Workplace Violence

Workplace Violence Amber Hart Brandy Hopkins Susan Swords

Workplace Violence • Physical or verbal assaults • Threats of assaults towards persons on duty at their place of employment • Problem • 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 families • Increasing number of mentally ill and criminal patients • Slow service in emergency rooms and clinics • Increasing number of patients under the influence of drugs or alcohol • Isolated work due to poor staffing • Lack of training in recognizing and managing violent situations

Workplace Violence • 160 deaths due to workplace violence in healthcare and social services from 1997-2010 • Healthcare leads all other industries with 45% of all nonfatal assaults against workers resulting in lost work days • OSHA currently has a set of guidelines to prevent workplace violence for healthcare workers • Only guidelines and more regulations are needed to reduce workplace violence among those working in health care (ANA, n.d.)

Statistics • 765,000 assaults occurred in healthcare resulting in lost work days from 1993-1999 • 8 nurses were fatally injured at work from 2003-2009 • 4 RNs received GSWs resulting in their death • 4 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/residents • 80 were inflicted by visitors or people other than patients • 520 RNs were kicked, hit or beaten • 130 RNs were squeezed, pinched or scratched requiring days off work • 30 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 bullying • Problem among nurses for decades • Nurses inflict psychological injury on each other • Can be overt or covert acts of verbal & non-verbal aggression that causes enough psychological distress for nurses to leave the profession • 53% student nurses report being put down by staff nurses • Threatening body language & strong verbal abuse has been reported by 48% of nurses, pharmacists and others • 56.9% of nurses report being threatened or experience verbal abuse at work (ANA, n.d.)

Background

Social • Employees 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 superiors • When employees experience any of these symptoms, it can adversely effect their work and the patients they care for • Support needed for employees who encounter workplace violence may decrease negative effects they experience afterwards

Economic • Victims miss on average 3.5 days of work and up to 6 weeks depending on extent of assault • Witnesses to the traumatic events are also at risk for developing psychological issues and missing work • Workplace violence can add up to $55 million in lost wages and that total doesn’t include annual sick leave or paid time off • Leads to decreased productivity affecting company’s bottom line • Estimated 20-40% turnover rate after a violence event • Costs approximately $22,000 to $64,000 to replace a nurse (OJIN, 2007) (Workplace Violence, n.d.)

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 violence • Medical 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 violence • Average cost to settle lawsuit outside court: $500,000 • Average amount awarded by juries: $3 million • If homicide occurs, it will bring negative attention and decrease in number of patients who may seek care at that facility (Workplace Violence, n.d.)

Ethical • Confidentiality • Ethical 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 threat • Usually a confidentiality clause preventing employer from disclosing information about terminated employee • Employers may also be concerned to warn future employers of employee’s conduct for fear of being sued over defamation of character or privacy (NetCE, 2009) (U.S. Department of Justice, n.d.)

Ethical • Duty of Care • Employers and Employees have the responsibility to provide a safe work environment • Employers must provide safe work environment and adequate training • Employees must follow safety instructions and report any safety concerns

Legal • Policies in place at individual healthcare facilities • Only 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 hours • 17 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.)

Political • 13 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 violence • Most states are lacking in passing legislation to protect healthcare workers from workplace violence • If hospitals do not enact policies aimed at workplace violence prevent, they can be held liable • Advocates needed at state and federal level to lobby for nurses and healthcare worker’s rights for protection against workplace violence

Stakeholders • Employees in health care profession • Employers • Insurance companies • Government Officials • Families of those working in health care due to the psychological effects the victims experience after being a victim of workplace violence

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

Policy Objectives, Alternatives & Recommendations

Objectives Workplace 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 field • Develop policies and legislation to mandate employers to implement programs to address incidents and complaints of workplace violence • Develop regulations to assess risk of workplace violence and measures to control that risk

Alternatives • Do 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 Plan • Mandate federally employers must follow OSHA’s recommendations to prevent workplace violence

OSHAs Recommendations • Management commitment and employee involvement • Worksite analysis • Hazard prevention and control • Safety and health training • Recordkeeping and program evaluation

Evaluation Criteria • Size and availability of funding stream • Ability to meet current and future demand • Political feasibility

Analysis of Do Nothing Option Criterion 1: Size and availability of funding stream Con May result in hidden costs Work comp claims Loss of work time New hirer training Legal services Investigation of incident • Pros • Nothing required so no funding needed. If do create policy can create to own budget • Will ensure states won’t have additional financial burden and have to cut funds from other areas

Analysis of Do Nothing Option Criterion 2: Availability to meet current and future demands Con Large incidence of workplace violence Needs are not being met and no policies exist to enforce workplace violence programs and prevention; healthcare facilities may not address problem • Pro • 14 states have recognized need and passed legislation • Allowing states to pass own laws allows them to make policies to address their individual needs

Analysis of Do Nothing Option Criterion 3: Political Feasibility Con Many states only enact laws after tragic workplace violence has occurred Political figures may not realize how widespread the issue is and it’s effects on healthcare workers If unaware, less likely to promote workplace violence legislation efforts • Pro • Nurse associations such as KSNA can represent nurses/healthcare workers and lobby for efforts to enact legislation • Lobbying efforts can help to create legislation unique to individual need of particular state

Analysis of Training & Education Program Criterion 1: Size and availability of funding stream Con Training may not be comprehensive enough May result in hidden costs to employees and employers • Pro • Cost Effective • May use OSHA’s prevention training program available on their website

Analysis of Training & Education Program Criterion 2: Ability to meet current and future demand Con May not be best prevention program OSHA recommends more • Pro • Simple start may lead to more legislation in future

Analysis of Training & Education Program Criterion 3: Political Feasibility Con Legislators may be resistance re: economic situation States have only enacted after tragic event • Pro • Simple • Cost Effective • Met with little resistance

Analysis of Comprehensive Safety Assessment Criterion 1: Size and availability of funding stream Con Costly Difficult re: recurrent economic status • Pro • More costly in the beginning but will save in the end

Analysis of Comprehensive Safety Assessment Criterion 2: Ability to meet current and future demand Con May need to re-evaluate healthcare and direction its heading and what is best for its needs • Pro • Best Option per OSHA recommendation

Analysis of Comprehensive Safety Assessment date Criterion 3: Political Feasibility Con Policy makers may think other needs more important especially because more costly alternative Reluctant to see problem of violence until tragedy occurs • Pro • Use KSNA for lobbying and • All healthcare workers unite • Proven to be effective so policy makers may be least resistant

Comparison of Alternatives

Recommendations • Third Policy Option • Management commitment and employee involvement • Worksite analysis • Hazard prevention and control • Safety and health training • Recordkeeping and program evaluation

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

Workplace Violence