Prevention of Workplace Violence Among Health Care Workers

Abstract

Workplace violence is common in health care settings. Occupational and environmental health nurses should educate employees about measures to prevent violence in the workplace.

Workplace violence (WPV) is any behavior or threat of physical injury, harassment, intimidation, or other threatening disruptive behavior at the workplace (Occupational Safety and Health Administration [OSHA], 2015). WPV is typically categorized into four types based on the perpetrator’s relationship with the establishment. Type I involves criminal activity such as robbery that is committed by a perpetrator that has no established relationship to the workplace. Type II includes a customer/client perpetrator that is a customer at the workplace and becomes violent while being served (e.g., patient being served by a healthcare worker). Type III includes worker-on-worker violence and can involve past or present employees of the workplace. Type IV occurs when the perpetrator has a personal relationship with an employee, such as domestic violence that spills into the workplace (National Institute for Occupational Safety and Health [NIOSH], 2006).

Type II violence is common in health care with nurses, nurses’ aides, sitters, physicians, and other workgroups being at high risk for experiencing violence by patients and hospital visitors (NIOSH, 2006; Pompeii et al., 2015). Pompeii et al. (2015) found the 12-month prevalence of WPV to be 39% in a large cross-section of healthcare workers. According to OSHA, HCWs are approximately 4 times more likely to require time off from work because of violence incurred at work than other types of work-related injuries (OSHA, 2015).

According to the OSHA’s Guidelines for Preventing Workplace Violence for Health and Social Service Workers (2016), hospitals should have a written WPV prevention program as part of their overall safety and health program. The components include management commitment and employee participation, worksite analysis, hazard prevention and control, safety and health training, and record keeping and program evaluation. A comprehensive program of medical and psychological counseling and debriefing for workers who have experienced or witnessed assaults is essential along with policies that ensure reporting, recording, and monitoring of incidents and near misses (OSHA, 2016).

A worksite analysis is an organized assessment process to identify existing or potential dangers that may lead to WPV (OSHA, 2016) and includes data from records analysis and tracking, job hazard analysis, employment surveys, and client/patient surveys. The employer should identify, implement, and evaluate the most efficient control measures to remove or decrease the hazards. Measurement and reporting of WPV incidents is essential to know the scope of the problem and if interventions are appropriate and working (OSHA, 2016). Based on study findings, Pompeii et al. (2015) emphasized the importance of integrating data for WPV across multiple reporting systems such as general safety reporting systems, workers’ compensation, the OSHA log, as well as intermittent worker surveys. Although this same study observed that participants reported 75% of the WPV events incurred, most (less than 10%) were not reported into the formal occupational health and safety injury surveillance systems. These findings highlight the need for hospitals to employ additional types of methods for ascertaining data about the frequency and context with which WPV events occur in their settings. These data are essential for informing WPV prevention programs.

Education and training of all workers about WPV prevention is essential to ensure awareness of potential hazards and how to protect themselves and coworkers. The training should cover deescalation techniques, management of assaultive behavior, and how to prevent and avoid assaults (OSHA, 2016). It should also include details about how and where workers should report these types of events. Crisis prevention intervention (CPI) training focuses on behaviors that could result in a crisis, effective response to behaviors that prevent escalation of the situation, use of verbal and nonverbal techniques to diffuse hostile behaviors, and coping with individual fears (CPI, 2017).

As violence escalates in every facet of society, individual and organizational precautionary measures are necessary to reduce hazardous situations. Occupational health nurses are invaluable members of the organization’s WPV response team. They can help identify hazards and control measures, conduct incident investigations, monitor trends, and establish corrective measures. In addition, they provide health care, support for workers and their families, and can educate workers about violence prevention.