Workplace Violence
Background
Workplace violence is a major public health concern that has increased in incidence and attention within the past decade. From 1993-1999 alone, 1.7 million incidents of workplace violence occurred annually in the US, with 12% of all victims reporting physical injuries. (BLS 2001).The healthcare sector leads all other industries, with 45% of all nonfatal assaults against workers resulting in lost work days in the US. (US Bureau of Labor Statistics- BLS, 2006). In its annual Workplace Safety Index, Liberty Mutual cites assaults and violent acts as the 10th leading cause of nonfatal occupational injury in 2002, representing about 1% of all workplace injuries and a cost of $400 million. (Liberty Mutual 2004). The incidence of violence is likely far greater than that which is reported resulting from inadequate reporting mechanisms and victim fear of isolation, embarrassment, and reprisal.
The results of an Emergency Nurses Association survey released in 2009 found that more than 50% of ER nurses had experienced violence by patients on the job and more than 25% had experienced 20 or more violent incidents in the past three years. Research showed long wait times, a shortage of nurses, drug and alcohol use by patients, and treatment of psychiatric patients all contributed to violence in the ER.
The National Institute for Occupational Safety and Health Administration (NIOSH) and the Occupational Safety and Health Administration (OSHA) define workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace. Violence includes overt and covert behaviors ranging in aggressiveness from verbal harassment to murder. (NIOSH 1996, OSHA 1996).
Violence claims a significant toll on all. In addition to the physical, emotional and mental affects on the victim, other negative effects include: financial loss resulting from insurance claims, lost productivity, legal expenses, property damage, and possible staff replacement costs. Prevention is essential for creating a safe and therapeutic environment for patients and a safer work place for healthcare workers. Healthcare workers who leave because of assaults and threats of violence contribute to a healthcare workforce shortage. It is possible to reduce and mitigate the effects of violence. One way is to establish a comprehensive program in the workplace, dedicated to prevention, collection of incidents and provision of support for those affected.
Although, there is no federal standard that requires workplace violence protections, effective January 1, 2009 for all accreditation programs, The Joint Commission has a new Leadership standard (LD.03.01.01)* that addresses disruptive and inappropriate behaviors in two of its elements of performance:
- EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.
- EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.
In addition, standards in the Medical Staff chapter have been organized to follow six core competencies (see the introduction to MS.4) to be addressed in the credentialing process, including interpersonal skills and professionalism.
To learn about specific recommendations from the Joint Commission, go to: www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm
Rather than wait for healthcare employers to volunteer to establish such programs, some states have sought legislative solutions including mandatory establishment of a comprehensive prevention program for healthcare employers, as well as increased penalties for those convicted of an act of violence against a nurse.
Enacted to Date
Legislation calling for a workplace violence prevention program, study of the issue or reporting of incidents has been signed into law in: IL, ME, NJ, NY, OR, WA and WV.
HI passed a resolution urging employers to develop and implement standards of conduct and policies for managers and employees to reduce workplace bullying and promote healthful and safe work environments.
States which enacted legislation to strengthen or increase penalties for acts of workplace violence affecting nurses include: AL, AZ, CO, HI, IL, NV, NC, and NM.
Summary of State Approaches
(2009) WV expanded previous protections and increased penalties for battery, malicious assault and unlawful assault against an government employee or contract worker to include all government workers and to expand this existing protection for health care workers to include contract health care workers.(2008) WV signed into law enhanced criminal penalties committed against licensed and certified healthcare professionals. This action represented the extension of the same protections to healthcare workers afforded other persons who serve the public and are regularly exposed to the threat of physical violence in the course of performing their jobs.
HI law (2008) focused specifically on assaults of those individuals employed at a state operated or contracted mental health facility; making it a class c felony when assaulted.
Both NJ and OR addressed workplace violence comprehensively in 2007. NJ passed the "Violence Prevention in Health Care Facilities Act", calling for select health care entities to establish violence prevention programs to protect workers. Essential provisions of the program include: creation of a violence prevention committee including a member of management, responsible for all levels of the program and with at least one half of the committee's membership to be that of direct care workers with the remaining members having relevant experience, expertise or responsibility at the facility; performance of an annual comprehensive assessment that includes facility layout, crime rate of the surrounding area, adequacy of staffing levels, presence of individuals who may pose a risk and a review of violent incidents at the facility at the very least; and development of a written violence prevention plan that identifies workplace risks and provides specific methods to reduce identified risks. OR's law requires a healthcare employer to conduct periodic security and safety assessments to identify existing or potential hazards for assaults committed against employees. The assessment shall include but not be limited to a measure of the frequency of assaults committed against employees that occur on the premises of a healthcare employer or in the home of a patient receiving home healthcare services during the preceding five years or for the years that records are available if fewer than five years of records are available; and identification of the causes and consequences of assaults against employees. Employers must also develop and implement an assault prevention and protection program for employees based on assessments conducted and provide assault prevention and protection training on a regular and ongoing basis for employees.
NY legislation enacted in 2006 requires public employers to develop and implement programs to prevent and minimize workplace violence; allows any public employee or representative of public employees who believes that a serious violation of a safety or health standard exists, or an imminent danger exists, to request an inspection; provides for enforcement of such requirement by the commissioner of labor.
In 2006, IL enacted the "Healthcare Workplace Violence Prevention Act" designed as a 2-year pilot project beginning with violence prevention training in 2006 and expanding to adoption and implementation of prevention programs with maintenance of records of violent acts in 2007. The legislation specified the Governor will convene a task force to evaluate the pilot project and report findings to the General Assembly by January 1, 2008. The same year, ME legislation required the Department of Labor to coordinate a task force to study workplace safety issues and provide findings and recommendations for any proposed legislation to reduce workplace violence before a joint standing committee of the legislature.
In 2005, WA passed legislation requiring that, by September 1st of each year, a report shall be submitted to the house committee on commerce and labor and the senate committee on commerce and trade, or successor committees, on efforts to reduce violence in the "state" hospitals.
Legislation enacted in NC (2004) provides for civil no-contact orders to be filed by either the employee who is victim of unlawful conduct or by the employer on behalf of the employee. The law also provides for protections from employer discrimination of the victimized employee.
Other states have approached the issue of workplace violence by elevating the category for the offense and subsequent penalty: AL (2006), AZ (2007), CO applies to workers in mental health facilities only (2005); IL (2003), NV (2003), and NM (2006). States which have afforded protections for specific categories of employees, exclusive of nurses are not listed.
2009 Introductions
Mandated employer establish prevention programs
- CA (AB1083) This bill expands the definition of a crime and would require hospitals to annually review and update the security and safety assessment and plan (curently required in law), to include information regarding aggressive or violent behavior at other facilities. The bill would also suggest that the plan include efforts to cooperate with local law enforcement and make available upon request, the assessment and plan to any employee or recognized bargaining agent of an employee.
- IL (HB374) Creates the Abusive Work Environment Act. Finds that the well-being of the State relies upon healthy employees free of abusive work environments, not specific to health care settings
- MA (SB988) comprehensive program required
- NY (AB391) applies to public employers
- OR (SB727) establishes that subjecting employees to abusive work environents is unlawful employment practice.
- UT (HB224/BR233) Health Care Provider Abusive Work Environment Prohibition Act which prohibits abusive conduct and retaliation; provides for a private right of action; establishes factors in determining abusive conduct; provides for affirmative defenses; provides for remedies; addresses relationship to workers' compensation etc.
Establish or increase penalties associated with assault of a healthcare provider
- IA (HB521) Enhances the penalty for assault by expelling saliva upon a person (paid or volunteer) in the capacity of peace officer, .... healthcare provider etc....; such action is considered an aggrvated misdemeanor.
- MA (HD2241/SD725) (HB1259, 1264, 1457, 1646, 1696) assault and battery on an emergency medical technician, an ambulance operator, registered nurse, registered nurse psychologist, physical therapist, occupational therapist, ambulance attendant, nurse’s aide, diagnostic technician including phlebotomists and EKG technician and security officer, while said technician, operator, registered nurse, registered nurse psychologist, physical therapist, occupational therapist, attendant, nurse’s aide, diagnostic technicians, including phlebotomists and EKG technicians, radiology technicians and security officers is treating or transporting, in the line of duty, shall be punished by imprisonment in the house of correction for not less than 90 days nor more than 2 1/2 years or by a fine of not less than $500 nor more than $5,000, or both. (SB1753) also applies penalities for assualt and battery, while (SB1757) " Act to Improve Nurse Safety" includes penalties for assault and battery on nurses along with a number of other workplace requirements: restriction of consecutive hours worked and required hours off between shifts and requirement for safe patient handling and movement programs in ehalth care facilities.
- MN (SB1845/HB1765)
- MT (SB205/LC1093)
- NE (LB668)
- NJ (AB2848/SB1779 specifically addresses assault of nurses); (AB3470/SB2344)
- NY (AB3103/SB2103); (SB4007); (SB4018); (SB6112)
- ND
(SB2293) addresses to the assault of state hospital employees specifically and imposes a penalty.
- OK (HB1360/SB955) ; (HB1360)
- TX (HB1482) specific to assault with bodily fluids; (HB2630) enhances penalties for assault of a healthcare provider or mental health services provider.)
- VT (HB223); (SB52 specific to nurses); (SB87 holds employer liable for abusive environments)
- VA (HB2436 specific to ER personnel); (SJR358 study incidence of violence in hospital ERs)
- WV (HB2566) (SB629)
Bill numbers have been provided to enable the reader to investigate specific provisions.
Given the few states that have been successful in enacting comprehensive legislation for healthcare workers, ANA created a model bill, "The Violence Prevention in Health Care Facilities Act" which requires a healthcare employer establish a program with emphasis on prevention and reporting.
Last updated 8/28/09
Disclaimer - Every effort has been made to provide a comprehensive report, but omissions are possible.