WORKPLACE VIOLENCE

1. WORKPLACE VIOLENCE Lake Regional Health System

2. Workplace Violence Statistics According to the US Department of Justice the workplace is the most dangerous place to be in America. The problem is so pervasive that the Centers for Disease Control (CDC) have classified workplace violence as a national epidemic. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” According to the Occupational Health and Safety Administration (OSHA), health care and social service workers face a significant risk of job-related violence. Certain occupations, such as taxi cab drivers, police officers, and convenience store clerks face a higher risk of being murdered at work, while healthcare workers are more likely to become victims of non-fatal assaults. (NIOSH 2002)

3. Workplace Violence Statistics The Bureau of Labor Statistics (BLS) reported 2,637 non-fatal attacks on hospital workers in 2008, a rate of 8.3 assaults per 10,000 workers, as compared to 2 non-fatal assaults per 10,000 workers in all private-sector industries. Nurses experience the most assaults, but physicians, pharmacists, nurse practitioners, physician’s assistants, nurse aides, therapists, technicians, home healthcare workers, social/welfare workers, and emergency medical care personnel are all at risk of violence by patients or a patient’s friends or relatives. Psychiatric units are particularly dangerous, as are emergency rooms, crises and acute care units, and admissions departments.

4. Workplace Violence Statistics • 55% of workplace violence cases (employee-to-employee) are due to work/personality conflicts, 26% are due to family or marital problems, and 19% are due to work-related stress. • Over 80% of the perpetrators of workplace violence are male, usually white and over 30. Though news accounts would lead us to believe otherwise, only 3% are former employees (20% are current employees). Actually, over two-thirds of physical and verbal attacks come from strangers or customers. This is especially the case for male victims. Women are more likely to be attacked by someone they know. For example, domestic violence spillover is the fastest growing category of workplace violence.

5. Workplace Violence Statistics The profile of potentially violent co-workers includes: • Previous history of violence toward the vulnerable, e.g. women, children, animals • Loner, withdrawn; feels nobody listens to her/him; views change with fear • Emotional problems, e.g., substance abuse, depression, low self-esteem • Career Frustration-either significant tenure on the same job or migratory job history • Antagonistic relationships with others • Some type of obsession, e.g., weapons, other acts of violence, romantic/sexual, zealot (political, religious, racial), the job itself, neatness and order.

6. Workplace Violence Statistics 99% of workplace violence perpetrators exhibit observable warning signs (often newly acquired traits: • Violent and threatening behavior, hostility, approval of the use of violence • “Strange” behavior, e.g., becoming reclusive, deteriorating appearance/hygiene, erratic behavior. • Emotional Problems, e.g., drug/alcohol abuse, under unusual stress, depression, inappropriate emotional display • Performance problems, including problems with attendance or tardiness • Interpersonal conflicts, e.g., numerous conflicts, hyper-sensitivity, resentment • “At the end of his rope”, e.g., indicators of impending suicide, has an unspecified plan to “solve all problems” • Access to and familiarity with weapons

7. Workplace Violence Statistics Triggering Events (the last straw, no way out, no more options): • Being fired, laid off or suspended; passed over for promotion • Disciplinary action, poor performance review, criticism from boss or coworkers • Bank or court action (e.g., foreclosure, restraining order, custody hearing) • Benchmark date (e.g., company anniversary, chronological age, Hitler’s birthday-as was the case for Columbine) • Failed or spurned romance; personal crises (e.g., death in the family, divorce, serious illness)

8. Risk Factors Risk factors for patient/family/visitor violence vary from hospital to hospital depending on location, size, and type of care. Common risk factors for hospital violence include the following: • Working directly with volatile people, especially if they are under the influence of drugs or alcohol, or have a history of violence or certain psychotic disorders • Working when under-staffed-especially during meal times and visiting hours • Transporting patients • Long waits for service • Overcrowded, uncomfortable waiting rooms • Working alone • Inadequate security • Lack of staff training for preventing and managing crises with potentially volatile patients • Unrestricted movement of the public • Poorly lit corridors, rooms, parking lots, and other areas

9. Warning Signs Watch for warning signs that may be associated with impending violence: • Verbally expressed anger and frustration • Body language such as threatening gestures • Signs of drug or alcohol abuse • Presence of a weapon

10. Responses to Violence Maintain behavior that helps diffuse anger: • Present a calm, caring attitude • Don’t match the threats • Don’t give orders • Acknowledge the person’s feelings (e.g., "I know you are frustrated”) • Avoid any behavior that may be interpreted as aggressive (e,g., moving rapidly, getting too close, touching or speaking loudly)

11. Responses to Violence Be alert: • Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor • Be vigilant throughout the encounter • Don’t isolate yourself with a potentially violent person • Always keep an open path for exiting-don’t let the potentially violent person stand between you and the door

12. Responses to Violence Take these steps if you can’t defuse the situation quickly: • Remove yourself from the situation • Call security • Report any violent incidents to your manager

13. The hospital’s policy LRHS’s Workplace Violence Policy (HR 612-635) defines violence as “misconduct which undermines the integrity of the employment relationship. Endangers other employees, guests, and patients.” Further, the policy states that “no employee should be subjected to violent behavior while performing his/her job or which interferes with his/her work effectiveness.”

14. The hospital’s policy According to LRHS’s Workplace Violence Policy, examples of inappropriate aggressive, and/or passive-aggressive behavior include, but not limited to: • Behavior that distracts, interferes with, or prevents normal work function or activities, including yelling, using profanity or vulgarity, verbally abusing others, making unreasonable demands for time and attention and/or action, or refusing a reasonable request for identification. • Behavior that includes physical actions short of actual contact/injury, oral or written threats to a person or property, whether in person, over the phone, or other means of communication, including electronic communication. • Behavior that includes physical assault, with or without weapons, behavior that a reasonable person would interpret as being violent, and specific threats to inflict physical harm. • Behavior that creates incidents that are stressful or traumatic that interfere with an individual’s or group of individuals’ ability to effectively function in their work environment. Possessing an unauthorized weapon on hospital grounds is grounds for immediate termination.

15. The hospital’s policy It’s important to report co-worker behavior that causes concern, even if it seems minor. LRHS’s Workplace Violence Policy outlines the reporting process as follows: “Any employee who feels that he/she has been the victim of or observes behavior prohibited in the policy should promptly file a complaint with the immediate supervisor, Department Head, or the Director of Human Resources, or in the event the complaint concerns the Director of Human Resources, the Chief Executive Officer.”.

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