From Classroom To Chaos: How Simulations Prepare Nurses For Real-World Violence And Broken Staffing Rules

We dive into violence in nursing from simulation labs to courtrooms and then pivot to the federal rollback of nursing home staffing rules. We end with a frank look at ANA membership and why excluding LPNs weakens nursing’s voice.

• UNC simulation tackles verbal abuse, escalation, and bullying
• Eight in ten nurses report workplace violence in the past year
• Classroom actors and debriefs build real de‑escalation skills
• Arkansas felony case underscores accountability for assaults
• CMS staffing rule rollback risks unsafe ratios in long‑term care
• Profit pressures versus patient safety and humane workloads
• Families want 24/7 RN coverage and reliable care hours
• Excluding LPNs from ANA fractures advocacy and unity

If you are an instructor or in nursing school, let us know in the comments: do you want workplace violence simulations in your program

Chapters

• 0:00 Warm Check-In And Setup
• 0:29 Why Simulate Workplace Violence
• 1:42 UNC’s Three Scenarios Explained
• 5:25 Stats And Funding Context
• 6:06 Reactions And What It Means For Students
• 10:17 Real-World Assault Case In Arkansas
• 14:05 Accountability And Felony Push
• 15:27 CMS Staffing Rule Rollback
• 19:17 Ratios, Profit, And Patient Harm
• 22:19 ANA Membership And LPN Exclusion
• 25:14 Recap And Listener Call For Comments

Transcript

SPEAKER_00: 0:00

Welcome in, welcome in with your Wakanda RN. I have a lot on my mind, but I'm not here to waste my time. Let's get into it, man. How's your week been? How you doing physically, mentally, spiritually? I always like to know. I always like to check in on my listeners, my followers. Hope y'all are doing well. Let's get into it today, man. Let's get into it today, man. I feel like healthcare there's always weird stuff going on, strange stuff going on. There's always something within the news of healthcare, man. Seems to always be the case. Now, normally we kind of start more on hospital settings, long-term care settings, but today we're actually going to start in a nursing school program. So, you know, there's all kinds of teaching and simulation, things like that that are done, right? You know, you may have a scenario where you go over folio catheters, you may go over a clinical scenario, may go over cold blue scenario, you may go over a lot of different scenarios. But for my listeners out there, have you ever done a clinical setting to where you practice workplace violence? Well, that is what a particular school is working towards. Very interesting. So the caption or the title says, Finally, a nursing school simulation that addresses workplace violence. Now, I must say that we're even addressing this in the first place is pretty sad, but let's get into it. Key takeaways. The nursing school at UNC Chapel Hill designed three real life scenarios to address workplace violence and nursing life simulations. Eight in ten nurses have experienced at least one type of physical, uh, excuse me, workplace violence within the past year. Three approved scenarios uh address verbal abuse, physical escalation of a patient, and nurse-nurse bullying. That last one's pretty sad, I'm not gonna lie. You know, we're talking about workplace violence, we're talking about nurse-to-nurse bullying. Um, let's see. Nursing schools employ numerous teaching methodologies throughout the course of the program. Most will utilize live patients during simulations by employing local actors or even students from the campus. The School of Nursing at UNC Chapel Hill is taking live simulations to the next level. In January, educators at UNC ran the first simulation specifically designed to address workplace violence. We know that one out of every four nurses will experience some sort of workplace violence during their career. That could be physical, mental, emotional abuse, said Valerie Howard, Dean of the UNC School of Nursing. It could be harassment, bullying. It's not always the physical violence that we think of. How does it work? Similar to other live simulations, students are given fake patients and are taught to address them as if they were real. And the simulation was occurring in the hospital setting. Educators run the simulation and may fill in the blanks, including health history, vital signs, and symptoms. When a live actor is present, there is a pre-established script. Emily Barksdale, nursing student at UNC, was one of the first to experience this new simulation that recreates workplace violence that nurses can encounter in the field. Barksdale walked in to see her patient and asked about the pain she was experienced to better understand the needs of the patient and communicate with the providers. The patient looked to Barksdale straight in the eye before saying, What? Are you trying to psychoanalyze me? Female dog. Barksdale then had to utilize techniques she learned in the classroom to de-escalate the patient and build a more therapeutic communication pipeline with them. So let's go over real quick some workplace violence prevalence. A 2023 study conducted by the National Nurses United found that eight and ten nurses have experienced at least one type of workplace violence within the past year. Nearly half of nurses reported an increase in workplace violence on their unit compared to the previous year. Only 3.8% of nurses reported workplace violence had decreased on a unit compared to the previous year. The most common types of violence reported were being verbally threatened, 67.8%, physically threatened, 38.7%, and being pinched or scratched 37.7%. A plan comes to fruition. The use of simulation to address workplace violence was made possible by a grant from the AARP, Health Equity, and Nursing Innovation Fund, matched by UNCs. Robert A. Ingram Institute for Equitable Healthcare Access. Real life scenarios. This is kind of what I think people are more interested in. Let's talk about. So these are their real life scenarios by UNC nursing program. Three, UNC Chapel Hill. The three scenarios that were developed to deal with different aspects of workplace violence provided students with the broadest range of possible real life scenarios. Verbally abusive, a confrontational parent of a child patient who was being involuntarily committed. Number two, a patient experiencing severe pain with escalation due to the patient feeling like healthcare providers weren't listening. Three, a coworker is trying to bully a nurse into doing something that doesn't align with policy. When people think of simulation, they think about what's happening downstairs to our SIM lab, right? The beds, the mannequins laying there, Howard said, we hired some actors to come in and portray some of these instances were workplace violence for nurses. We had an audience sitting right there. We did this in the classroom. Very low budget, low cost, but very realistic. We got to emphasize the low budget and low cost, huh? The program was a success during the initial trial period. It ended in July, and many students expressed positive feelings towards it. All but a few of the participants, and when I say a few, I'm talking one or two agreed that the training was extremely valuable. The pre-briefing that we did, the actual scenario, then the debriefing, they felt like this could translate into practice, Howard said. The results were very positive. Okay. And we're just gonna stop right there. All right, and we're back. So interesting, man. I haven't seen or heard any other nursing program that is doing this. I can see a trend in the future where there's more nursing programs. They're actually gonna have live scenarios to where they practice workplace violence. It is very sad. It is very unfortunate. But, you know, I read some of the statistics earlier, which I'm glad that they put on this particular website concerning numbers concerning workplace violence. But that's the world we live in. I mean, but this but the other aspect to that as well, the other flip side of that is, you know, we want to see less of that. You know, I think the numbers, I think it was like 3.8%. You know, people did a survey, they said they only saw 3.8% decrease in workplace violence compared to the previous year. That is not enough. That is not enough. If we want more people into this field, we got to see a decrease in workplace violence. There's no if, and buts to it. There needs to be people that are held accountable. There's people who need to be, you know, tried to the extent of the law because, guys, this this field is declining rapidly. Yes, healthcare as a whole is becoming more innovative, but in terms of nurses, nursing, in terms of that aspect, you got people that just they're just tired. They don't want to be in this field. And this is part of it, and it's part of it due to workplace violence. So that's something that needs to be addressed. And hopefully, hopefully, in the near future, the right people will hear this, get the information, and get more laws in place because it should be a felony to lay hands on any healthcare worker. I mean, come on now. Come on now. I mean, I've I've talked about stories earlier on in the year. It's just completely unacceptable. People should be able to go to their jobs, take care of their patients, and go home safe and sound. And unfortunately, some of my colleagues have not gone home safe and sound. Some of them have ended up in ICU, some of them end up in the emergency department, and some of them, very few, have actually lost their lives working in this field because it's so violent at times. So, on one hand, it's sad that this is even a thing, but at the same time, I mean, if it's out there, I mean, why not prepare the students for what's actually out there? So I'm sure the one or two students who weren't very happy about having to do the stimulation, they probably maybe were rethinking their career choice. And honestly, I really can't blame them because if you listen to the news, you see what's on social media, I mean, it's it will scare any reasonable person. But a lot of us who've been in healthcare for many, many years, we've just dealt with it. We've just dealt with it, we've had to put up with it, and it's just become a part of our lives. But it that should not be the norm. So if you are an instructor listening to this, if you're somebody who's in nursing school, let me know your thoughts in the comments below. Do you want to see workplace simulation within your nursing school? Let me know in the comments below. That's to me that's a very, very interesting topic. All right. So moving right along, can you guys guess what my next topic is? It's very on hand with this topic. And guess what, y'all? Guess what? Yes, we're moving right on to workplace violence. Go figure. Go figure. So let's talk about this very briefly. A patient rips out nurse's hair and now faces felony charges. An 18-year-old in Arkansas faces a Class D felony charge after allegedly yanking hair from a nurse's scalp during a confrontation. Yes, hair from the scalp. Kyra Fox, an 18-year-old from Nobel, Arkansas, now faces felony charges after allegedly pulling hair from a nurse's head during an incident in Johnsboro. Um, Craighead County District Judge David Bowling found probable cause to charge Fox with second-degree battery, causing physical injury to medical personnel classified as Class D felony under Arkansas law. This case represents more than just one isolated incident. Violence against nurses and other healthcare workers has become increasingly common across the United States, according to the Bureau of Labor of Statistics. Healthcare workers experience workplace violence at rates five times higher than workers in other industries with nurses bearing the brunt of these attacks. The legal response to this case demonstrates Arkansas's commitment to protecting healthcare workers through and enhanced penalties. Under Arkansas law, what might typically be charged as a misdemeanor becomes Class D felony. When the victim is a healthcare professional performing her duties, if convicted, Fox can face up to six years in prison and fines reaching$10,000. Um okay. We're gonna stop right there. So look, look, nobody, nobody wants to see this, hear this, deal with this. I get it. But you should be able to go to work and not worry about your weave being pulled out. Ladies, can you imagine you just trying to go to work? And some of you ladies, y'all got y'all's weave game and wig game intact, and somebody grabs your weave and they pulling on it, they tugging on it, and you can't get away, man, and they just rip that thing right on out, man. You weave along with your the remaining of the hair that you may have. That's terrible. Really, really terrible. But not to not to be mean or anything, but I mean, seriously, though, like you try to just do your job and then somebody grabs your hair and they pulling it from the scalp. A ripping your hair out from the scalp. Like, ridiculous. Ridiculous. Let me know, man, because it's hard out here, man. There's people that's I think I think there's less retaliation from nurses. Um, I can't speak for my CNAs and my text. I can't speak for y'all. But I think there's a a lot less retaliation from the CNAs, or excuse me, from the nurses because they work so hard to get their license, man. I remember the long nights, the hard times, the perseverance, the getting through, and then they like, man, it's just not worth it. It's just not worth it. Now, other people, I mean, they ready to knock if you buck. They ready to throw down. You know, I'm saying Bone Crushers playing in the background. You know what I'm saying? I'm a millennial I'm a millennial, so I may be out of touch for probably some of you listening to this. But um, I'm just saying, they ready to throw down, they're ready to fight. You know, they ain't never scared. So I'm just saying, like, there's some people who they're ready to throw down, and you might trigger something, but there's other people like they like they work too hard, they're not gonna throw away their license for that. But it's ridiculous. It's ridiculous. Now, this occurred in Arkansas, but there's plenty of other states that need to follow suit, and they just haven't yet. So, other states, y'all need to get on the ball. You know what I'm saying? Don't make this a misdemeanor. Go ahead and follow Arkansas and make go ahead and make it a Class D felony. Protect our workers. Please protect the workers. Don't, don't, don't mess around. Go ahead and make it a Class D felony. Get these people up out of here, man. Because we need we need All right, man. That's topic number two. But let me know in the comments below. Have you been grabbed like that? Have you been snatched? Have you been snatched to where somebody got a hold of your head, they got a hold of you, you weave, and that sucker's about to come out. Let me know in the comments below. Alright. So our next topic is CMS revokes the nursing staff requirement. Some of you probably didn't even didn't even know that that was even a thing, to be completely honest with you. And if you didn't, I mean, I mean, I kind of understand it, but some of you who are pretty aware in the news, you you're aware of this. Uh just call them. I'm just reading y'all. It was this occurred during the Biden administration, late during the Biden administration, but now it's eliminated by the Trump administration. So let's talk about it. Okay. During a majority regulatory shift, the Department of Health and Human Resources moved to roll back most of the federal nursing home minimum staffing requirements that were finalized in 2024, significantly reshaping the oversight landscape of long-term care facilities and the nurses who work in them. The change affects nursing homes participating in Medicare and Medicaid, and now raises new questions about how adequate staffing will be defined and enforced moving forward. The 2024 federal staffing rule issued under the abiding administration set the first minimum nursing staffing standards for long-term care facilities. It required at least 3.48 hours of nursing care per resident per day, including a minimum of 0.55 hours from registered nurses and 2.45 hours from aid/slash certified nursing assistants, along with a requirement that a registered nurse be on site 24 hours a day, seven days a week. These things were applied to Medicaid and Medicare certified nursing homes nationwide. Why HHS is repealing most provisions? In late 2025, HHS and the Centers for Medicare and Medicaid Services issued an intern final rule rescinding most of these staffing mandates, including the HPRD minimums in the 24-7 nursing RN requirement, while leaving certain assessment and planning expectations in place. Federal officials cited concerns that the 2024 rule would disproportionately train nursing homes in rural and tribal communities with severe workplace workforce shortages, increasing the risk of facility closures, and reduced access to care in areas already facing limited options. Analysis used by HHS estimated that full implementation would have required nursing homes to collectively hire on the order of 100,000 additional caregivers a target that many providers argue was unattainable under the current labor market conditions. The rule was highly controversial and faced significant oppositions from multiple states, with several judges rescinding it over the years. And we can keep going, man. But at the same time, y'all get the gist. I get the gist. Y'all want to read the full article, you are more than welcome to, but we're gonna go ahead and talk about that real real quick. Real real quick. So so to be honest with you guys, um my honest thoughts on this, because when it first happened under the Biden, the Biden administration, I mean, on one hand, it kind of sounded a little bit ridiculous to have 24-7 RN coverage, but at the same time, I thought about the people, the actual people in nursing homes. And if you talk to families, if you if these which these people did not do, by the way, I'm calling y'all out, the people who rescinded this, if you were to talk to the families collectively, families within the nursing homes, they would tell you, yes, put an RN in the facility 24-7. We want the highest level of care we possibly can, and we will want a registered nurse because a lot of these times in these nursing homes, I mean, you're working with skeleton crews, you're working with the bare minimum requirements, and having the bare minimum requirements does not always equate to better care. So that's a thing. It doesn't equate to better care. And so I look forward to the challenges that these nursing homes were going to have to face in terms of trying to meet these, trying to meet these requirements. Because they said it was required over, what, 100,000 additional caregivers, and then this troubled, you know, rural areas and tribal areas and and all that. I mean, that sounds good, but we will never know because there was, I mean, it never was implemented to where they had to attempt. And, you know, that 100,000 additional caregivers spread out across states, I mean, the number seems astronomical, but across U.S. homes, it's really not. You know what is astronomical, though? One nurse to 60 patients, one nurse to 50 patients, one nurse to 40 patients. Those numbers are astronomical. Those numbers are insane because that has that's what's happened. So you got all these people that are lobbying, begging, please rescind these mandates. But you know what they're not begging for? They're not begging to have to bring in more money into their homes to pay staff to where they can have more staff on site. Because guess what? If they have to bring in more staff, that's less revenue that they're excuse me, that's less money that they have to use to pay their staff. That's more money that they can pocket. Because guess what? For a lot of these people, it is just the profit. You can get away with one nurse to 60 or one nurse to 70 or whatever, two CNAs for the whole building, or three CNAs for the whole building, whatever. They don't care. They don't care. They've been getting all that money all these years. They're not gonna care about that. So I didn't feel sorry for them one bit when they had to meet these mandates under the Biden administration. But now all of a sudden they get their way and it's a bad look for nursing homes. It's a bad look for nursing homes. And it'll continue to be a bad look for nursing homes. It is. And if you never work long-term care, some of these numbers may seem insane to you or made up. They're really not. They're really not. I got people who are medical and non medical listen to the show, and it's a very real thing. And now, some of you, let's say you're a patient, listen to this, you're you're a former patient, and you feel left out if your nurse told you, you know, you're one of six, you're one of seven and you feel neglected because your calllight doesn't get answered on time. How do you how do you what do you think what happens when there's you times that by ten there's ten more of you within a nursing home. Can you imagine that? Because that's what occurs. That's what goes on. But these owners, some of these ministries, they're not going to tell you that. No, I'm not painting a picture for all of them, but there's some of them who are just flat out greed and there's they're very greedy and the greed described in the Bible. But that's just the way that it's been so that's my thoughts regarding that situation. But please let me know what you guys think below because I'm thinking about the patients. I'm thinking about the people who are actually in the homes. That's what I'm thinking of. I'm thinking of patients who have literally passed away because they were not checked on for hours. That's the type of stuff I'm thinking about. I'm thinking man I I mean I got stories for y'all man I'm telling you man I I'm thinking about somebody who was suffering mentally and ended up taking their own life because of shortages. So I'm not trying to hear what somebody's lobbying about they're gonna make the point about rural areas and tribal areas. I'm not trying to hear all that because to be completely honest the ratios for nursing homes should never have been established in the first place without it being safe. So they were implemented with with unsafe staffing and now we're playing catch up. But that's my thoughts with that y'all can let me know in the comments below what you think about that. But that is that is my that's my thoughts. So my last subject for you guys today and this last subject for me is a little a little bit on the lighter side you guys can definitely let me know what you what your thoughts but have you guys you I'm sure you guys have heard of the A N A the American Nurses Association right you guys have heard of that so just real real real fast we're just gonna go some of you probably can't see this it's okay I'm gonna read it to you guys so bear with me here um we're we're talking about the joint like the membership options benefit cost all this stuff from the American Nurses Association you know this is supposed to be if you join you'll receive benefit support and representation from A and your state nurses association so here's some of the things if you join for the cheap price of$1,261 dollars the cheap price you'll get 36 free C and E courses you'll get um you know a free printed copy of their award-winning peer-reviewed journal um you'll get a$100 discount I mean I take the$100 on the$1,261 but hey hey hey option to participate in mentoring programs access to the nurse burnout prevention program I mean you can save money on advancing your education there's a tuition discount program there's opportunities to grow and expand your professional network there's personal benefits such as travel ticket discounts professional liability insurance auto home life all this stuff you and this hey you have the ability for run for office apparently so all this stuff you can do with the A. You know what it doesn't say on here it doesn't say that it's just restricted to registered nurses. It's just restricted to registered nurses. So you know just a quick search I don't you know you know I was looking up I think there's over a little bit over a thousand LPNs excuse me pardon me way more y'all than that a million LPNs in the United States and y'all can't join the American Nurses Association. Can't join you can look but you can't touch you can wonder but you can't have can't join it can't join it. And really I was looking at the nurse Erica's video she did a podcast with I can't remember if it was the president it was one of the members of the American Nurses Association. She asked them directly can LPNs join and they said and this person said not at this time if they will in the in the near future and that still has not happened today. An American Nurses Association why why can't LPNs join the American Nurses Association that is crazy to me that is bizarre to me I'm not a member of the American Nurses Association. I I like my$1,261 dollars I like it. I'm gonna keep it to myself and do something else with it. But hey if you're I read that package to you guys if that package sounds intriguing just go to the website get signed up and maybe you too can run for office within the American Nurses Association. So that's what I got for y'all with that. All right so man real quick we talked about you know nursing school simulation that addresses workplace violence still insane we talked about how um there is an 18 year old in Arkansas that is being charged with a with a felony for pulling hair off of a nurses we talked about CMS revoked the nursing staff requirement we also talked about how LPNs cannot join the American Nurses Association. If you like topics like these and other topics please comment below let me know some things you want me to cover some things you want me to discuss and talk about but thank you guys for tuning in with your Rakondar and hope you guys have a blessed rest of the week. I love you guys and I'm out