Workers in many industries face hazards related to workplace violence, but the problem is particularly acute in healthcare. Data from the U.S. Bureau of Labor Statistics (BLS) indicate that while healthcare workers experience less than 20 percent of all workplace injuries, they suffer 50 percent of violent assaults. In 2010, BLS estimated that nearly 8 of every 10,000 workers in general medical and surgical hospitals incurred a non-fatal injury from workplace violence that required at least one day away from work. These data are supported by a forthcoming paper in the American Journal of Industrial Medicine, which estimates hospital workers’ career prevalence of experiencing workplace violence to be around 50 percent. Industrial hygienists at hospitals and other healthcare facilities may be asked to play a role in developing and implementing a workplace violence prevention program—a daunting task, for sure. Workplace violence is unlike many of the traditional hazards familiar to industrial hygienists. Carbon monoxide is the same villain wherever it is found, but workplace violence has myriad forms and affects everyone differently. Unlike bloodborne pathogens or chemical stressors, the target organ of workplace violence could be any part of the body. It also affects the mental health of the victim. You can’t take a gas meter and detect workplace violence concentrations. You can’t take measurements and design a workplace violence arrest system. This is the nature of violence: it is not unique to a hospital or an industry. It is an omnipresent condition of humanity that permeates all settings, including the workplace. CHARACTERIZING VIOLENCE Since at least 1996, researchers have used a common system for classifying acts of workplace violence. The classifications are based on the relationship between the victim and the perpetrator:
  • Type I: homicides and acts with criminal intent where there is no relationship between the victim and the perpetrator
  • Type II: customer or client violence against employees
  • Type III: worker-on-worker violence
  • Type IV: domestic violence that spills over into the workplace
The most prevalent type of workplace violence suffered by healthcare personnel is Type II. The perpetrator is a patient who becomes violent while being served by the worker. In 2000, AIHA adopted a white paper on prevention of workplace violence, which acknowledged that Type I and Type II were the most frequent fatal and non-fatal violent acts in the workplace. Reflecting a belief that occupational health protection strategies would be more effective in combating Type I and Type II events, the white paper called on occupational safety and health professionals to concentrate on Type I and Type II acts and the countermeasures that can prevent and mitigate them. This year, employers and EHS professionals received two important contributions and some much needed guidance for mitigating workplace violence in the healthcare setting: new guidelines from OSHA, and a position statement from the American Nurses Association (ANA). OSHA GUIDELINES The surveillance of Type II violence in the healthcare setting is essential to informing prevention and mitigation strategies. However, under-reporting of Type II violent events on the part of workers is often a barrier to adequate measurement and management of these events. Studies suggest that workers talk to their managers and coworkers about these events but that formal reporting into a system with oversight by occupational safety and health professionals doesn’t happen unless the worker incurs a physical injury. Even then, workers often do not report. To improve surveillance of Type II violence, hospitals must develop a comprehensive program that considers the safety and health of workers. OSHA recently published “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” which outlines five essential elements of a workplace violence prevention program:
  1. management commitment and worker participation in which both parties are involved in the creation and operation of a workplace violence prevention program
  2. work site analysis and hazard identification, including a step-by-step assessment for identifying potential or existing workplace violence hazards
  3. hazard prevention and control in which data collected as part of the work site analysis are used to inform the development of prevention strategies
  4. workplace violence prevention training for staff and management, including training workers on where and how to report events
  5. recordkeeping and program evaluation
Data on Type II violent events are essential to a program’s success. For work site analysis and hazard identification, OSHA provides recommendations for using existing or newly collected data to examine specific jobs and tasks with high Type II violence rates. Hazard prevention and control involves a range of engineering, administrative, and work practice controls. Hospitals should have post-incident procedures and services to ensure victims are appropriately cared for and supported, followed by an incident investigation to collect contextual details about the events. Recordkeeping and program evaluation go hand-in-hand; the workplace violence program can’t be evaluated without a comprehensive recordkeeping approach. OSHA recommends that the numerous data sources where workers report be pooled together and that hospitals establish a uniform violence reporting system as well as a mechanism for managers to report events they learn about from their workers. It’s essential that your organization have a mechanism for measuring what is happening with respect to workplace violence.
New Guidance for Protecting Healthcare Workers