Although workplace violence is now recognized as a specific category of violent crime that calls for distinct responses from employers, law enforcement, and the community, most incidents that employees/ managers must deal with daily are not even reported to company officials, let alone to police.
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.
Scope
California’s Workplace Violence Prevention in Health Care standard went into effect on April 1, 2017. This standard applies to work in specific health care facilities, service categories, and operations. There is currently no Federal OSHA standard for Workplace Violence in Healthcare. When necessary, Federal OSHA will rely on the General Duty Clause for enforcement of any place of employment with recognized hazards that can cause or are likely to cause death or serious physical harm to their employees. Click the links below to view the applicable requirements.
General Duty Clause: Section 5(a)(1) of the OSH Act
Citations
California: Title 8, Division 1, Chapter 4, Subchapter 7, Group 2, Article 7, 3342. Violence Prevention in Health Care
A summary of the recommendations includes the following:
- 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:
- 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 mealtimes 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 Workplace Violence Prevention Plan. To prevent violence in healthcare, employers should develop a Workplace Violence Prevention Plan that is part of their IIPP, that is always in effect in every unit, service, and operation. The plan must be specific to the hazards faced by the employees and corrective measures. The plan should be in writing and employers should evaluate periodically and review annually.
- Develop a procedure for employees to report concerns.
- Maintain a violent incident log. Record information about every violent incident, post-incident response, and workplace violence injury investigation. Omit any personal identifying information. The employer must review the log annually.
- Use engineering controls as feasible. These 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 (e.g., two-way radios).
