I didn't consider workplace violence to be a top priority at my hospital. I'd hear about staff injuries from patients in the emergency room and intensive care unit, but they seemed sporadic and isolated. Later, I began to hear about the fears that the nursing staff was expressing about the aggressive behavior of visitors and patients in those locations.

Then my daughter started working as a social worker at a large medical center in the Chicago area. One day, she was providing services to a young injured gang member treated while under police custody. One of his constant companions was his 16-year-old girlfriend.

When the patient was out of the room for testing one day, the girlfriend asked my daughter if she could help her get away from her boyfriend. She felt threatened and abused. My daughter provided information needed to seek assistance, including the name and location of a shelter. And, the victim could readily report her concerns to the police who were guarding her “boyfriend” while he was hospitalized.

The next day, the girlfriend was still at the boyfriend's side. One of the nurses cautioned my daughter, because the patient was making threatening remarks about the “social worker” and what she had said to his girlfriend.

My daughter was able to avoid further contact with the patient, and he was sent back to jail shortly thereafter. But that story worried me and reminded me of the concerns expressed by staff at our hospital when caring for similar patients.

I recall several occasions when injured patients were brought to our ER and treated in our ICU for gunshot wounds. Our policy was that we would not lock down our hospital without good reason, since we had never had any serious consequence of a liberal visitation policy. Therefore, it was quite easy for “family members” to visit our gunshot victims at all hours.

The families could be quite large and would quickly become agitated if any restrictions were placed on their ability to visit their “loved ones.” We had no process for checking for weapons and certainly no metal detectors at our entrances. Our security department consisted of 5 to 6 staff covering the 200-bed facility 24 hours a day, 7 days a week.

Healthcare Has the Highest Rate of  Workplace Violence of Any Private Industry

According to OSHA, (Occupational Safety and Health Administration), the healthcare industry has a rate of injuries from workplace violence that is about 4 times that of private industries. Eighty percent of those injuries are caused by patients. And these incidents are consistently under-reported.

Even less likely to be reported are verbal threats to staff. When surveyed, 50% of nurses state they have been verbally abused within the prior 12 months. The highest risk of injuries is experienced by psychiatric aides, followed by nursing assistants.

Such injuries add significantly to health care costs. These costs include workers compensation costs, direct care and treatment, and replacement staff for injured workers. There is also evidence that such injuries result in medication errors, other patient safety issues and reduced patient satisfaction (presumably because of anxious or preoccupied care givers).

I understand how psychiatric aides can find themselves in these high risk situations. I recall several complaints investigated at our facilities by the Joint Commission because of alleged overuse of restraints, or injuries to psychiatric patients caused by overzealous security guards when called to restrain an agitated patient. But relaxing security measures can result in increased employee injuries.

The alternative to aggressively protecting staff on our psychiatric units might be more injuries such as those at Western State Hospital in Lakewood, Washington, or the attack caught on tape at Erie County Medical Center in Buffalo, New York. Staff members were seriously injured in both incidents.

And physicians are not exempt from the violence. Last year, in Boston, a physician was shot and killed by the son of a husband and wife he had treated.

Prevention

Some of these incidents can be prevented. According to OSHA, an effective workplace violence prevention program consists of the following components:

1. Commitment by management, and involvement of care givers in the program
2. Completion of a work site assessment and identification of hazards
3. Formal hazard control and prevention measures
4. Training in workplace safety for employees
5. Record-keeping and regular program evaluation

And in the event that a healthcare worker is injured in spite of a rigorous violence prevention program, a root cause analysis should be done to identify breakdowns in the program.

Next Steps

As a hospital leader, you should inquire into the current status of workplace violence prevention at your facility. If a formal program does not exist, you should lobby for establishing one.

Be certain that the human resources department is keeping track of these injuries. The workers compensation carrier should be able to provide a summary of such injuries and their associated costs.

Look at trends over the previous 5 years. If rates are increasing or are already higher than expected, push to find out why. And institute a plan to reduce such injuries, following OSHA recommendations.

Share Your Knowledge

Please describe any cases of workplace violence you have seen in the Comments.

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