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Vulnerability Risk Assesment Toward Workplace Violence Prevention In Health Care Settings

March 15, 2016

By Paul Clements, PhD, associate clinical professor, Division of Graduate Nursing

In November 2014, much of the nation was riveted when disturbing video footage from a hospital unit showed a 68-year-old hospital patient attacking a group of nurses with a metal pipe pulled from his bed. Completely surprised, they are seen running through a nearby door, however, the patient manages to land several blows on one nurse who has fallen in the hallway. She is subsequently hospitalized for her injuries and the emotional trauma for the other survivors is significant. How could something like this (warning, content is graphic) happen in a hospital setting? 

According to the Occupational Safety & Health Administration (OSHA), workplace violence (WPV) is an officially recognized hazard in the health care industry. WPV is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It can affect and involve health care providers, patients and their family members, and visitors. WPV ranges from threats and verbal abuse to physical assaults and even homicide. In one report, the Bureau of Labor Statistics (BLS) data reported health care and social assistance workers were the victims of approximately 11,370 assaults by persons; almost 19% (i.e., 2,130) of these assaults occurred in nursing and residential care facilities alone. Unfortunately, many more incidents probably go unreported.

According to the National Institute of Occupational Safety and Health (NIOSH), assaults in health care have become far from an isolated incident. Health care workers are hit, kicked, scratched, bitten, spat on, threatened and harassed by patients with surprising regularity. Additionally, violent encounters additionally include those from family members, visitors, and even from disgruntled employees. In one 2014 survey, according to data from the Bureau of Labor Statistics, almost 80 percent of nurses reported being attacked on the job within the past year. Further, health care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S., and attacks show no sign of slowing down.

According to a media interview after the episode in Minnesota, the hospital initiated a training program to teach workers how to recognize and de-escalate potentially violent situations. Many hospitals still lack this basic safety measure, however—it is not only an oversight that leaves caregivers vulnerable, but more importantly, it should be one of the earliest and primary levels of intervention employed when risk for vulnerability has been determined to be at an increase. Established, expanded or enhanced violence-prevention plans—including training and incident reporting—can lessen the risk, but their adoption is often generally disregarded with thoughts of “we don’t have too much of a problem with violence here at our facility”.

This attitude subsequently discourages health care workers from reporting assaults, thus compounding the problem (and contributing to under reporting and ultimately a misperception about the true rates of violence in a facility) – becoming the proverbial “vicious circle”.  In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections health care employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. The policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with workers of the facility. Additionally, by assessing their worksites, employers in the health care industry can identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well written and implemented Workplace Violence Prevention Program is critical to ensure that all workers know the policy and understand that all claims of workplace violence will be investigated and remedied promptly. NIOSH recommends that all hospitals develop a comprehensive violence prevention program.

No universal strategy exists to prevent violence. The risk factors vary from facility to facility and from unit to unit within a facility. Employers are advised to form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All affected workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.

Over the decades, the interface between “forensic” issues and health care has widely expanded beyond malpractice cases, reflecting a barometer of the contemporary era where violence has become recognized as a recognized issue. As such, it is important to educate health care providers regarding early assessment and methods of de-escalation in situations where violence is at high potential or an actuality.

Clements will be presenting at the upcoming Forensic Trends in Health Care Conference being held on April 15-17, 2016. The Conference is intended for providers and educators in the health care sciences, as well as professionals who have direct contact with victims and/or offenders across disciplines and areas of practice. The combined session offerings will examine the contemporary trends and issues related to the wide range of interpersonal violence, crime and sudden violent death that may be encountered in a variety of health care settings.