Protecting Our Caregivers From Workplace Violence

from the Norfolk District Attorney’s Office

Why the healthcare industry faces increased workplace violence & what can be done to prevent it.

In many ways, workplace violence in health care can be compared to domestic violence a generation ago. Back then, police, prosecutors, judges and society too often gave domestic violence victims the wrong answers: “This is a private matter; it isn’t an assault if your spouse does it.” And the remedies sometimes employed have become legend. To the perpetrator:“Take a walk around the block” To the victim: “Stop doing whatever you were doing to precipitate the event”.

Law enforcement, the courts and victims began working together to change those perceptions. Society now tells victims of domestic violence that it is never okay for one person to use violence against another, regardless of relationship, and that no provocation makes violence acceptable.

The same standard should be applied for the victims of workplace violence in health care. It is never okay for one person to use violence against another, no matter what the situation is. Health care employees work around the clock in facilities and private homes caring for millions of people. Health care was the largest industry in the United States in 2004, and is projected to create more new jobs than any other industry between now and 2014.

Health care workers experience violent assaults at a rate four times higher than other industries; for nurses and other personal care workers, this rate jumps to 12 times higher.

In a 2004 survey, half of responding Massachusetts nurses reported having been punched at least once in the previous two years. In another study, 75% of Emergency Room physicians had been threatened in the last year, 28% had been assaulted, and 18% had obtained a gun for protection.

Health care is a fast paced and, at times, highly emotional environment. Patients are in pain, waits are long and family members and friends can become distressed. Both victims and perpetrators of crimes must be provided with care, and health care workers may not know if the patient, family members or friends have a history of violence.

Workplace violence affects all health care workers. Victims can be doctors, nurses, aides, technicians, or receptionists or admissions workers delivering unpopular news about insurance status or wait times. Patients and visitors can also become victims and witnesses.

Most workplace violence comes in the form of verbal threats and physical assaults, and drug and alcohol abuse is often involved. The offender can be a patient, visitor or another health care worker.

Surveys indicate that less than half of those assaults are reported to hospital management; even fewer are ever brought to the attention of police. Violence in the workplace has a negative effect on everyone: victims, witnesses, the workforce, and the institution itself. In addition to physical injuries, victims and witnesses suffer psychological trauma, the entire staff feels less safe, and the institution may be faced with low employee morale, monetary losses, liability issues and embarrassing public relations.

Verbal threats to do bodily harm should be taken seriously. Threats many times precede a violent act, andan attempt or threat to do bodily injury to another by force or violence is a crime.

Services, clienteles, staff, and physical facilities vary widely in the health care environment – from doctor’s offices to hospitals to home health care. Workplace violence prevention programs that are tailored to the organization’s specific needs will be most effective in reducing the frequency and severity of violent incidents.

The following steps can be taken in any workplace violence prevention plan:
- Educate employees about workplace violence prevention policies and plans
- Communicate a clear definition of workplace violence
- Solicit input from frontline employees to help identify risk factors, report
- problems, and suggest improvements and interventions
- Require employees to report all incidents of workplace violence
- Develop communication systems that alert staff to a patient’s history of violent behavior
-Track all reports of violence to identify trends that can be addressed
- Identify steps for employees and managers to take when violence occurs
- Focus on ways to make the physical environment safer (this can be as simple as replacing all broken light bulbs)
- Provide prompt and comprehensive assistance for victims and witnesses of violence

All staff, including contract staff, volunteers and credentialed physicians, should receive basic training on workplace violence prevention, including, but not limited to: the institution’s workplace violence policy, definitions of what constitutes workplace violence, warning signs of escalating negative behavior, de-escalation techniques, procedures to follow when violence occurs (including how and where to report violent incidents), and information on what support will be given to victims of workplace violence.

Home health care organizations (visiting nurse/hospice and palliative care) must take special precautions. This may involve requiring security to accompany caregivers on visits, and even the refusal to provide services in particularly dangerous situations until the safety of caregivers can be assured.

Law enforcement can play a proactive role in keeping the health care environment safe. The mere presence of a police officer can be effective in reducing crime. Communication should be ongoing between health care institutions and their local police departments as to what constitutes a crime, when the police should be called, who to call (specially appointed liaisons may be developed), and what happens when a crime is reported.

The Massachusetts Sex Offender Registry Board is another useful law enforcement tool. Health care institutions can determine if the patient they are treating is a Level 3 sex offender by checking its website at www.mass.gov/sorb. Local police departments can provide information on Level 2 offenders.

While the frequency of workplace violence in health care is higher than in most industries, there are steps that administrators, law enforcement and employees can take to decrease the risk and improve the safety of staff, patients, friends and family that are all a part of the health care environment.