Statistics showing that nurses and other hospital staff face a greater risk of being attacked at work than any other profession has raised growing concerns in recent years about the surge in violence against healthcare workers. According to the U.S. Bureau of Labor Statistics, 52 percent of all the incidents of workplace violence reported to the agency in 2014 occurred against workers in the healthcare and social assistance industry.
The situation has become so dire, in fact, that nurses unions have started to incorporate demands for increased security into their collective bargaining negotiations. As part of an agreement reached between the Minnesota Nurses Association and Allina Health earlier this year, Allina agreed to provide 24-hour security staffing in its emergency departments.
The issue has also not fallen upon deaf ears in state legislatures. According to the American Nurses Association, a number of states, including Connecticut, Illinois, Maryland, Minnesota, New Jersey, and Oregon all require private hospitals to provide employer-run workplace violence programs. In October, California became the most recent state to join this group as the state’s Division of Occupational Safety and Health approved a rule that requires hospitals, as well as other healthcare providers, to perform security assessments that also incorporate feedback from workers and subsequently develops a plan to help mitigate the identified risks.
Although he’s not generally in favor of adding yet more legal directives to the plate of an industry already saddled with a heavy regulatory burden, Jeff Young, CPP, CHPA, president of the International Association for Healthcare Security & Safety (IAHSS), believes that this type of oversight on workplace violence is not a bad thing.
“We’re overregulated as it is, but I think any type of regulation that puts the onus on the employer to provide this type of oversight, training, risk assessment, etc. to mitigate any type of employee workplace violence, I think we’re all for it,” Young says. “This (issue) has been at the forefront for me and others who serve in similar (security) roles at hospitals and hospital systems throughout the world.”
Young, who also serves as executive director for Lower Mainland Integrated Protection Services at Fraser Health in Canada, says that while many hospitals already incorporate workplace violence prevention initiatives into their overall security plans, the fact is there is a minority of facilities that either don’t or certainly not to the degree that these types of state regulations require.
“I think that by at least having these regulations that it sets a benchmark for those organizations to adhere to,” he adds. “And even with a standard, there are some agencies and organizations that exceed it because they see value in supporting the employee and workplace safety.”
In addition to requiring healthcare providers to develop and implement workplace violence prevention programs of their own, many states have also opted to increase the penalties for those found guilty of assaulting nurses, doctors and other hospital staff. While this would seem like a simple way to help deter violent acts, Young says many prosecutors are hesitant to purse assault cases against patients as a substantial portion of those who end up attacking healthcare workers are themselves victims of mental illness or drug addiction.
“I know in a lot of jurisdictions, district attorneys in the U.S. or in Canada, the Crown Counsel, are reluctant to press charges against patients due to the inability to prove that there is a mental intent to commit a crime given their state of mind, be that mental health issues or addiction issues with drugs. I am interested to see if that legislation will have some impact and work.” Young says. “That said, some of these folks, once they get into the criminal justice system, the justice system has the ability to require treatment for whatever their illness may be where they may not seek or have that treatment available to them otherwise.”
Young believes one of the underlying factors that have contributed to this recent rise in violence against healthcare workers is the fact that hospitals are only seeing the “sickest” of patients today. In fact, a study released earlier this year by the Minnesota Hospital Association found that hospitals across the state are being overused for mental healthcare.
“I think the acuity of the folks we’re seeing in hospital has risen over the years and that acuity includes mental health and addiction patients as it does all other types of patients,” he says. “Unfortunately, the mental health and addiction patient population is usually that population that we attribute to violence and aggression within our hospitals.”
Young says that hospitals are going to have to take a risk-based approach to security moving forward if they want to start to put a greater dent in the number of assaults that are taking place against healthcare workers each year.
“A good start is to look at the OSHA guidelines for workplaces violence. I think it’s a good overview and there are other organizations like the IAHSS that has lots of resources available to hospital folks to start putting together a violence mitigation program,” he adds. “We would be able to assist those facilities that don’t have a healthcare protection professional on staff and again, it’s not just a security function but it has to be multi-discipline approach and there has to be clinical buy-in as part of the program and occupational and workplace health buy-in so it really is a multi-discipline approach to mitigate hospital violence.”
