Although OSHA enforces a duty of care on employers to protect staff from foreseeable hazards and has produced guidelines for preventing workplace violence for healthcare and social service workers, most state laws to prevent workplace violence in the healthcare industry fail to protect traveling nurses.
In 2015, a study published in The BMJ revealed that traveling nurses working in the community are twice as likely to experience workplace violence as nurses working on their employers' premises. Although the study was based on community nurses working in the Australian health service, its results mirror those of studies conducted in the UK and elsewhere in Europe.
In the U.S., it is difficult to find accurate statistics relating to workplace violence in the healthcare industry due to substantial under-reporting. To further complicate the distinction between violence directed at traveling nurses and on-premises nurses, OSHA combines home health aides, nursing aides, and psychiatric aides in its Workplace Violence in Healthcare report (PDF).
State Laws to Prevent Workplace Violence in the Healthcare Industry
Despite the under-reporting of workplace violence in the healthcare industry, it has been calculated that the rate of serious workplace incidents (those resulting in workers taking time off to recover from their injuries) is four times higher in the healthcare industry than an average of all other industries combined. To counter this alarming statistic, OSHA provides a series of workplace violence resources:
- Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (PDF)
- Preventing Workplace Violence. A Road Map for Healthcare Facilities (PDF)
- Workplace Violence Prevention and Related Goals: The Big Picture (PDF)
Many states have increased the criminal penalties for violent assaults on healthcare personnel. However, a number of these laws are “location-specific” (i.e. only apply in Emergency Departments) and fail to take into account violent assaults on healthcare personnel working outside the healthcare facility. Indeed, of nine states that have passed legislation requiring healthcare facilities to implement workplace violence programs, only Oregon's laws specifically address “Home Health Care Services”.
Hope that Federal Action Improves Safety for Traveling Nurses
The failure of state laws to protect traveling nurses is not necessarily the fault of state legislators. Without accurate statistics to work with, many legislators will be unaware of the scale of violence experienced by traveling nurses, so measures are not introduced to address it. Fortunately, proposed action at the federal level may result in better protection against workplace violence for traveling nurses.
Last November, Connecticut Rep. Joe Courtney introduced his Workplace Violence Prevention for Health Care and Social Workers Act (HR 7141). The bill calls on the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, but with home health care workers specifically mentioned.
Although the bill has not yet progressed any further than the House Committee on Education and the Workforce, it has some notable co-sponsors - including Rep. Ro Khanna who contributed to California's Workplace Violence Prevention in Health Care standard (PDF) and who introduced his own federal proposals last March (PDF), which significantly contained a section about security communication devices for traveling nurses.
The standard promulgated under this paragraph shall include procedures for hazard evaluation and control that fit the work settings unique to home health and hospice, which shall include, but not be limited to, each of the following:
(A) Procedures to identify and evaluate environmental and patient-specific risk factors such as the presence of weapons, evidence of substance abuse, or the presence of uncooperative cohabitants. At minimum, such procedures must be utilized during intake procedures, at the time of the initial visit, and during any subsequent visit when there has been a change in conditions.
(B) Procedures to correct workplace violence hazards in a timely manner, which shall include, at minimum, procedures to ensure employees will not work alone in households where there is a high risk for violence, provision of functional and maintained security or communication devices for all employees working in a patient or client’s home or community, and provision of dedicated and available security personnel to respond to reports of violent incidents or threats.
(C) Procedures for responding to actual or potential workplace violence emergencies that shall include, at minimum, obtaining help from security personnel required under subparagraph (B), or law enforcement agencies as appropriate.
Khanna Not the First to Call for Security Communication Devices
Rep. Ro Khanna's bill is not the first set of proposals to call for security communication devices for traveling nurses. Oregon´s laws to address workplace violence on traveling nurses stipulates employers must measure the frequency of assaults in the homes of patients receiving home care health services and - regardless of the outcome - employees may refuse to treat a patient unless “equipped with a communication device” they can use to alert law enforcement to an assault.
Although no other states have introduced similar measures to protect traveling nurses, several hospitals have implemented solutions that give traveling nurses one-click access to law enforcement. This solution also receives geo-targeted alert notifications and can act as a virtual escort so healthcare managers are informed when a nurse has been unexpectedly delayed at a patient's home or failed to arrive for their next appointment.
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