Safety & Compliance News

Health care settings

Health workers worldwide face a high risk of violence, with 8–38 percent experiencing physical attacks, while others are subjected to threats or verbal abuse, according to the World Health Organization (WHO). Most incidents involve patients or visitors. Those at greatest risk include nurses, patient-facing staff, emergency room personnel, and paramedics.

General Duty Clause

Although OSHA doesn’t have a workplace violence standard, employers must provide a workplace that’s free of known health and safety hazards. This is addressed in OSHA’s General Duty Clause (GDC), Section 5(a) of the Occupational Safety and Health (OSH) Act.

The following elements are necessary for OSHA to prove a violation of the GDC:

• The employer failed to keep the workplace free of a hazard to which employees of that employer were exposed;
• The hazard was recognized;
• The hazard was causing or was likely to cause death or serious physical harm; and
• There was a feasible and useful method to correct the hazard.

A general duty citation must involve both the presence of a serious hazard and exposure of the cited employer’s own employees.

During a violent incident investigation, OSHA inspectors would likely gather evidence about whether an employer knew that a potential workplace violence hazard existed and whether there were feasible means to prevent or minimize such hazards. Investigators might also look at evidence of any potential whistleblower retaliation in which workers complained about workplace violence risks or reported injuries from workplace violence incidents.

Health care facilities have been cited when staff were injured by violent patients or visitors. In one case, nurses were regularly assaulted, but the hospital had no prevention program, no staff training, and no reporting system. OSHA stepped in using the GDC. Prevention could have included de-escalation training, secure facility layouts, panic buttons, and post-incident support.

Tips for preventing violent acts

In most workplaces where risk factors can be identified, violent acts can be prevented or minimized.

Building respectful workplaces is one way to do this. The most common forms of uncivil behaviors are when employees:

• Address others in disrespectful ways,
• Interrupt those who are speaking, and
• Micromanage people to an excessive degree.

Providing employees with civility training — which differs from anti-harassment training — can help to create more respectful work environments with less conflict. While civility training isn’t only focused on preventing harassment, that could be a component.

Research has shown that incivility can be a precursor to harassment. In contrast to anti-harassment training, civility training tends to give employees positive examples of how to behave, versus actions to avoid.

The training typically includes a focus on:

• Interpersonal communication,
• Conflict resolution, and
• Effective supervisory techniques.

How civility training is presented will depend on the size of the workforce, demographics, location, industry, etc. There is no one-size-fits-all approach. The point is to get employees to be more aware of how their words and actions impact others, and how they should treat everyone with respect.

It’s also important to watch for signs that someone could turn violent. While there’s no guarantee that one or more questionable behaviors equate to a potential incident, some warning signs come from someone experiencing personal or work issues.

They could be struggling financially, going through a divorce, or having health issues. Work triggers could stem from negative employment actions, like a demotion or termination, or other types of conflict.

Key to remember: April is Workplace Violence Prevention Month. Now’s the time to focus on ways to keep all employees safe.

Case in point

An employee works well with an accommodation for years. A new leader is hired and makes some changes, including removing the accommodation without reviewing its effectiveness. The leader instead:

Changes and risks

Sometimes, new leaders make changes that can put the company at risk. Removing an effective accommodation without a valid reason puts the employer at risk of a disability discrimination claim.

Accommodations aren’t always forever

Employers don’t have to keep providing an accommodation forever, but before removing an effective one, they should have a good reason to do so.

Employers should ask themselves what has changed (other than leadership)?

• Did the job change?
• Did the employees’ needs change?
• Did the workplace change?

If leadership is the only thing that changed, the employer might have a tough time defending its actions, particularly if those actions lead to termination.

New leaders might question the validity of an accommodation. If so, they may review the accommodation by engaging in the interactive process with the employee to ensure that the accommodation remains effective and needed. Revoking a previously granted reasonable accommodation without any other action can violate the ADA.

The accommodations for the employee in the above story included using a walker and being allowed to occasionally sit. The employer is now facing the possibility of owing the employee back pay, front pay, reinstating the employee, plus paying compensatory and punitive damages.

Training

Training new leaders in the current accommodations the company is providing, and what not to do, might help avoid violations and reduce risks. All managers and supervisors should be familiar with accommodation obligations under the ADA and how to respond to employees seeking job accommodations. They should know that each situation must be addressed individually, and there’s no “one-size-fits-all” workplace accommodation.

Key to remember: A change in leadership can open employers up to risk if the new leaders aren’t familiar with the applicable laws and take actions they shouldn’t.