When Amy Castillo, BSN, RN-BC, took steps to keep colleagues in her unit safe from workplace violence, she had no idea it would morph into a multidisciplinary, systemwide safety initiative called .
Castillo, a clinical nurse in 6 West at Ronald Reagan UCLA Medical Center, a medical-surgical unit that provides specialized post-operative care to adult patients, became alarmed when she heard about an escalation of assaults against nurses. Then it happened in her unit.
During a night shift, a patient assaulted a nurse, grabbing her arms and punching her in the face when she reached for her phone. The incident escalated when the patient removed his clothing, bolted from his room and ran onto the floor, swinging his EKG leads.
“Not only did he attack our staff, but patients could hear what was going on, and they were terrified, too,” Castillo recalls. A code gray (signifying an abusive or combative person) was called to notify hospital security. “They responded in one minute and two seconds, but that minute can be a very long time when you’re trying to escape somebody.”
Castillo and her colleagues participated in a debriefing session following the incident, and that “started getting the subject rolling on how to prevent this from happening in the future,” she says.
Honoring her grandma
Castillo grew up in Orange County, one of four children in her family. She first trained to be a licensed vocational nurse and worked in UCLA’s neurology outpatient clinics, overseeing the medical assistants. She eventually switched to the department’s education office, which offered greater flexibility for her to attend college.
Juggling school, motherhood and a full-time job as a department manager left her bone tired and questioning her decision some nights. But Castillo was determined to earn her nursing degree, in part to honor her grandma, Marjorie, whose dream of becoming a nurse was shot down by a high school guidance counselor who told her she didn’t have the intelligence to be a nurse.
“My grandma told me this story later on in her life,” Castillo says, wiping away tears. “I did it for both of us.”
Castillo earned a Bachelor of Science degree from Mount St. Mary’s University, becoming the first in her family to complete a college education. She started her career on 6 West, a surgical specialty unit, as a new graduate in 2015.
“I love my unit. The people can make or break where you work, and we’ve got good people here,” she says.
Early safety advocate
The incident in her unit moved the needle forward on the subject of workplace violence. But true to her nature, Castillo was one step ahead. As co-chair of her Unit Practice Council, she had already initiated interventions to make her unit safer. During the pandemic, the Unit Practice Council designed the Code Gray Bag containing supplies, such as restraints and personal protective equipment, that might be needed during a code gray response. The bag was housed at nursing stations in the unit.
Castillo and the Unit Practice Council also mobilized and inspired their nursing team to achieve an outstanding completion rate of 70% for Crisis Prevention Intervention (CPI) training, a set of techniques to recognize escalation in potential aggressive behavior and ways to mitigate an aggressive situation.
The numbers speak to its success. Data from electronic incident reports in Castillo’s unit in 2019 show 20 safety events and four workplace injuries. In comparison, from January to July 2021, those numbers had dropped to 6 and 0, respectively. CPI training has now been extended to all UCLA Health staff.
More innovation
But Castillo wasn’t finished. Next, she designed The Gray Dot, a visual symbol placed outside a patient’s room alerting staff of potential high-risk situations.
“You go to help because it’s your nurturing nature, but you may not know all the patients on the floor,” Castillo explains. “The Gray Dot means ‘See the nurse before entering.’ This allows anybody entering the room – nurses, physicians, staff, people delivering food – to see that patient has been known to be verbally or physically aggressive, or they have the potential.”
The Gray Dot will be rolled out systemwide over the coming months and started a larger conversation about workplace safety, leading to A Safer U. Through this initiative, nurses in high-risk units now have wearable duress buttons they can press to summon security. A system to flag high-risk patients in their electronic records will launch later this year.
Award winner
Castillo’s contributions have not gone unnoticed. Recently, she was one of 30 nurses – 10 from UCLA Health – to be honored by the Simms/Mann Family Foundation’s , which recognizes nurses for outstanding care with a $10,000 gift.
By the program’s design, recipients embody “a bias toward action, capacity for self-direction, originality and creative instincts, courageous and bold thinking, and the potential to achieve even more.”
Castillo says she was surprised and humbled by the award.
“I truly just did something I thought was good for our unit,” she says. “I wanted our nurses to stop being abused. Being there when our co-workers are getting beat up by a patient is traumatic. You think you’re doing something small to prevent that from happening, not realizing that this ‘little baby’ of yours will take off and go through the entire hospital.”
Castillo says she hopes the Off the Chart program will show bedside nurses that they, too, can make a difference. “I hope that it will make other nurses recognize that ‘I have a voice. I can make an impact.’ ”
Future direction
Castillo continues to work on workplace violence prevention through her Unit Practice Council. In November, she and UPC Chair Christopher Lee, BSN, will attend Sigma Theta Tau’s biennial convention in San Antonio to report their data to a cohort of global leaders in nursing. Sigma is the International Honor Society of Nursing.
She’s also eyeing a role in management in the future. “I know from my experience that I can provide even more change at the leadership level,” she says.
But first, her sights are set on a little downtime – perhaps at a favorite Disney theme park with her husband and their two children. “We haven’t taken a vacation since 2018,” Castillo says, “so it will be a much-needed and much-appreciated vacation.”
Jennifer Karmarkar is the author of this article.
