A comprehensive risk management plan is critical for those who are employed by health organizations. The General Duty Clause from the Occupational Safety and Health Act of 1970 (Act) requires all employers to provide a work environment “free from recognized hazards that are causing or are likely to cause death or serious physical harm.” Workplace violence is a recognized hazard within the healthcare industry, and as such, employers have the responsibility under the Act to abate the hazard.
Healthcare workplace violence leads to increased absenteeism by healthcare workers, increased use of sick leave, lower productivity, low morale and increased requests for transfers. Violence in the healthcare workplace is a major disruption to job satisfaction. It can result in added costs from workers’ compensation, patient lawsuits and costs associated with hiring and training replacement workers due to staff turnover.
Many factors contribute to the occupational risks facing healthcare workers today, but a fundamental problem is a healthcare culture that focuses more on patient safety than on worker safety. Healthcare is not considered a particularly dangerous profession, yet when violence does occur, it is often labeled as “part of the job.”
Management needs to take workplace violence seriously and implement procedures to mitigate such incidents. Three major factors should be considered: environmental, administrative and training.
Environmental conditions—such as changes in noise levels, odors and lighting—can be upsetting to some patients. To alleviate these conditions, review the layout, design and amenities of the physical workspace. Eliminate unmonitored entries and stairwells, provide sufficient lighting and provide mirrors on blind corners. Keep in mind—unsecured furniture, fixtures and decorative items provide opportunities to be used as weapons and should be removed from the workplace. Consider creating a barrier between the worker and the violent person, such as enclosing a worker’s station.
Changes in work practices and administrative procedures can help prevent violent incidents by ensuring that adequate staff are available, especially at the riskiest times and in the riskiest areas. Also, make sure no one is working alone. Develop systems for communicating relevant information on patient history and behaviors to all direct care staff, from one shift to the next.
Train and educate all staff members in identifying potential violent behaviors and how to protect themselves. FREQUENT TRAINING also reduces the likelihood of being assaulted.
Training should include information on types of injuries or problems identified in the facility and the methods to control the specific hazards. Most importantly, instruct employees on limiting physical interventions in workplace altercations whenever possible and train all employees to behave compassionately when an incident occurs.
For the healthcare worker, your words and demeanor have the power to defuse tensions. Be attuned to your tone of voice, choice of words and body language. It is important to be cognizant of and control your body position and posture so as not to inadvertently escalate an already tense situation.
If a patient shows signs of loss of self-control and problem-solving ability, verbal and nonverbal interventions can still be effective but additional precautions should be taken. The focus now turns to protecting yourself and those around you. Observing an out-of-control person is frightening and may trigger your own “fight or flight” response. Emotional containment is important so that proper procedures and protocols are remembered and followed.
Don’t go it alone; enlist the help of security or colleagues. Be prepared to use your panic device and to physically remove yourself, if necessary. Position yourself to exit easily. Remove other patients or visitors from the room. Response to an out-of-control person may require physical and/or chemical restraint, in which case you should follow your healthcare organization’s policies and procedures for next steps. It is important that you continue to engage the patient, tell them what you are doing and why you are doing it.
Successful workplace violence prevention programs empower healthcare workers to come forward when incidents occur. Healthcare workers must know and believe that incident reports are taken seriously by management. Those involved in the incident should be included in the process and receive feedback regarding the status of the investigation and anticipated actions.
By Eric Wokas, Risk Control Consultant
