Updated June 12th, 2018 - In June of 2017, an emergency room patient stabbed a nurse at a hospital in Southbridge, Massachusetts. The patient, who was later identified as Conor O'Regan by a Worcester County District Attorney, fled the scene, leaving the nurse with serious injuries. The nurse was airlifted to UMass Medical Center and was stabilized, while O'Regan was apprehended outside of the hospital campus by Southbridge Police. According to Boston News, hospital officials said the assailant had been through the registration process and was being directed for care. This incident is not uncommon in the healthcare field, which has an alarming rate of workplace violence.
Healthcare is a noble profession, but it's often taxing work. Doctors, nurses, social workers, counselors, and technicians are under a tremendous amount of stress, especially in emergency units. In recent years, financial strain on these institutions has increased the difficulty of the work. Patients are often grateful to receive good care, but might be unaware of how dangerous working in healthcare can be. Recent studies show that workplace violence among healthcare professionals is far too prevalent.
The National Institute for Occupational Safety and Health describes workplace violence as "violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty." While most employee safety programs focus on physical assault or threats, verbal abuse and and harassment are equally capable of causing fear and stress for workers. Working in healthcare almost guarantees you will experience this type of workplace violence in your career, and all types of abuse must be considered when crafting a safety plan. Hospitals, nursing homes, and other healthcare facilities should be safe for patients, but also for the professionals working there.
In 2016, the New England Journal of Medicine published a comprehensive report on of “Workplace Violence against Health Care Workers in the United States”. The statistics are alarming, and found that though healthcare and social assistance employees make up only 12.2% of the working population, nearly 75% of workplace assaults occur in the healthcare sector. These numbers don't account for potential under reporting in other industries, but the statistics still show a need for workplace safety reform in healthcare. Here are the a few of the noteworthy stats:
- 80% of Emergency Medical Services personnel have been attacked by patients.
- Homicide is the second leading cause of workplace death for home healthcare workers.
- 78% of Emergency Department physicians and 100% of Emergency Department nurses have experienced violence from patients within the last year.
- The annual incidence of physical assault in a psychiatric setting is 70%.
- Among nursing homes with dementia units, 59% of nursing aides reported being assaulted by patients weekly and 16% daily.
- 46% of nurses reported some form of workplace violence during their five most recent shifts.
- Between 2000 and 2011, there were 154 shootings with injury either inside or on the grounds of American hospitals.
These statistics might be shocking, as healthcare workers are four times as likely to sustain a violent injury on the job than workers in private industry. The rates of workplace violence in healthcare are also higher than those for retail, construction, or manufacturing. There are a variety of factors that contribute to the lack of safety for healthcare employees, and while these vary by healthcare facility, the level of risk is fairly universal.
Why Are Healthcare Violence Rates So High?
There are many reasons that violence in healthcare is so prevalent. There are many risks involved in healthcare, a profession that tackles difficult situations by nature. In order to address the issue, it's important to understand these challenges. In 2017, OSHA compiled a list of the common risk factors. Reasons included working with people with a history of violence or who are under the influence of drugs, the physical labor of lifting or moving patients, independent work style, poor facility design, insufficient infrastructure, or lack of adequate lighting, and lack of adequate emergency communication. The rates of violence vary by location, as healthcare facilities in areas with access to firearms or neighborhoods with high crime rates might be most susceptible.
The single greatest risk factor for healthcare employees is financial and staff shortage. Ever-growing demand for care puts a strain on healthcare systems, and staff is overworked as a result. In order to manage the demand for care, there needs to be an increased access to training and support for employees.
Staff is not often given the appropriate amount of training to recognize or manage violent and aggressive incidents. New challenges in the profession - such as the opioid crisis, which poses new risks for employees, should be met with the appropriate trainging Without enough training these situations can go unnoticed and will continue. There is often a stigma against speaking up about assaults that happen within healthcare facilities. The violence is often tolerated and victims are discouraged from speaking up or discussing the issue further.
The staff shortages in healthcare facilities across the United States are also responsible for the crisis of violence crisis. Low staffs forces nurses to multitask, and can leave patients feeling they aren't receiving the attention they need or want. Neglected patients can lead to a hostile environment, as the longer a patient has to wait the more likely they will become aggressive.
Similarly, managing shift changes is also a challenge. One approach to meet this challenge is to use polling via a mass notification system as a way of identifying staff that are available to come in on short notice, if other employees call out. The poll can automatically close once enough staff have responded.
Healthcare Violence Prevention Laws
In some states, laws have been passed to ensure that healthcare facilities have plans that protect their staff. In California, Cal OSHA recognized the growing trend of violence in healthcare, and proposed sweeping regulations in 2011. The regulations require every healthcare employer to create a Workplace Violence Prevention Plan and alarm or other similar system.
In March, Representative Ro Khanna and twelve other House Democrats introduced legislation intended to curb workplace violence in healthcare facilities. The initiative was called the Health Care Workplace Violence Prevention Act, and would direct OSHA to create a standard that would require health care facilities to develop and implement facility and unit specific workplace violence prevention plans. "Health care workers, doctors and nurses are continuously at risk of workplace violence incidents – strangling, punching, kicking and other physical attacks – that can cause severe injury or death,” Khanna wrote in a press release, according to Safety + Health. "This is simply unacceptable. The Health Care Workplace Violence Prevention Act puts a comprehensive plan in place and is a national solution to this widespread problem modeled after the success seen in California.”
The bill was largely supported by the healthcare community, including the largest union of nurses, National Nurses United. If passed, hospitals would be required to assess for environmental risk factors, patient specific risk factors, and staffing or security efficiency. This bill would address several key risk factors related to workplace violence in healthcare, and could make dramatic change in the system across the United States.
Strategies For Violence Prevention In The Medical Field
The first step toward a safer healthcare system for employees is to reevaluate healthcare facilities for potential threats. In an interview with Safety + Health, National Nurses United Co-President Deborah Burger explained how doctors and nurses can help improve hospital environments. "There are a number of interventions that can reduce violence in the hospital," Burger told the magazine. “For example, affixing furniture and lighting so they can’t be used as weapons, maintaining clear lines of sight between workers while they are caring for patients, and providing easy access to panic buttons or phones to call for help. It is imperative that nurses, doctors, and other health care workers, along with security staff and custodial personnel, are all involved in the development and implementation of these plans.”
Many healthcare facilities are taking advantage of technology for preventative measures. Security technology can be especially helpful for dealing with staffing shortages. It's important that every hospital provides an easy form of communication between a patient and staff member. All the patient has to do is simply press a button to talk to a staff member. This not only makes workflow a little more organized and efficient but also gives the patient a greater sense of security and comfort. Another tool is a sound detector that can detect when a patient’s voice sounds aggressive or something breaks and staff will be notified, before the situation escalates.
Technology can also help to improve communication in hospitals or other healthcare facilities. An emergency notification system can help keep employees notified, and is a proactive approach to emergency situations such as a natural disaster or active shooter.
An anonymous two-way text tip system can be a valuable tool in healthcare, allowing patients or staff to report any suspicious activity on the hospital campus. It will also allow employees a discrete way to report incidents harassment or o violence from fellow staff members to a human resources department.
Workplace violence doesn't have to be accepted as part of the healthcare profession. Hospitals and other healthcare facilities need to invest in the safety of their employees, as well as patients. By reassessing the hospital environments for risk, pushing for increased safety legislature, and leveraging technology, the sustainability of healthcare can be improved in the United States.