Workplace Violence

Amber HartBrandy HopkinsSusan Swords

Workplace ViolencePhysical or verbal assaultsThreats of assaults towards persons on duty at their place of employmentProblem

Many people believe that it’s just “part of the job”Cases of workplace violence often are not reported, therefore it’s not recognized as a true problem

Why Healthcare Workers Are At Risk

High incidence of weapons on patients and familiesIncreasing number of mentally ill and criminal patientsSlow service in emergency rooms and clinicsIncreasing number of patients under the influence of drugs or alcoholIsolated work due to poor staffingLack of training in recognizing and managing violent situations

Workplace Violence160 deaths due to workplace violence in healthcare and social services from 1997-2010Healthcare leads all other industries with 45% of all nonfatal assaults against workers resulting in lost work daysOSHA currently has a set of guidelines to prevent workplace violence for healthcare workersOnly guidelines and more regulations are needed to reduce workplace violence among those working in health care

(ANA, n.d.)

Statistics765,000 assaults occurred in healthcare resulting in lost work days from 1993-19998 nurses were fatally injured at work from 2003-2009

4 RNs received GSWs resulting in their death4 RNs received other fatal injuries

2,050 assaults & violent acts were reported by RNs resulting in an average of 4 days away from work in 2009

1,830 were inflicted with injuries from patients/residents80 were inflicted by visitors or people other than patients520 RNs were kicked, hit or beaten130 RNs were squeezed, pinched or scratched requiring days off work30 RNs were bitten

In 2009, the ENA reported that more than 50% of ED nurses had experienced violence by patients and 25% had experienced 20 or more violent incidents in the past 3 years

(ANA, n.d.)

Lateral Workplace Violence

Also referred to as horizontal violence or bullyingProblem among nurses for decadesNurses inflict psychological injury on each otherCan be overt or covert acts of verbal & non-verbal aggression that causes enough psychological distress for nurses to leave the profession53% student nurses report being put down by staff nursesThreatening body language & strong verbal abuse has been reported by 48% of nurses, pharmacists and others56.9% of nurses report being threatened or experience verbal abuse at work

(ANA, n.d.)

Background

SocialEmployees may experience psychological trauma, fear of returning to work, effects on relationships with coworkers and family, feelings of powerlessness or incompetence, and fear of criticisms by superiorsWhen employees experience any of these symptoms, it can adversely effect their work and the patients they care forSupport needed for employees who encounter workplace violence may decrease negative effects they experience afterwards

EconomicVictims miss on average 3.5 days of work and up to 6 weeks depending on extent of assaultWitnesses to the traumatic events are also at risk for developing psychological issues and missing workWorkplace violence can add up to $55 million in lost wages and that total doesn’t include annual sick leave or paid time offLeads to decreased productivity affecting company’s bottom lineEstimated 20-40% turnover rate after a violence event

Costs approximately $22,000 to $64,000 to replace a nurse

(Workplace Violence, n.d.)

(OJIN, 2007)

Economic (continued)Victims can have psychological and physical issues after the violent incident including

Insomnia Hypertension Depression GI issues

Unexpected medical expenses due to injuries from workplace violenceMedical expenses may occur more frequently in those who’ve experience lateral violence compared to those with physical injuries from violent acts

(ANA, 2012)

Economic (continued)Employees who are victims are more liable to sue, especially where no policies are in place to prevent or prepare for workplace violenceAverage cost to settle lawsuit outside court: $500,000Average amount awarded by juries: $3 millionIf homicide occurs, it will bring negative attention and decrease in number of patients who may seek care at that facility

(Workplace Violence, n.d.)

EthicalConfidentialityEthical dilemma: should healthcare professionals disclose information of patients who may be seen as a threat or danger to their communities?

May include terminated employees who pose a threatUsually a confidentiality clause preventing employer from disclosing information about terminated employeeEmployers may also be concerned to warn future employers of employee’s conduct for fear of being sued over defamation of character or privacy

(U.S. Department of Justice, n.d.)

(NetCE, 2009)

EthicalDuty of CareEmployers and Employees have the responsibility to provide a safe work environment

Employers must provide safe work environment and adequate trainingEmployees must follow safety instructions and report any safety concerns

LegalPolicies in place at individual healthcare facilitiesOnly California has mandates that requires victims of assault/battery resulting in injury from firearms or other weapon must be reported to law enforcement within 72 hours17 states have increased penalties for violent acts against nurses

NY made it a felony and put nurses in the same category as police officers, firefighters and emergency responders

(Crowley, C.F., 2010)(ENA, n.d.)

Political13 states have mandated laws regarding violence in the workplace specific to healthcare facilities

Most of those laws involved training and developing security plans

18 states have advocated and legislation was passed aimed at preventing workplace violenceMost states are lacking in passing legislation to protect healthcare workers from workplace violenceIf hospitals do not enact policies aimed at workplace violence prevent, they can be held liableAdvocates needed at state and federal level to lobby for nurses and healthcare worker’s rights for protection against workplace violence

StakeholdersEmployees in health care professionEmployersInsurance companiesGovernment OfficialsFamilies of those working in health care due to the psychological effects the victims experience after being a victim of workplace violence

Issue StatementHow should the federal government regulate guidelines and programs to decrease workplace violence among healthcare workers?

Policy Objectives, Alternatives & Recommendations

ObjectivesWorkplace violence legislation would ensure awareness and preparedness in the event of a workplace violence incident would occur

Acknowledge frequency and effects of workplace violence in healthcare fieldDevelop policies and legislation to mandate employers to implement programs to address incidents and complaints of workplace violenceDevelop regulations to assess risk of workplace violence and measures to control that risk

AlternativesDo Nothing Option

Currently workplace violence laws are enforced created and enforced state by state with no federal mandate

Kansas has no laws

Violence Prevention Training Mandate federally employers must educate employees on definition of workplace violence and their rights

Security and Safety PlanMandate federally employers must follow OSHA’s recommendations to prevent workplace violence

OSHAs Recommendations

Management commitment and employee involvementWorksite analysisHazard prevention and controlSafety and health trainingRecordkeeping and program evaluation

Evaluation CriteriaSize and availability of funding streamAbility to meet current and future demandPolitical feasibility

Analysis of Do Nothing OptionCriterion 1: Size and availability of funding

streamProsNothing required so no funding needed. If do create policy can create to own budgetWill ensure states won’t have additional financial burden and have to cut funds from other areas

ConMay result in hidden costs

Work comp claimsLoss of work timeNew hirer trainingLegal servicesInvestigation of incident

Analysis of Do Nothing OptionCriterion 2: Availability to meet current and

future demandsPro14 states have recognized need and passed legislation Allowing states to pass own laws allows them to make policies to address their individual needs

ConLarge incidence of workplace violenceNeeds are not being met and no policies exist to enforce workplace violence programs and prevention; healthcare facilities may not address problem

Analysis of Do Nothing Option

Criterion 3: Political FeasibilityProNurse associations such as KSNA can represent nurses/healthcare workers and lobby for efforts to enact legislationLobbying efforts can help to create legislation unique to individual need of particular state

ConMany states only enact laws after tragic workplace violence has occurredPolitical figures may not realize how widespread the issue is and it’s effects on healthcare workersIf unaware, less likely to promote workplace violence legislation efforts

Analysis of Training & Education Program

Criterion 1: Size and availability of funding stream

ProCost EffectiveMay use OSHA’s prevention training program available on their website

ConTraining may not be comprehensive enoughMay result in hidden costs to employees and employers

Analysis of Training & Education ProgramCriterion 2: Ability to meet current and future

demand

ProSimple start may lead to more legislation in future

ConMay not be best prevention programOSHA recommends more

Analysis of Training & Education Program

Criterion 3: Political Feasibility

ProSimple Cost EffectiveMet with little resistance

ConLegislators may be resistance re: economic situationStates have only enacted after tragic event

Analysis of Comprehensive Safety

Assessment Criterion 1: Size and availability of funding stream

ProMore costly in the beginning but will save in the end

ConCostlyDifficult re: recurrent economic status

Analysis of Comprehensive Safety

AssessmentCriterion 2: Ability to meet current and future demand

ProBest Option per OSHA recommendation

ConMay need to re-evaluate healthcare and direction its heading and what is best for its needs

Analysis of Comprehensive Safety

Assessment dateCriterion 3: Political Feasibility

ProUse KSNA for lobbying and All healthcare workers uniteProven to be effective so policy makers may be least resistant

ConPolicy makers may think other needs more important especially because more costly alternativeReluctant to see problem of violence until tragedy occurs

Comparison of AlternativesCriteria Do Nothing Education/

TrainingComprehen. Assessment

Funding Stream

+ ++ +

Ability to MeetDemand

- + ++

Political Feasibility

+ + +

TotalScore

1 4 4

RecommendationsThird Policy Option

Management commitment and employee involvementWorksite analysisHazard prevention and controlSafety and health trainingRecordkeeping and program evaluation

When Is This Okay & Just A Part Of The Job?