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Workplace violence is any violent act that occurs in the workplace and creates a hostile work environment that affects employees’ physical or psychological well-being. Healthcare workers are especially at risk of physical violence, threats and harassment, or other threatening behaviors at work. OSHA recommends healthcare employers develop a workplace violence program that includes a front-line defense of establishing a zero-tolerance policy toward workplace violence from workers, patients, clients, visitors, contractors, and others. All healthcare workers should stay alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be intimately familiar with workplace safety policies, procedures, and resources on violence prevention.
Scope
Workers in hospitals, nursing homes, and other healthcare settings face significant risks of workplace violence. Many factors contribute to this risk, including working directly with people who have a history of violence or who may be delirious or under the influence of drugs. Data have shown the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) to be more than four times greater in healthcare than in private industry, on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined. Many more assaults or threats go unreported.
Regulatory citations
- 29 USC 654 — Duties of employers and employees (including Pub. L. 91–596 “OSH Act of 1970” 5(a)(1), the “General Duty Clause”)
Note: Several states have requirements to varying degrees related to healthcare workplace violence. In addition, some accreditation organizations require the issue be addressed.
Key definitions
- Muggings: Aggravated assaults, usually conducted by surprise and with intent to rob.
- Physical assaults: Attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives.
- Threats: Expressions of intent to cause harm, including verbal threats, threatening body language, and written threats.
- Workplace violence: NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.
- Type 1—Criminal Intent: Violent acts by people who enter the workplace to commit a robbery or other crime—or current or former employees who enter the workplace with the intent to commit a crime.
- Type 2—Customer/Client/Patients: Violence directed at employees by customers, clients, patients, students, inmates or any others to whom the employer provides a service.
- Type 3—Co-worker: Violence against co-workers, supervisors, or managers by a current or former employee, supervisor, or manager.
- Type 4—Personal: Violence in the workplace by someone who does not work there, but who is known to, or has a personal relationship with, an employee.
Summary of requirements
While OSHA does not have specific requirement, the agency expects healthcare employers to keep employers safe. Recommendations include:
- Assess the risk. The risk factors for violence vary from situation to situation depending on location, size, and type of care. Common risk factors include the following:
- Working directly with volatile people, especially, if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses;
- Working when understaffed-especially during meal times and visiting hours;
- Transporting patients;
- Long waits for service;
- Overcrowded, uncomfortable waiting rooms;
- Working alone;
- Poor environmental design;
- Inadequate security;
- Lack of staff training and policies for preventing and managing crises with potentially volatile patients;
- Drug and alcohol abuse;
- Access to firearms;
- Unrestricted movement of the public; and/or
- Poorly lit corridors, rooms, parking lots, and other areas.
- Develop a safety and health program. To prevent violence in hospitals, employers should develop a safety and health program that includes management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting. Employers should evaluate this program periodically.
- Develop a procedure for employees to report concerns.
- Use engineering controls as feasible. These controls can include: developing emergency signaling, alarms, and monitoring systems; installing security devices such as metal detectors to prevent armed persons from entering the facility; installing other security devices such as cameras and good lighting in hallways; providing security escorts to the parking lots at night; designing waiting areas to accommodate and assist visitors and patients who may have a delay in service; designing the triage area and other public areas to minimize the risk of assault; placing curved mirrors at hallway intersections or concealed areas; providing staff restrooms and emergency exits; installing enclosed nurses' stations, deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas; and arranging furniture and other objects to minimize their use as weapons.
- Use administrative controls. These can include: Designing staffing patterns to prevent personnel from working alone and to minimize patient waiting time; restricting the movement of the public in hospitals by card-controlled access; and developing a system for alerting security personnel when violence is threatened.
- Train workers: Conduct mandatory training for employees to learn, at a minimum, the following items: (a) How to recognize the earliest stages of a possible assault; (b) How to avoid or mitigate potential violent encounters (including some words that non-English speakers may use to help de-escalate an assault; (c) How to seek refuge/assistance if violence appears imminent; and (d) How to use restraint and/or release techniques.
- Establish a comprehensive program of medical and psychological counseling and debriefing for employees experiencing or witnessing assaults and other violent incidents.
- Provide reliable means of communication to employees who may need to summon assistance. One possible means of communication is the use of two-way radios.