Healthcare workers are victims of a high incidence of violence in hospitals, nursing homes, rehabilitation centers, VA facilities and other healthcare centers. According to the Bureau of Labor Statistics, healthcare workers experience the most nonfatal workplace violence compared to other sectors, accounting for close to 70% of all nonfatal workplace assaults causing missed work days in the U.S. In addition, a 2014 survey of 762 registered nurses found more than 75% experienced violence, with emergency nurses reporting a significantly greater number of incidents.
Despite the high number of affected healthcare workers, there are no federal laws regulating such behavior. Only seven states require employers to run some form of a workplace violence prevention program and 26 states have laws designating penalties for assaults on nurses. The Emergency Nurses Association (ENA) president Dana Brecher told Safety and Health Magazine the organization's goal is to make violence against nurses a felony in all states. Currently, this is a felony in 31 states. However, many say hospitals don’t focus enough on worker safety and education and need to step up to make an impact.
Dr. Gary Goodman, an attending emergency department physician at several hospitals in central Florida, and a spokesperson for the American College of Emergency Physicians (ACEP), says hospitals don’t have the opportunity to vet out patients who may be dangerous when they come through triage. He says healthcare workers have to “walk a very fine line when communicating with a patient and the patient’s family ... Most hospitals are faced with patient satisfaction, so they don’t want to come across as offensive. If I had a dollar for every time patients would present through triage and you wouldn’t know they are capable of violence, I would be a very rich man.”
Another ED physician, Dr. Tom Tobin, who has been a victim of workplace violence, said: “Although this is atrocious in its own right, the lack of response and concern by hospital leadership is even more egregious.” He agreed with Dr. Goodman it’s difficult to screen patients prior to entering the ED for weapons. He said most hospitals have removed metal detectors at entrances “as this is thought to be uninviting and poor customer experience,” and many have removed the visible presence of security, wanting them to “blend in.”
Zero tolerance policy
The American Nurses Association (ANA) recently issued a position paper stating: “[T]he nursing profession will no longer tolerate violence of any kind from any source." The paper recommends nurses and employers “collaborate to create a culture of respect.” Jamie Dawson, MPH, senior policy advisor, occupational health and safety at ANA, said the Bureau of Labor Statistics has tracked workplace violence in healthcare settings over several years and has seen a steady increase in violence.
The ANA recently mentioned their ongoing health risk appraisal in the paper. Preliminary findings showed of 3,765 RNs and student nurses questioned about workplace safety, 43% reported they had been threatened by a patient or family member, and 24% said they had been physically assaulted. However, Dawson said many events go unreported as violence is often accepted as part of the job. "We're working very hard to get the message out that it isn't part of the job and violence can no longer be tolerated."
A recent book published by the ANA and co-authored by Dr. Jane Lipscomb, RN, FAAN, professor at the University of Maryland's Schools of Nursing and Medicine, said the current emphasis on patient satisfaction and customer service has been an additional factor in underreporting of workplace violence. Lipscomb wrote: "workers are often discouraged from reporting patient behavior for fear of poor satisfaction scores."
The Occupational Safety and Health Administration (OSHA) defines workplace violence as "any act or threat of a physical violence, harassment, intimidation or other life threatening, disruptive behavior that occurs at the work site." Dawson says OSHA's General Duty Clause states employers must provide a work environment that's free of recognized hazards, noting, "It's somewhat of a blanket statement, but it has been used to enforce guidelines when organizations have had violent incidents that were recognized but not abated and hospitals have been penalized."
This was the case when OSHA inspected Bergen Regional Medical Center LP in Paramus, NJ and found eight incidents of workplace violence between February and June. Lisa Levy, director of OSHA's Hasbrouck Heights office, said, "With so many incidents, it's clear that this facility's workplace violence program is ineffective and should be improved immediately to protect employees and ensure a safe workplace." The medical center was cited for failing to keep the workplace free of hazards and for incorrectly recording workplace injuries. Proposed penalties total about $13,600.
Dawson said she couldn't speculate why hospitals haven't been more proactive. "I think we need to keep working towards this culture of safety. Where safety, not just for patients, but also for healthcare workers is prioritized above anything else because healthcare workers deserve to have a safe environment."