas and talked training, security and giving nurses tools and different things. I think there's a lot of just thought about how do you create these cultures of safety? I don't know if any hospital system's got it right. First of all, what is your idea of a culture of safety, and then is there anyone that really has a best practice at the moment where they're keeping their entire team safe through training or prevention or whatever?

Mel:

I think there's a lot of chatter about the culture of safety. If you look at some of the documents put out by the ANA and other large organizations, and even some people in this space that are trying to do some work themselves and that are well-known in the space, they just use this phrase. There's not anything tangible that they give. Even with the Bill H.R. 1195, the Workplace Violence Bill, it was tabled because of the fact that it's very vague. That's something that if you look at a book by a gentleman named Jeff Cooper, he's a United States Marine, and he wrote a book called The Principles of Defense. That book talks about one of the key elements ... There are seven key principles of self-defense, and one of them is decisiveness. I think that starts when we look at a culture of safety. In order for personal defense to be applicable, it has to be self-generated. That's a huge problem.

Nurses traditionally are not decision makers. They're great at patient care, they're great at relating to people, they're great at, "If you give me an order, you give me a protocol, I will follow it to the T." But they're not the type of people that create the protocol. Not only that, but they don't have the time to do it in operational tempo. When you're asking someone to create a culture of safety, first of all, they don't know what a culture of safety looks like because it's been like, "Oh, well that's just working in ED. You're going to get assaulted," and we dismiss it. Then when you ask them to create one, they don't even know how to do that.

I as myself, the first time I really saw an excellent kind of culture of safety program was at the University of Maryland Shock Trauma. I don't know if anybody knows anything about Baltimore, but it's right next to Lexington Park. We averaged about nine to 12 gunshot wounds at night in Shock Trauma, so the violence there is pretty significant. When you come on, even as a traveler, you take an hour-long safety briefing class where the Baltimore City Police Department comes and gives you a lesson on things. That was probably the first time and the most thorough safety briefing I've ever had. I think about that often as I've moved forward through this in the last year. But that's just a minimum.

If you're sitting in a classroom and you hear a safety briefing once a year and then you're in a situation six months later, how are you really supposed to know what to do? You're probably panicking. One of the things that we like to say and recommend is that you should have protocols in place because we need to be decisive. The minute that you know that an attack is going to happen to you is the minute that you need to decide exactly what you're doing. We don't have time to create that in that moment, so we need to have a protocol. It's the same as you have a sepsis protocol. If your patient has a fever in the ED, if the lactic comes back at 2.0, you fire your sepsis protocol, and there's a whole standing order set that you can go ahead and do blood cultures, yada, yada.

We have similar system based on our experts. I kind of reached out and I was like, "Who can I find that is a security expert other than my business partners who are Marines?" They have this great skill set, situational awareness, they follow a system and protocols. We've partnered with Covered 6, which is the largest security company in the world probably, private security company, in the world and they do even Elon Musk's rocket security. They transport his rockets. These guys were awesome. I contacted them, I'm like, "Hey, I'm just this nurse." He's like, "First of all, stop. You're not just a nurse. You're incredible, and thank you for what you're doing and yes, we'll help you in any way." They've been really helping us to take the expertise that they have in the security of industry and what a culture of safety looks like now. They're very modern, they have a lot of updated protocols, and then to translate those into what could be possible for the bedside.

I think nurse managers and clinical managers, educators, administration, while they know it's a problem, they're not educated enough to know exactly what the solution is, especially if there hasn't been a very concrete solution that exists in the space of, okay, when the violence is happening, when deescalation training doesn't work, then what do you do? What does that look like from the time that the assault happens, the reporting afterward, and then most importantly, the support of the staff afterward? People make recommendations and say, "Well, you should do this," but there's no actual standard and no protocol. That's what where on the hunt to create.

Dan:

Yeah. I love that, and I agree. I think the culture of safety is this spoken phrase that hasn't always been backed up with data or how do you measure that you're in a culture of safety. Like you said, you can say a culture of safety and then say, "This is just how it is at XYZ ER."

Mel:

Right. There is a way that we measure that. In the security industry, they look at instances. We at Cortex use an algorithm. Algorithms are really easy to follow, nurses understand it. Now of course with TikTok and the generation of really those Gen Z and millennial people, they understand what an algorithm means now. We say that in order to quantify that, my advice would be to someone in administration at a hospital that's like, "Okay, I want to create this culture of safety. How do I measure it?" First, you want to total up all your incidents. This is why it's so important that reporting is done properly, and that it's encouraged. As a nurse manager, I think your role really is to try and foster an environment where it's not punitive. Unfortunately, a violent event is considered a sentinel event by JCO. That's something that we would like to be able to help encourage in the space of getting rid of that negative thought about the event and saying, "Okay, we need the data." It's not punitive. It's okay that it's happening at the moment because we need to address it.

But once you start totaling up your events, what you're really looking for is we know the violence is going to happen. How many times when the violence happened or the patient started yelling or whatever the trigger is, and we have a list of appropriate triggers, we transition them by a color coding system. As they move up the color coding system, how many times in this quarter or this last month did we move from a yellow to a red? If we started out our training and it was three times this month the patient moved from a yellow to a red and next quarter or next month, it was only one time, then we know that our metrics are working. We know that our data is showing us that our training is absorbing.

But if we don't have the incidents in the beginning to start reporting, we can't do that. A lot of times we don't report until it's too late. You know how they say the patient's pain is real. If patient says they're 10 out of 10 and they're texting on the phone, you should still kind of believe. You never know they might have a chronic disease and they're just managing it well. There's that big push for a patient's pain is real. Same thing. If a patient says, "I'm going to hit you," they're going to hit you. In our book that counts as it's happening, and we automatically move them up that algorithm. I think that nurses are so used to, ""Okay, well they're going to hit me. Sure you are, whatever, it won't be my first rodeo.

That type of mentality is really not helping other people. In that book, again, to reference Jeff Cooper, he says that part of the portion of self-defense is being ruthless. That's where we get, "Oh my gosh, don't talk about anything negative with the patient. Don't talk about being ruthless, Don't talk about being angry." We don't want to promote that, but there is a type of ruthlessness in being a great advocate for not only yourself and your own safety, but your colleagues' self and safety.

I think if you can tell your nursing staff, "Okay, we're in this together. By that I mean when there's a patient that's escalating, if we don't all deal with it the exact same way and follow this protocol, then that patient is going to think that they can get away with it next time, and next time it might not be you. Next time it might be your best friend or it might be the cleaning lady that you really adore. It will be someone different the next time, and that's what we really need to do is be ruthless in our efforts to standardize this, create a standard, and be able to get the metrics to promote a protocol across the board."

Dan:

What do you say to the nurse that says, "Well God, another assessment, Now I've got to assess some for violence. I've got to assess some for risk at home. I've got to assess some for sepsis, I've got to assess some for COVID. Now it's just another checklist thing that no one's going to do anything with. It goes into the EMR and becomes part of the infinite data set."

Mel:

That's really where our program is innovative because I've been there. Don't give me another thing that I've got to do. Nurses are already overloaded. The way that we operate is by really using security to the best of their ability. I don't know if you know this, Dan and your listeners, but in order to be a hospital security guard in the United States, all you have to do is take an online exam. You could take that, and then there you go. There's not much training in this space. What we say is it's a partnership. As soon as that patient starts escalating, we have an alert badge that we can use. There's other things that we recommend and there's other possibilities and ways that you can make this algorithm begin. But the important part is identifying it early and then getting other people in there to help you.

It's a partnership, it's a collaboration and letting security start opening the report. Just like if the police come to respond to an event, they create a report. Well, why can't security be there documenting and starting the report? Then when the nurse has time and gets caught up, they approach them even if it's the next shift or the next interaction that they're able to have, "Hey, let's go ahead and finish up getting that data that we need to complete this report."

But security really is the one that we want to begin making these, and they really have the skill set. A lot of them were veterans or police officers, so if we give them the proper training of how to relate in the healthcare environment, it doesn't take much training. It's not extensive, and they have an interest. They want to be a resource, they want to be able to help us, and they really should be the ones kind of carrying that reporting and then we contribute to it. But leaving a reporting to nursing supervision when they're trying to run 1,000 bed hospital at the same time as report every incidence of violence, just that's not realistic at all.

Dan:

We see the numbers from ENA. Over 50% of nurses or close to 50% of nurses have experienced violence in the past XYZ months. That's probably underreported.

Mel:

Way underreported. Our surveys are more like 98%. The interesting fact is from a psychological standpoint, the threat of violence or actually experiencing a violent event, it's the same psychological response. That's why we say as soon as the patient's exhibiting certain behaviors is when you start your alert. We're not waiting until you get hit or until they throw something at you. That's too late. What are the things that led up to that? Because most of these people are very disorganized thought processes. They're in the hospital, they're sick, a lot of times they're there maybe involuntary committed, there's other reasons. But our opportunity to intervene by having a organized thought process versus someone that doesn't is right before the incident occurs and right after. That's your opportunity to change the narrative. Understanding that we have that kind of leg up on them by being able to have an organized thought process really gives us an opportunity to intervene at the right time.

Dan:

I think you brought up another piece in there that I want to dig into too. There's the assessment and positioning yourself in different ways or situational awareness so that if the patient becomes violent, you can address it. But then there's the other piece of you can't eliminate violence completely. It's probably impossible because it's irrational behavior, it's unpredictable. Things can move very quickly even if you have the best situation awareness, things change, so you have to protect yourself. Talk a little bit about some of the things that you researched around how nurses can wear clothing that can protect themselves.

Mel:

That's a key thing to bring up, Dan, is really that. We can't stop it. We can't just say, "Okay, let's live in a bubble and you exist, and you can't get close to your patient." That's unrealistic. I think that there's a lot of training companies that are out there right now that we're using that focus on great ways to try and prevent it from happening, but no one's operating in this space of when it does. That's really where our core portion was. Then I realized, "Okay, if we're going to operate in this space of violence is going to occur, now what do we do, we need to offer them some solutions that are tactile."

One of the things that we've done is partner with a company called BitePRO, and they're out of the UK. The UK has different standards for their psych facilities than we do. They are really a wonderful company. They're invented by this guy named Robert Kaiser. He was a UK Special Forces ... I mean, I met with this guy and I was shaking in my boots. I was like, "Oh my gosh, this guy's awesome." He's a complete John Wick type guy. He created this body armor in addition to slash proof, bite proof and blunt force trauma blocking clothing. They use it in the UK in a lot of their behavioral health facilities, but there's simple as sleeves that go over the arm so if a patient tries to bite you, it can't break the skin.

We have spent the last six to eight months talking with them, learning about their products, what they offer. The blunt force trauma vest is really neat. It is only front-facing for healthcare workers. It's lightweight. It can be worn kind of inconspicuously so the patient doesn't know, especially if they're really paranoid and they're going to get triggered. We have different degrees of the type of protection. But we have kind of grouped them together in a bin. From my experience working in the ED and as a nursing supervisor and working in all these hospitals, I was like, "I think that this group of equipment would be appropriate for the triage desk," versus, "This group of equipment is appropriate for trauma," and, "This group of equipment is appropriate for behavioral health."

They had the products but they didn't have the training. We took the training to our security experts and developed the training and the protocol. Basically somebody can get the bin, scan the QR code in case they forget how to use it. Following that kind of medical device sales rep kind of way, we have a clinical rep and a tactical rep that will help the tactical side with security and the clinicians on that side with the product. Really neat, innovative. I've had my dog, horses, kids bite me with the stuff and nothing happens.

Dan:

No, but I think that's the whole package. We were doing this class activity. One of the goals was eliminate violence in the ED. I challenged them to think big. What would you have to do? I mean, we had ideas all the way from just taze everybody to Ativan Mist as they walk through the emergency ward.

Mel:

Tazing doesn't work because most of the time the patient's already agitated. You taze them, it makes it worse if you're not trained to use a taser really well. There's the time before the taser, after the taser, what are you doing? One of the things that we like to do is establish a safe working distance. It's as easy as every single patient assume, assume every single patient is going to hit you or kick you or become violent. That's, I think, difficult for nurses. We shouldn't assume everyone's going to hurt us. Well, the statistics are saying this, the data is saying this.

As an evidence-based practice, we have to look at the data. If we can say that, "Okay, this is the data, and so when you walk into the room, what are you doing when you walk into the room?" The first thing is awareness. It's the same time you're assessing your patient, you're assessing this situation, you're assessing what's happening in the room and where you can go. Then as the patient progresses down this algorithm and they start showing some behaviors that are a little concerning, first of all it's knowing the behaviors, just like you know sepsis signs and symptoms and then it's "Okay, now I'm moving them down the algorithm. What can I do to modify my behavior and my response," because it's really about responding instead of reacting. Because if we're reacting, it's too late. We've waited too long.

Dan:

Yeah. No, I love that. I think it's hard for nurses to think about that because you're trained to touch and care and be near the patient and sort of do that healing thing. But at the same time, you're right, the data is showing that ... Look at police officers, they approach it with, "I might need to assess this situation and if I feel safe, then I can move in closer and we can do the next level things." You don't have to not touch a patient or treat them all they're going to punch you in the face, but you have to do that initial assessment like you talked about, and if you have any worry wear the protective piece as well. We've got to normalize this behavior rather than just walking in, getting punched, walking out, be like, "Oh, I guess it's just how it is."

Mel:

Yeah. I think there's the key thing about the police. We have these old holding techniques. They've kind of gotten themselves in a situation where people are saying, "Oh well, we can't do any tactile holding techniques until the police come because of the issue." That's why we really partnered with an organization like Covered 6, who's really innovative and they have the best, most modern techniques, and there's nothing out there in the healthcare market like that. That kind of tackles that area of that confrontational, that physical piece.

We have varying levels of the training. Just at a basis we believe everyone should have self and situational awareness training, and then the second tier is really adding on the equipment if you're in a patient care area, and then it's the teamwork. Approaching the situation and understanding that we're in it together. Say for instance, Dan, I'm in a room and I'm the primary nurse and I'm taking care of the patient and all of a sudden the patient yells at me or starts throwing things at me. The first thing that I need to do is be like, "Whoa. Okay," and realize what's happening and make sure I'm between the door and the patient. Then, say the housekeeper is out there and she's mopping the floor and she hears this. That's the perfect time to intervene. We're not waiting until I start yelling for help. We're listening to our surroundings. That housekeeper can initiate that protocol. She can go to the phone, do what she needs to do for security or use the badge, go in and she becomes the second person observing.

As soon as you go in and you have a plan ... Remember how I was saying you have that rare time period in between where their thoughts are very disorganized and if you can stay organized, you're going to be a step ahead of them ... We recommend two to three people response, then they're escalating. They're really out to the point where we're having an issue. Well, now the alert's been triggered, security's on their way, then their charge nurse can come already dressed in the appropriate BitePRO or SlashPRO, whatever thing that is in the bin that's recommended for that situation and now we're protected. You get the two people that are not protected out, the person has a focus.

I mean, there's lots of different things that we can do and modify for different situations and different levels of comfortability. I'm 4'11". I'm not going to go up against it doesn't matter how tough I think I am, a 6'5" 250 guy. He's still going to lay me out. My priority needs to be my safety at that point. But I may be able to take over as the medication nurse and be able to maintain that portion of it and make sure that that order set is being initiated as soon as he starts yelling. Our clinical side is able to kind of talk to the physicians and update them with best practice and getting them the idea that medications do work when they're given early and appropriately. In the meantime, what can we do to protect ourselves?

Dan:

Yeah. Agreed. I love the framework that you have. A lot of our listeners are nurse leaders as well, nurse managers, CNOs, name the type of formal leadership role. What are some of the tips you have for nurse managers, CNOs in order to sort of help build that real culture of safety and create that space that nurses can start assessing and be okay with protecting themselves?

Mel:

I think the most important part is don't [inaudible 00:26:49] the violence. I know when I was a nurse manager, it was kind of like they'd come in the office and be like, "This just happened," and They might be upset and you're like, "I know, oh my gosh, I'm so sorry. I remember this one time this patient did this to me." I think that in our effort to be compassionate sometimes it feels like we're dismissive. So really avoiding that conversation. I think being supportive and promoting a no tolerance culture begins with the immediate response. Say there's a code gray called or a code whatever, and it's a violent patient. First of all, you get your employee a safety. Treat any immediate injuries. If they say something like, "Oh, it's fine, it's fine. This isn't my first rodeo." I say that a lot. Your immediate response should be, "Okay, well it's not okay with me, and I'm going to begin the official report now, and I'll assist you in completing it when we have time."

Really trying to promote that area of, "Okay, I understand you're okay, but it's not okay with me." Nurses have a lot of feeling of apprehension about returning to the assignment sometimes and that should be assessed. I know that was one of the ANA recommendations was adequate time after the assault coverage after the assault occurs. Well, right now we don't even have coverage for pre-assault. We're hemorrhaging nurses and that's not always possible. But even allowing them a couple minutes to just go and take some slow deep breaths. One of the breathing techniques that the Marine Corps uses is called box breathing and it's Marines that run long distances and then have to lay down and take a sniper shot. Their adrenaline's going, so we kind of renamed it the stabilizer to kind of promote what it's doing. But it's basically encouraging your staff member, your nurse, to take three slow deep breaths. We say deep breaths, but it's really the force of the inhalation should match the force of the exhalation in both length and pressure.

When you're doing that because your heart, your cardiac and your respiratory system are related, you're basically telling your brain like, "Hey, everything's fine. We're in homeostasis. We're not in a fight or flight response." Offering them a cool drink of water, that's another ... You're kind of tricking your senses into thinking about something else. I think another underutilized service that we recommend is the chaplain [inaudible 00:29:05] service. They come for usually codes. When they're called overhead, the chaplain shows up. Just allowing them to have a resource and say, "Hey, I'm here for you. Is there anything you'd like to talk about?" Because other people have different situations to violence.

My first husband was very, very violent. Sometimes when I have a gentleman that's escalating, I have a little bit more of a trigger than other people. I think that's important to offer them a safe place to go immediately. We have a lot of wellness programs and, "Oh. Well, you can go talk to a therapist," but nurses aren't using them. We know the research is saying that they aren't. Kind of just being a little bit more encouraging and having that immediate response. Then also telling them that they're doing an excellent job. "You're a really good nurse. This is not your fault." Even if it is their fault, because this is the other portion. A lot of nurses like to escalate and I'm guilty of that. I'm 100% guilty that if I'm working my fourth or fifth shift in a row and somebody throws a urinal of pee at me, I'm going to be real upset. Sometimes that is the issue is that the nurses escalate or they don't have adequate self-awareness training.

Sometimes like up North we act a lot different than people down in the South. My arguing with a patient may be just the way me and my mother talk to each other, but the patient may feel that, unfortunately I'm very abrasive. It's a lot of where your upbringing and other things relate. Part of our training is really to teach that, teach your own self-awareness. That's really important in the beginning. Maybe the nurse manager understands that that's an issue and brings it up, but not at the time that it happens. Like, "Katie, why did you argue with the patient? This is what happens when you argue." No, that is not the right time. It really should be conducted in a formal review where you offer solutions and education to the nurse in a nonpunitive manner. That's where your management and your judgment as a manager comes in.

Maybe the nurse is a bad fit to work in psych that day because they've worked so many shifts in a row. Or maybe they just don't understand how to talk to people because they're from a different part of the country or they were raised differently. I think gathering information as soon as possible.

For upper level management, the CNO, I think it goes a long way when they follow up when something really traumatic happens. For the love of God, please do not send flowers. I've heard how many nurses tell me that, "Oh yeah, I was assaulted, I broke my occiput, and the CNO sent me flowers." It's very dismissive. I think one of the things that you can do is very simple. Send an email, send a text message. "Hey Katie, it's Mel, the chief nursing officer. I was just checking up on you after the event last month. How are you feeling? I wanted to let you know that we'll be rolling out some new education for all our sitters to help them identify warning signs of escalation and to call security sooner. Let me know because I'm here for you should you do have any more thoughts or ideas going forward." Then always thank them. "Thank you for your excellent patient care." I think that, you're acknowledging the situation, you're asking how they're feeling, you're encouraging their input, and then you're also saying what you're doing about the matter. It didn't just fall on deaf ears.

Dan:

Yeah. I think that's the key. It's got to be meaty, authentic interactions on how to stop it and learn from it and coach in the moment and not pizza parties and flowers. Those can be pieces of it, but there's got to be some addressing the issue.

Mel:

Maybe it's when you start tracking your metrics and you've gone from the last quarter you had 10 violent events and only two of them or one of them out of the 10 escalated to a red. Heck yeah, throw a pizza party. "You guys deserve it. You're putting in the work to prevent the violence, and we acknowledge that." But it shouldn't be just random. It should be something that's showing that we see what you're doing and we're happy that you're participating.

Dan:

Yeah, no, I think that's good tips both for frontline nurses in protecting themselves, situational awareness, protective clothing, what nurse leaders can do to address the system issue, and then how do they follow up once it happens. We talked about a lot today and we're coming to our end of our time. What's that one nugget you want to hand off to the audience that either provokes them to think about this differently or gives them something to act on tomorrow?

Mel:

First of all is to be aware. To constantly be watching what you're doing, how you're interacting and start observing. The second piece of it really is to understand that this is a problem and that we're not going to fix it overnight. But nurses are the perfect innovators. They're the MacGyvers. If we're going to get the data to change this, it's going to be through us. I think understanding that reporting is important because we have to be ruthless in our protection of each other. Starting to report and doing it properly is the first part of being able to fix this so that we can provide predictive analytics. What are the things that are going to cause violence? What are the instances and the patient populations that kind of trend that way? We need to find the trend, and I think reporting is so important and if you have questions about reporting, we're happy to help.

Dan:

I love that. I think the nurses need to own this piece of it because it's happening to them and not wait for someone else to come fix it for them. I think we need to also challenge the norms of things like the three letter training that we have to all get all the time. It's not enough.

Mel:

It's not enough. Jeff Cooper says, "If you know that you can fix it and you know what to do, you will use the training." The problem is if you get that training once a year, it's not enough. It's not enough training. We need to simulate those situations, and VR is a great way to do it and some other things that we're doing.

Dan:

Agreed. Well, Melissa, thanks so much for being on the show. Where can people find out more about your work and engage with you? I know you mentioned LinkedIn. What other platforms are you on?

Mel:

LinkedIn is perfect. Also, they can go ahead to our website at cortexgold.com. It's C-O-R-T-E-X Gold, delivering the gold standard for healthcare security. They can reach out to us there or on LinkedIn. Send us an email. We have a lot of free resources. I'm all about fixing this, so that's my priority is getting access. If a nurse leader has a particular event or a particular question, we are here to assist them and allow them to continue providing patient care while we kind of work in the background to make sure it's as safe as we possibly can.

Dan:

Yeah. Go check out Melissa's website, engage with her on social, give her a call. She's very passionate about this stuff as you can tell. Has a lot of data that's just not uncovered and a different solution looking at other industries to help support and build a culture and practice of safety for nurses, which is desperately needed. Melissa, thanks so much for being on the show and look forward to what you're up to and seeing you launch this thing off the ground.

Mel:

Thank you so much. I appreciate it, Dan.

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