A Word About Violence in the Workplace

Dear Colleagues,

It’s happened to most of us.  If it hasn’t happened to you, you’ve probably witnessed it.  If you haven’t, I hope you never do!    I’m talking about the common abuse experienced by nurses:  hitting, kicking, beating, and/or shoving (GAO, 2016):   Workplace Violence.

The US Occupational Health and Safety Agency (OSHA) defines workplace violence as “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior, that occurs at the worksite”. It ranges from threats and verbal abuse to physical assaults and even homicide, and can involve nurses, other staff, patients, and visitors.

(OSHA, 2015).  As nurses we need to believe that workplace violence is not part of the job, no matter what we have been told.  Now, attention & resources are being directed to stopping this serious problem.  The Joint Commission for Health Care Organizations has published a handbook for prevention that was written by a nurse!  To get a copy visit this link:

https://www.jointcommission.org/workplace_safety_violence_prevention_toolkit/

Workplace violence takes many forms and OSHA has categorized them. These are:

Type I (Criminal Intent): Results while a criminal activity (i.e., robbery) is being committed and the perpetrator has no legitimate relationship to the workplace.

Type II (Customer/client): The perpetrator is a customer or client at the workplace (i.e., health care patient) and becomes violent while being served by the worker.

Type III (Worker-on-Worker): Employees or past employees of the workplace are the perpetrators.

Type IV (Personal Relationship): The perpetrator usually has a personal relationship with an employee (i.e., domestic violence in the workplace).

(OSHA, 2015)

The Bureau of Labor Statistics reports that 50% of all workplace related assaults across all industries & professions involve health care workers.   In the US, nurses and other direct care staff experience  4 times the  rate of injury due to workplace violence when compared to workers in all other industries and are more likely to be out of work as a result. (OSHA, 2015).  Phillips (2016) informs us that Type II violence accounts for 75% of aggravated assaults and 93% of all assaults against healthcare workers.  This is confirmed by the Governmental Accountability Offices:  The most common causes of violent injuries resulting in days away from work in health care were hitting, kicking, beating, and/or shoving (GAO, 2016).  In hospitals & other healthcare settings, approximately 24,000 workplace assaults were reported between 2010 and 2013, with most threats and assaults occurring between noon and midnight (Wyatt et. al, 2016).

As nurses, we know the most common type of workplace violence in healthcare is “Type 2”  – verbal or physical abuse and assaults perpetrated by patients, their family members, and visitors, toward nurses & other direct care staff.   In one 2014 survey on hospital crime, Type II violence accounted for 75% of aggravated assaults and 93% of all assaults against employees (Phillips, 2016).  In healthcare, the highest rates of violence occur in emergency rooms, but happen in geriatrics, the ICU, general medical & psychiatric units. (OSHA, 2015). This data about reported assaults is disturbing.  But as nurses, we know the situation is much worse:  Most assaults go unreported because we brush them off as being “part of the job”.

This is not the case.  Nobody has the right to assault anybody else, least of all someone who is trying to care for them or a family member –  or even a coworker.   Please don’t make excuses for the perpetrators:  Violence is a behavior that needs to stop.

So what can we do?  Here are some suggestions:

1.  Report hazardous situations promptly to your manager

2.  Report every assault in writing

3.   Be informed. Start with the Toolkit link above

4.  Work with your employer provide a safe environment.  Remember, the Joint Commission is on your side.

5.  Practice extreme self-care.  There is a huge body of evidence to suggest the most stressed nurses are the ones who are assaulted.

For more information, in addition to the JCAHO site above, visit the following websites:

nursingworld.org/workplaceviolence

osha.gov/worksafetyinhosptals

osha.gov/workplace

Remember Maslow’s hierarchy of needs:  Nothing is more basic than our safety.

Best regards to all!

Leslie