Take Proactive Steps to Protect Healthcare Workers from Workplace Violence

By Jim Burke

Experiencing violence on the job has almost become routine for healthcare workers, particularly nurses. What’s also become a given is the role played by alcohol and drugs.

Take the seriously intoxicated man who had been transported to a north Georgia hospital emergency room, bleeding from the head where he’d hit himself with a beer bottle. Not only was he combative with the ER staff, including hitting a pregnant nurse and physically and verbally assaulting local police who had been called in to help, but he refused to stay in clothed in his hospital gown. The man had to be given stitches before he was taken to jail with a blood alcohol limit three times the legal limit.

Violence against healthcare workers, particularly in the emergency room setting, has reached near-epidemic levels, far more severe than in any other industry. Nurses, mainly women, are most vulnerable; in a survey last year, more than 75 percent of the nurses responding said they’d been victims of attacks. But physicians are at risk, too. Nearly half of emergency physicians, a recent study found, were assaulted on the job and 71 percent had seen co-workers attacked.

Digging into the circumstances, other research showed that 54.7 percent of the violence was meted out by drunk patients, 45.9 percent by patients high on drugs and 43.1 percent, those with mental health issues. People with such issues have been more likely to seek emergency room care, experts suggest, given cutbacks in state and federal funding for mental health and addiction treatment programs.

“Safety first” provisions should be the first line of defense for health care organizations in protecting their workers:

• Ensure the common waiting area is separate from the emergency room where care is provided.
• Have a security officer escort patients identified as a risk into treatment rooms.
• Mandate a buddy system. No one is ever left alone with patients who exhibit specific red flag characteristics – aggressiveness or a high level of confusion or anxiety, for example.
• Install easily accessible “panic” buttons in treatment rooms.
• Provide de-escalation training to clinicians and patient-facing staff.

Most states have regulations designed to curb the violence against healthcare workers. California’s regulations are the model for the national Health Care Workplace Violence Prevention Act introduced this year. It would require OSHA to create a standard requiring health care employers to implement workplace violence prevention plans and ensure their workers receive training on how respond.

Many organizations have already put policies and programs in place, with existing regulations providing a framework. Here’s how you can be more proactive in protecting your team and minimizing the risk of violence against healthcare workers:

• Threat and vulnerability assessments. Threat assessments identify the potential for violence weighed against past events, area crime trends and risk factors. The vulnerability assessment identifies security gaps like parking, vehicle and employee movement patterns. Intrusion detection mechanisms, alarms and building and unit entry controls should also be evaluated.
• Emergency action plans. Procedures, roles and responsibilities are laid out, along with guidelines for training and threat management response. They should be integrated with those of local emergency response agencies.
• Active shooter response plans. These spell out the response structure for incidents, including resources (like law enforcement), guidelines on victim assistance and provisions for “safe” rooms.
• Violence-free workplace programs. These provide guidelines for managing threatening situations, and dealing with victims, risk screening and case management. Safety and security measures are spelled out and management priorities are clearly stated.
• Training and education. In addition to training on procedures, roles and responsibilities, de-escalation training for clinicians and patient-facing staff can help prevent some incidents from getting out of control.

Emergency room employees have a tough job in the best of circumstances. Hospital administration has a responsibility to make the environment as safe as possible, and not just for the issue of liability. It’s the right thing to do.

HUB International’s team is ready to help your organization respond proactively to workplace violence and other risks the healthcare industry must manage.