On April 9, 2001, nurse Alda Ellington, 47, was on duty at a Port St. Lucie, Florida, hospital when she was attacked and killed by a patient. On February 26, 2001, nurse Bernadette Moreno, 27, was killed while at work in a clinic in Finegayan, Guam, when she attempted to help another nurse, Lucia Maguadog, 43, who had been shot and killed by her estranged husband.

While assaults that result in severe injury or death generally are covered by the media, it’s common that when nurses are assaulted and injured by patients or coworkers while on duty, the incidents are not reported. Working in a health care facility is considered to be the third most dangerous job in the United States.

Workplace violence takes a high toll on victims of assaults, and on victims’ coworkers. Often, follow-up counseling is necessary. Posttraumatic emotional stress is often a more debilitating problem for workers than are physical injuries. In the end, when workers’ health suffers, so does productivity. The ANA and other organizations have lobbied OSHA to address the hazards of violence in the workplace, but OSHA so far has issued only voluntary guidelines, the Guidelines for Preventing Workplace Violence for Health Care Workers. In brief, the guidelines identify four components of a workplace violence prevention program:

• management commitment and employee involvement

• worksite analysis

• hazard prevention and control

• safety and health training

Why Violence is Growing

According to OSHA, health care and social-service workers are at high risk for work-related violence because of several factors, including staffing shortages that lead to isolated work with patients; a need to better train staff to recognize and cope with potentially violent patients; wider use of hospitals by law enforcement for criminal holds the trend toward releasing mentally ill patients from hospitals before they are ready for independence; relatively lax security in hospitals and surrounding parking areas available to hospital staff; the tendency of criminals to view hospitals, clinics, and pharmacies as places where drugs and money are available; and the general ease with which all members of society can obtain guns.

Understanding The Issues

Based on findings presented at the Workplace Violence Intervention Research Workshop, held in Washington, DC, in April 2000, and reported in the February 2001 issue ofAmerican Journal of Preventive Medicine,researchers have categorized acts of violence:

• random acts where no relationship may exist between perpetrator and victim

• violence committed between customers and clients (for instance, between health care workers and patients)

• violence committed against coworkers

• personal relationship or domestic violence that can be committed in any setting where the intended victim is accessible to the perpetrator. Each type of violence may require a different approach, and certain health care work sites may be at higher risk for certain types of violence.

In the past few years, violence in the workplace has come to be compared with other occupational hazards, and necessitates some of the same control measures routinely implemented by health and safety professionals worldwide. The aim of such measures is to try to eliminate a hazard first, and then, if necessary, to implement work practice controls or recommend use of personal protection equipment.

• By addressing violence as a systems problem that can be addressed with systems fixes, facilities can attempt to eliminate hazards through preventive measures. This approach shifts the focus away from either blaming the victim or profiling patients as potential perpetrators.

• As with all workplace hazards, prevention is the key to managing the situation. Nurses should work with employers to help establish as safe an environment as possible.

• Participate in or initiate regular workplace assessments to identify hazards. Work with other employees, your safety committee, security officers, the union, and management. Consider the factors, previously identified, known to contribute to assaultive behavior.

• Work with management to implement changes, monitor incidents, and determine if control measures are effective. Possible actions include establishing zero-tolerance policies regarding violence, improve staffing levels, have experienced clinicians on each shift, train staff to deal with escalating violence, install controlled access systems, consider use of metal detectors, provide lighting and video surveillance, enforce wearing of ID badges, and install panic buttons.

• Be alert for potential violence and suspicious behavior and report it.

• Be supportive of colleagues who encounter workplace violence. Make sure they report incidents and receive all necessary treatment, including counseling.

• Know your patients. Both physical and psychological factors may lead patients to behave aggressively. Assess patients completely for their potential for violence and take appropriate precautions.

You should expect your employer to provide a safe workplace, using written policies, employee training, proper staffing, and follow-up of any incidents. Use all avenues available to you to work proactively with management to improve your work environment for all staff.

Coping With Violence

When violence does occur, what should you do?

• Report any threats or actual violence to your supervisor. Document the situation, including names of victims, witnesses, perpetrators, and any environmental factors.

• Call the police if necessary. Nurses who are assaulted at work have the same rights as workers assaulted on the job in any other setting. Nurses are entitled to file a police report to assure that the incident is investigated properly by police.

• Get medical attention, including counseling and evaluation.

• If you are in a collective bargaining unit, contact your union.

• Inform your state nurses association if problems persist.

• Know what your state is doing, and participate in lobbying for greater protections for nurses and other health care workers.

• Get involved in policymaking that will establish a zero tolerance of violence in health care settings. Learn about your CMA’s and the ANA’s efforts surrounding this issue, and use information from those efforts to press for increased safety where you work. Work for greater protection for nurses and other health care workers.

Workplace violence affects everyone. Help establish zero tolerance for violence in all workplaces. Provide vital support for coworkers who experience violence. Making workplaces safer is the responsibility of every nurse and every employer.

Reference

1. Merchant JA, Lundell JA. Workplace Violence Intervention Research Workshop, April 5–7, 2000, Washington, DC. Background, rationale, and summary. Am J Prev Med 2001;20(2):135-40.

Resources

For a hard copy of ANA’s brochure on workplace violence, Workplace Violence, Can you close the door on it? call (800) 274-4ANA for up to 10 free copies. Ask for item WP-5.

OSHA Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers www.osha.gov and search for the guidelines, or call
(202) 693-1888.

To orderCreating a Secure Workplace: Effective Policies and Practices in Health Care,go to the American Hospital Association’s publications Web site.

www.nursingcenter.com