Health Care Workplace Violence

1. Health Care Workplace Violence “Any physical assault, threatening behavior, or verbal abuse occurring in the workplace.” —The National Institute for Occupational Health and Safety (NIOSH)

2. Spontaneous eventsThese are unpredictable and represent 15% of all workplace violence events. Situational eventsThese are preceded by warning signs and represent 85% of all workplace violence events. Types of Workplace Violence

3. Nontreatment Issues Proliferation of guns and other weapons Gang activity Abusive domestic and personal relationships Influence of chemical abuse Opportunity for property crimes Treatment Issues Frustration with inadequate resources Unrealistic expectations (often in relation to behavioral health) Overcrowded care delivery environments Unreasonably long wait times for care Lack of perceived caregiver respect Lack of communication Issues Contributing to Health Care Workplace Violence

4. Making threats Demanding unnecessary services or attention Acting chronically disgruntled Pacing with a display of being tense and angry Making unwarranted claims of entitlement Challenging authority, invading personal space Flushed face, twitching face or lips, and shallow breathing Escalating loudness, often with profanity Using overly aggressive actions and language, possibly due to intoxication or drug abuse Making statements about losing control (veiled threats) Opening and closing of the hands and/or using the index finger to point Darting or jerking eye movements, rapid looking around Workplace Violence Warning Signs

5. Show that you are listening to the individual and respect his or her feelings. Indicate that you want to help resolve the situation and do not make any promises you cannot keep. Display sincerity, do not make threats, and do not set limits that you cannot enforce. Clarify communication and ask for specific responses. Ignore challenges and comment only on the person’s behavior. Move and speak slowly, quietly, and confidently. De-Escalation Techniques • Stand at an angle to the disturbed person, which is less threatening than directly facing him or her. • Do not invade personal space; stay at least 4 feet from the individual. • Do not maintain a rigid stance or cause the individual to feel cornered. • Do not touch the individual, unless it is necessary to manage extreme behavior. • Break eye contact with the individual to reduce the suggestion of aggression or control.

6. Notifying the security department immediately. Removing the individual’s name from census information. Informing caregiver staff about the threat and precautions already in place Restricting visitation Advising the individual’s family Assigning the individual to a room close to the nursing station Locking stairwell/exit doors to prevent entry into unit Requesting increased security patrols of the unit Assigning a sitter to the individual Requesting a security officer to the individual’s room (often paid for by the individual/family) Notifying police as appropriate Protecting a Patient at Risk

7. Protecting Yourself from Workplace Violence • Adjusting hours of work, at least by an hour • Reassigning you to a different and, if possible, more protected parking location • Providing security or a companion escort to/from car or other means of transportation before/after work • Changing your work assignments • Adjusting your work assignment area • Maintaining daily and weekly contact with the security department • Providing assistance in obtaining a restraining order

8. Make an effort to remember conversations you may have overheard before or during the incident. Obtain identity information from persons who may otherwise leave the area before security can interview or detain them. Memorize the physical description of perpetrators or others who may have fled the scene. Be alert for unusual behavior that may occur before security responders arrive or while they are occupied managing the scene. Reassure and support care recipients and other staff. Maintain an appropriate level of confidentiality regarding details of the incident. Staff Involvement in Security Incidents

9. Workplace Violence Prevention Program • Zero tolerance for threats or staff violence of any kind • Mandatory reporting of a known threat to a staff member, visitor, or patient • The ability to report an event 24 hours a day • Authorization for emergency precautionary steps 24 hours a day • An evaluation team to review and form action plans when time is not necessarily of the essence • Ongoing monitoring of any security situation • Education on workplace violence