Workplace Violence in Healthcare: Risks and Prevention

Introduction

More than five million U.S. healthcare employees from numerous professions carry out a wide range of responsibilities—and in doing so, they are exposed to significant safety risks, including workplace violence. Current records indicate that hospital personnel are at high risk for encountering violence on the job. Reports show that violence typically occurs during periods of higher activity and increased interaction with patients, such as at mealtimes, during visiting hours, and during patient transport. Attacks can occur when services are denied, when a patient is involuntarily admitted, or when a healthcare employee attempts to set limits on eating, drinking, or tobacco and alcohol consumption (USDOL, 2001).

Background: Risk Factors for Workplace Violence

Patient-related risk factors include intoxication by alcohol or drugs, a prior history of violence, psychiatric conditions such as schizophrenia, gang membership, possession of firearms, and being a young urban male of lower socioeconomic status.

Environmental risk factors include lengthy waiting times, overcrowding, unpleasant waiting areas, understaffing, working alone, unrestricted movement of the general public within facilities, poorly lit corridors and rooms, inadequate security, and insufficient employee training and policies for preventing and managing potentially violent individuals and visitors.

OSHA and NIOSH Prevention Frameworks

The Occupational Safety and Health Administration (OSHA) identifies five fundamental components of an effective violence prevention plan:

1. Management commitment and employee participation; 2. Worksite analysis; 3. Hazard prevention and control, including security systems, safety training, and adequate staffing; 4. Safety training; 5. Recordkeeping and program evaluation.

Recordkeeping and program evaluation includes the OSHA 300 log of work-related fatalities, illnesses, and injuries that result in restricted work or days away from work. This log helps identify where hazards exist, who is being harmed, and which work procedures lead to injury and illness.

The National Institute for Occupational Safety and Health (NIOSH) provides a broad range of prevention strategies organized into environmental controls, administrative controls, and behavioral approaches (NIOSH, 2002).

Environmental Controls

• Create emergency signaling, alarm, and monitoring systems.
• Install security devices such as metal detectors to prevent armed individuals from entering the facility.
• Install additional security measures such as cameras and adequate lighting in corridors.
• Provide safety escorts to parking areas at night.
• Design waiting areas to accommodate and assist visitors and patients who experience delays in services.
• Design triage areas and other public spaces to minimize the risk of assault.
• Provide staff restrooms and emergency exits.
• Install enclosed nurses' stations.
• Install deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas.
• Arrange furniture and other items to minimize their potential use as weapons.

Administrative Controls

• Design staffing patterns to prevent employees from working alone and to reduce patient waiting times.
• Limit the movement of the general public in healthcare facilities through card-controlled access.
• Establish a system for notifying security personnel when violence is encountered, such as panic or duress alarms and closed-circuit video.
• Flag the records of high-risk patients.

Behavioral Change

Provide all employees with training in recognizing and managing assaults, handling conflicts, and maintaining awareness of potential threats (NIOSH, 2002).

Recognizing and Managing Potentially Aggressive Individuals

NIOSH identifies the following indicators that may signal impending violence: verbally expressed frustration or anger; threatening body language or gestures; signs of substance or alcohol intoxication; and the presence of weapons. Assault rarely occurs without verbal aggression preceding it. The publication Violence in the Emergency Department: Tools and Strategies to Create a Violence-Free ED by Patricia Allen describes the STAMP method, which identifies high-risk behaviors such as staring and pacing (Allen, 2009).

Recommended methods for managing a potentially aggressive individual include:

• Trust your instincts if you feel uncomfortable around someone.
• Stay alert and do not isolate yourself.
• Have security personnel nearby and call them at the first sign of a threat.
• Maintain a safe distance and keep a clear pathway to an exit.
• Project a calm, attentive demeanor.
• Do not match threats or issue commands.
• Acknowledge the individual's feelings.
• Avoid any conduct that could be interpreted as hostile.
• Limit direct eye contact.

Conclusion: Organizational Response to Violence

Violence can occur in the workplace despite preventive measures. Employers must be prepared to address its aftermath by fostering an environment that encourages open communication and by establishing written procedures for reporting and addressing physical violence. Organizations should provide and encourage counseling whenever an employee is threatened or assaulted.

References

Allen, P. (2009). Violence in the emergency department: Tools and strategies to create a violence-free ED. Springer Publishing Company.

Emergency Nurses Association (ENA). (2010). Emergency department violence surveillance study.

Janocha, J. A., & Smith, R. T. (2010). Workplace safety and health in the health care and social assistance industry, 2003–2007. Bureau of Labor Statistics.

NIOSH. (2002). Violence: Occupational hazards in hospitals.

U.S. Department of Labor, Bureau of Labor Statistics. (2001). Survey of occupational injuries and illnesses, 2000.