Workplace Violence
In 2014, NIOSH (National Institute for Occupational Safety and Health) reported Healthcare workers make up about 11.5% of the total workforce in the US, however, those same healthcare workers were the victims of over one-half of the non-fatal workplace violence injuries. In 2018, those numbers had increased to 73% of all non-fatal workplace injuries due to violence committed in the healthcare industry. Today, healthcare workers are 5 times more likely to be victims of workplace violence than any other profession. It is estimated that in the US, fiftytwo healthcare workers are assaulted every day and these numbers are estimated to be grossly underreported. Historically, nurses have been told not to report workplace assaults because it is “part of the job” or because “nothing will come of it”, and fear retaliation when they do make a report. Some sources estimate that reporting of assault incidences is as low as 3%.
Workplace violence includes physical violence such as being hit, pinched, pushed, bitten, spit on, and any other type of physical assault. Also included are verbal assaults such as being cursed at, threatened, demeaned, and yelled at. Assaults could include intimidation in word or deed, cyber-attacks, and stalking of a healthcare worker. There are cases of healthcare workers being injured or murdered as a result of being stabbed or shot and multiple incidences of healthcare workers being held at gunpoint. These assaults could be committed by the patient or by family and friends, or they may occur during a break-up of patient-on-patient attacks. Healthcare worker violence has been inflicted on all healthcare workers including social services, housekeeping, and any other employees of the healthcare system.
While these assaults occur in all areas of healthcare, there are higher numbers of incidents in the emergency departments, psychiatric units, geriatric units, and geriatric facilities. Nurses who work in psychiatric units and geriatrics have experienced a 3.5 times higher rate of violent incidents which contributes to the stark shortfalls of nurses willing to work in these areas. No area of healthcare is immune to these assaults. In 2023, fatal incidences were reported in an obstetric unit, a neonatal unit, and during a home health visit.
Nurses, in particular, are leaving the profession for many reasons and one of the cited reasons for leaving is the risk of violence they face on the job. There are few professions where being assaulted is considered to be a part of the job. As educated and licensed individuals and dedicated professionals, a safe work environment should be a realistic and attainable expectation.
The solution to healthcare workplace violence is as multifaceted as the issue itself. The answer begins with a systematic attitude of no-tolerance at the national, state, and local levels.
Strong national and state legislation can help address the issue by implementing laws to keep employees safe. Strong laws that enforce healthcare facility safety standards can help send a message that healthcare workers will no longer tolerate violence. Requiring risk assessments at the facility level can help determine the safety of the employees. Risk assessment findings may require the facility implement monitoring at the facilities with the use of guards or metal detectors (or install safety alarms or badge alert systems for each employee). The institution of violent patient drills, and active shooter drills, may also be implemented to increase safety.
The system for reporting incidents at the State and local police level should be reviewed to ensure the process for reporting is not complicated but thorough. A system where violent patients or employees are flagged to alert other facilities of violent individuals may be necessary to prevent repeat offense. Thirty-two states have passed laws making assaults inflicted on healthcare workers a felony, but these laws are inconsistent from state-to state. Penalties differ based on where the assault occurred, the types of assault, and on whom the assault was inflicted. (For example, some states only protect nurses in the emergency department.) Consistent reporting, enforcement, and conviction will protect the healthcare worker.
The best way to ensure the safety of the staff is for the facility to enforce the rules that are set in place. Safety begins with a NO TOLERANCE ATTITUDE. Typically, attitude starts with facility leadership and trickles down to every person in the facility. Consistent support of the staff from all parties makes it clear to staff that violence will not be tolerated. Support for the victim at the facility level is imperative.
Patients and families need to be educated on what is considered violence and the consequences of participating in violent activities. The Zero Tolerance policy should be considered a part of the patient's admission orientation. Patient education should include dispute resolution in an appropriate nonviolent way, should it be necessary.
Education for staff on de-escalation techniques for angry patients and family members is important. Facility policy should include action steps in the case of a violent incident. After an incident of violence has occurred, the facility must be prepared to take action which may include a patient warning, or reprimand and/or the banning of visitors. If a patient has exhibited violence, all interactions with patients from that point forward should include two or more staff. All assaults should be reported with the authorities even when those assaults include patients with psychological diagnoses or who are otherwise compromised. Accurate reporting is crucial for the healthcare industry to fully determine the impact of workplace violence on the industry.
When a facility has a measurable and enforceable violence prevention program in place, the quality of care increases and workplace violence will decrease.