Hospitals are houses of healing. Doctors, nurses, assistants and even campus security professionals come to work every day hoping to make a difference. Unfortunately, hospital employees also know that as they come in to work, that day could be the day violence strikes.

More than 570,000 violent crimes occurred against workers in the United States in 2009. From 2005-2009, simple assaults made up 78 percent of all workplace violence incidents, and 10 percent of workplace violence victims worked in medical occupations, according to the U.S. Bureau of Labor Statistics and the U.S. Department of Justice.

Emergency departments, specifically, can be prone to acts of violence. In a 2009 study by the Emergency Nurses Association, 25 percent of the nurses surveyed said they had been physically attacked by patients more than 20 times in the previous three years, and 20 percent reported that they had been verbally abused more than 200 times in that same time frame. Sadly, many of these same nurses reported they did not report these incidents out of fear of retaliation and lack of support from hospital administration.  

Hospitals Can’t Afford to Deny There Is a Problem
Earlier this year, a psychiatric hospital in Maine was fined $6,300 by OSHA for allegedly failing to provide adequate safeguards against workplace violence. The hospital experienced more than 90 incidents of patient-on-staff violence from 2008-2010.

The hospital was fined, but not simply because the incidents happened. The fines were levied because the hospital failed to identify that the problem existed, failed to implement the policies, procedures, training and other safety measures to help prevent the violence from re-occurring, and failed to provide staff with the skills needed to respond safely.

In September, OSHA recognized the need for better training and supports by issuing Uniform Procedures for OSHA field staff to use when investigating complaints of workplace violence. The purpose of these new compliance directives on workplace violence is to provide OSHA inspectors with general policies and procedures that apply when workplace violence is identified as an immediate hazard.

Related Article: OSHA Issues Guidelines for Investigating Workplace Violence

All employers should keep these directives in mind as they establish their own policies to prevent and respond to incidents of workplace violence, especially organizations with a higher prevalence of attacks. One industry that OSHA has repeatedly identified as having a high incidence of workplace violence is the healthcare and social services industry.

Implement Appropriate Policies, Procedures, Programs
Although no specific OSHA standards for workplace violence exist, the General Duty Clause mandates that employers provide a place of employment that is “free from recognizable hazards that are causing or likely to cause death or serious harm to employees.” Employers that have experienced workplace violence, or who are aware of threats, intimidation, or other workplace violence indicators should look to implement workplace violence prevention policies, procedures and programs.

Policies and procedures should delineate specific prevention and response measures for each category. Staff should be trained to be aware of the policy and procedures that the hospital employs. Training should emphasize strategies staff can use to help foster a sense of care, welfare, safety and security, such as:

1. Promoting a workplace culture that values respectful interactions: As staff interact with patients, do they make sure to take enough time with each patient to explain everything the patient might want/need to know? Do staff members use language that the patient finds easy to understand? Do staff interact with each other in a manner that shows respect?
2. Paying attention to behavioral warning signs: Learning to recognize early warning signs (such as changes in facial expression, breathing and body language) means a staff member is more likely to respond to the patient’s needs before the stress and anxiety escalates to violence.
3. Assessing objects in the workplace that could be used as a weapon or as a behavioral trigger: As you assess the different areas within the hospital, try to assume the perspective of an anxious patient. Is there anything you can see that could be used as a weapon? How can the room be arranged so that these potential weapons are not as accessible? Is there anything you see, hear, smell or feel that might serve as a behavioral trigger? Does the area feel warm and inviting, or cold and sterile?
4. Practicing and promoting a team approach: Using a team approach helps staff maintain a professional approach to resolving conflict, while also maintaining a higher degree of safety.
5. Drilling all relevant response protocol: Responding appropriately as a team requires practice, and staff should be afforded the opportunity to be trained and to rehearse response protocols.

Workplace violence should not be considered just part of the job. There are many reasons why a patient,  visitor, or  fellow staff member might act violently. Just being in the hospital can cause anxiety for many, and pain and stress related to the patient’s medical diagnosis only adds to that anxiety.

Violence can be prevented when staff has the proper tools and when the hospital’s organizational culture fosters respectful interactions between staff, patients and visitors. When hospital employees feel respected and safe, they, in turn, will help patients feel respected and safe.

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