Our healthcare team members and their patients are exposed daily to the dangers of workplace violence that has resulted in real casualties. Not only has this threat caused physical injury but has resulted in the collateral damage to the organizations’ culture of safety.
A Tangible Threat
The data for workplace violence in healthcare is showing some disturbing trends. In 2018, according to the Bureau of Labor Statistics, the healthcare all-worker incidence rate for nonfatal occupational injuries and illnesses involving days away from work was 10.4 incidents (per 10,000 FTE), compared to the incidence rate of 2.1 for all other work professions. Simply put, our healthcare team members are 5 times more likely to suffer a workplace violence injury than all other work professions. Additionally, healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence that same year. The number of injuries from violent attacks against medical professionals grew by 63% from 2011 to 2018. Our places of healing have become places of violence and suffering.
Reviewing recent news events and stories demonstrate that violence in healthcare has had devastating effects:
- “A Home Health RN in the Northwest was shot and killed while on a home visit to a new patient recovering from a stroke.”
- “A Man was arrested for allegedly choking infants and assaulting nursery staff at a Midwest medical center”
- “Two hospital staff were killed by a man visiting his girlfriend after giving birth”
- “A recent survey of more than 1,500 physicians found that 86% of those physicians had witnessed or experienced bullying or harassment by clinicians or staff in the past five years.”
Although physical violence, even death, occurs within our healthcare facilities, it should be noted that harassment, non-physical aggression, and bullying are more prevalent forms of workplace violence.
Healthcare Teams at Risk
What places our team members at risk? Although it seems that more incidents are being reported since the beginning of the COVID-19 pandemic, data shows that workplace violence was escalating well before the public health emergency. A number of contributing factors are creating the challenging work environment. This would include the incidence of increasing alcohol and drug abuse, stressful conditions (long wait times, overcrowding in waiting rooms, delays in receiving care), increasing gang activity, lack of community mental healthcare resources, inadequate security, and other issues. Additionally, staff shortages, increased patient morbidities, exposure to violent individuals, and the absence of strong workplace violence prevention programs and protective regulations are all barriers to eliminating violence against healthcare workers.
The risk factors for violence vary from hospital to hospital and in home care settings, depending on location, size, and type of care. Violence may occur anywhere in a hospital, but is most frequent in psychiatric units, emergency departments, waiting areas, and in geriatric/long-term care units according to data. A great many healthcare staff work outside the hospital in high-risk public sector healthcare settings such as prison and jail medical units, drug and alcohol residential treatment facilities, clinic-like settings, or as visiting nurses. The degree to which each of these workplaces emphasizes worker safety can vary widely.
Impact on the Organization
The effects of violence in healthcare can be as diverse as to the form it takes. Basically, workplace violence effects can be categorized as Direct and Indirect. Direct effects of violence are fairly clear. These would include physical injury (minor or even severe), some of which may result in temporary or permanent physical disability (even death) which may prevent a healthcare worker from remaining in their job. What is not visible, but can be equally devastating, is the psychological trauma that occurs to a victim or even a witness to workplace violence. In some circumstances, psychological trauma may cause more damage to the healthcare team as multiple witnesses to violent incidents may never be the recipient of the physical assault but be severely traumatized, even leaving the organization or healthcare as a result.
Indirect effects of workplace violence can affect a limited number of staff or spread throughout the organization and affect its culture as low worker morale, increased job stress, elevated worker turnover rates, reduced trust of management/co-workers, and the creation of a hostile work environment.
Just as concerning is that according to the Centers of Medicare and Medicaid Services (CMS), intimidating and disruptive behavior among colleagues can foster medical errors and contribute to poor patient satisfaction and otherwise preventable adverse outcomes.
New Standards and Expectations
The threat of workplace violence on healthcare workers, patients, and the impact on the safe delivery of care has gained the attention of the government and regulatory organizations. The Joint Commission released standards mandating the existence of a workplace violence prevention program for 2022. Additionally, CMS released its expectation of healthcare organizations in addressing the threat of workplace violence in November 2022 (QSO-23-04-Hospitals).
The common themes for addressing workplace violence in these new standards and expectations include:
- An assessment of the organization for internal and external environmental risks that may predispose the incidence of workplace violence. This may include identifying patients at risk of injuring others or themselves. This risk assessment should be conducted with an “all hazards” approach and repeated as necessary to identify new and emerging risks.
- Development of policies and procedures to prevent and respond to workplace violence. This would include training and education of staff in prevention and response.
- Using the concepts of continuous process improvement to analyze incidents for trends and deploy mitigating actions to address identified gaps
- Ensure that there is a process for follow up and support to victims and witnesses affected by incidents of workplace violence.
- Involvement of Leadership in addressing workplace violence in their capacity to set expectations and direct/support mitigating actions.
Organizations should consult with both CMS and their accrediting organization for details on performance expectations in addressing these new and updated requirements.
Summary
With the increasing incidents of workplace violence in healthcare, organizations must ensure they are prepared to demonstrate their actions in addressing this concerning threat to safe patient care. This will require involvement by leadership to ensure assertive actions in determining the level of risk of their organization and the follow through of initiatives to address them. This is essential to ensuring that staff and patients are provided a safe environment but also will be a key focus area for survey by regulatory agencies.
To learn more about how we can help with Workplace violence programs and training contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
