Violence In Healthcare

Right now, somewhere near you, police are being dispatched to a disturbance
in a local community. The officers will use the modern day law enforcement
tools they have available to control the situation: tasers, pepper spray,
handcuffs, etc. In some cases the individual causing the disturbance may have
a mental disorder and is delivered from police custody to a local hospital
emergency room for examination.

Hospital emergency staff members are not equipped with the same tools police
officers have on the street and are subsequently attacked by out of control
patients. The only assistance that hospital staff has is to wait for hospital
security to arrive and help control the situation through verbal commands or
placing the patient in restraints. Situations like this occur daily in hospitals
across the country and emergency department staffs are on the frontline of an
epidemic of violence.

While hospitals are places for healing, they are also places of business. At
times, the two identities create internal struggle. Regardless of the reason for
their visit, many patients and visitors may be fearful or apprehensive upon
arrival to the hospital. Hospital staff arrives wondering what patients they will
interact with and what emergency situations they might face. Hospitals want
their facilities to be seen as safe places where patients can heal.

There is a great need for hospitals to create a sense of balance between taking
care of patients, conducting themselves as a business, and maintaining or
ensuring a safe environment for everyone. If armed officers walked the
hospital halls, would that make patients and their families feel better
protected? Or, would they be more apprehensive? Would a metal detector at
all hospital entrances make patients feel safe? When there is larger security
presence within a hospital facility, it can cause a feeling of fear rather than
safety. Patients will vote with their feet by choosing to visit another hospital
with a more inviting environment.

Another alarming aspect is the way violence and threats have been
institutionalized over the years. During a safety committee meeting, I was
asked to report on an incident where a nurse was slapped while taking vitals.
Nurses on the committee would cringe at the idea of this, which is a primary
example of workplace violence. One nurse stated that after 20 years, these
acts of violence were “just part of the job”. Imagine working in a service
industry where you are verbally or physically attacked by customers on a
regular basis. Would this type of treatment be thought of as acceptable? What
if this type of negative treatment went on for 20 years?

In addition to the growing concern of violence in the workplace, is the growing

cost of Workers’ Compensation. It is estimated that $55 million per year is
spent on workplace violence.1 The cost of Workers’ Compensation associated
1
"Violence: Prevention, Management, and Survival (VPS) Independent Study - General Industry."
Violence In Healthcare

with workplace violence is not only devastating economically, it psychologically

impacts those who have been attacked or exposed.2 I have seen the lasting
effects of many violent attacks, including one specific situation where a nurse
was trapped in a hospital room. She was attacked by a male patient who
began slapping and punching her. After taking a month off to recover from her
wounds of a black eye, bruises, and scratches to her face and arms, the nurse
returned to her unit to resume her career. Although the attack occurred 6
years ago, the emotional damage exists to this day. Soon after her return to
work, she found herself alone in a room with a male patient and was overcome
with fear, which resulted in a panic attack. She left the patient’s room in
tears, resigned from the hospital, and gave up her nursing career.

Health care workers are the most compassionate people you will ever meet.
They work countless hours and deal with situations that would break most
others. While many states have worked to place laws on the books to help
keep healthcare workers safe, more needs to be done.

In 2007, the State of Oregon passed House Bill 2022 requiring hospitals,
ambulatory surgical centers, and home health care services operated by
hospitals to implement strategies to protect health care employees from acts
of violence in the workplace.3

House Bill 2022 requires health care employers to: (a) Conduct periodic
security and safety assessments to identify existing or potential hazards for
assaults committed against employees; (b) Develop and implement an assault
prevention and protection program for employees based on the assessments;
and (c) Provide assault prevention and protection training on a regular and
ongoing basis for employees. In addition, health care employers are required
to maintain a record of assaults committed against employees either on the
health care employer premises or in the home of a patient receiving home
health care services.4

A review of the first report produced by the Oregon law for calendar year 2008
shows that there were 1061 assaults reported. Of those 1061 assaults , 99% of
the reported attacks occurred in the hospital, 50% of the attacks occurred in
the behavioral health or psychiatric unit, 13% occurred in the medical or
surgical unit, and 11% occurred in the emergency room.5

National Association of Safety Professionals. 2010. Web. 3 May 2010.

2
Rep. U.S. Department of Justice Federal Bureau of Investigation at 15 (2002). Print.
3
H.R. 2022, Prepared By Oregon Occupational Safety & Health Division (Oregon-OSHA), Department of
Consumer and Business Services 4 (2007) (enacted). Print.
4

H.R. 2022, Prepared By Oregon Occupational Safety & Health Division (Oregon-OSHA), Department
of Consumer and Business Services 4 (2007) (enacted). Print.
5
H.R. 2022, Prepared By Oregon Occupational Safety & Health Division (Oregon-OSHA), Department
of Consumer and Business Services 4 (2007) (enacted). Print.
Violence In Healthcare

In almost all cases, the assailant was a patient. More specifically, 57% were
behavioral health patients and 39% were general patients. The most commonly
listed reasons for the assault were that the person was a behavioral health
patient (32%), had a history of violence (26%), or had emotional issues (19%).6

The majority of victims were identified either as certified nursing assistants,

orderlies, or aides (42%), or as registered nurses or licensed practical nurses
(32%). Most assaults resulted in a minor injury, including mild soreness, small
bruising, and scratches (80%). However, the remainder of assaults involved
major soreness, lacerations, and large bruises (18%). In 2% of cases reported,
the resulting injury was severe and was defined as a bone fracture or head
injury.7

The reported data shows that violence in the workplace is a very critical issue
and requires more attention at all hospital levels. One element missing from
the report is the incidence of staff-on-staff violence, which is not surprising,
given the desire to avoid publicizing a hospital’s “dirty laundry”. However,
there are many nurses, other healthcare staff, and hospital human resource
managers who can confirm the prevalence of this issue.

As previously stated, hospital staff work long hours and are under tremendous
pressure due to the high patient volume. The staffing models are designed to
increase efficiency, and the idea of “more with less” has become the hospital
leadership mantra. This pressure is felt by staff at the front line and causes
conflict between staff at all levels. Increased competition and shrinking
reimbursement have forced hospitals to do whatever is necessary to keep their
doors open and remain the community asset we have come to rely on.

Be proactive. Train staff on de-escalation techniques to ensure they have tools

to deal with potentially violent situations. Security Managers and Emergency
Department Managers should work with local law enforcement to establish
open dialogue and foster positive relationships. A thorough review of all
policies and procedures should be conducted to make sure they are up-to-date
and relevant. A risk assessment should be conducted of all facilities and
security enhancements should be implemented as needed. It is the
responsibility of hospital leadership nationwide to ensure their staff is safe
from harm, so they in turn can help others heal.

John Reid
IKRconsultants.com

6
H.R. 2022, Prepared By Oregon Occupational Safety & Health Division (Oregon-OSHA), Department
of Consumer and Business Services 4 (2007) (enacted). Print.
7
H.R. 2022, Prepared By Oregon Occupational Safety & Health Division (Oregon-OSHA), Department
of Consumer and Business Services 4 (2007) (enacted). Print.