Workplace Violence Is Not Part of Your Job

All too often, nurses, the front line of healthcare, are faced with the threat of harm and violence. Incidents of violence against nurses often involve patients or family members as offenders, however, workplace violence can also occur at the hands of a co-worker, physician or even someone a nurse knows from outside her job. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as violent acts, including physical assaults and threats of assaults, directed toward persons at work or on duty.

Insert Sidebar on front page: ONA is gathering data on workplace violence incidents in order to reach our goal of preventing violence against nurses in the workplace. Information in this survey is confidential and will only be usedfor the purpose of collecting data on the prevalence of violence in the workplace. Visit www.ohnurses.org to take the survey.

While reports showing violent acts against those in the nursing profession show higher incidence of workplace violence than in many other professions, incidents of workplace violence are widely unreported for many different reasons.[1] Some of those reasons include: “the perception that reporting violent incidents might have a negative effect on customer service reports or scores; ambiguous policies for reporting incidents; fear of retaliation by emergency department management, hospital administration, nursing staff or physicians; the perception that reporting incidents was a sign of incompetence or weakness; lack of physical injury as a result of an incident; the attitude that violence is to be expected; and lack of support from administration and management.”[2]

In the case of one ONA member, a physician began verbally attacking her in a patient care area. When the department director asked the nurse and physician to move the conversation, the physician proceeded to grab the nurse by both arms, continuing to berate her. Unfortunately, the nurse neither filed a police report or a grievance over the matter. But she did contact her local unit representative. While the result was not as favorable as it could have been with a grievance, ONA was able to work with management and the physician was reprimanded.

Nurses working under an ONA collective bargaining agreement need to remember that there are things that can be done to remediate concerns regarding violence in the workplace. Ideally, hospital management and ONA can work together in combating the threat of workplace violence. Joint endeavors can include a violence prevention program, workplace training programs, and labor/management and health and safety committee work.

Unfortunately, there are times when management refuses to acknowledge a problem exists, or refuses to correct an obvious workplace violence hazard. In addition to filing incident reports, ONA collective bargaining nurses have the right to file a grievance in such situations. Other measures include strengthening language in the collective bargaining agreement that provides added measures of protection for nurses, or which might implement a process by which labor and management can jointly review incidents of workplace violence. Such processes make it easier to hold management accountable for implementing protections that reduce the likelihood of recurrent violent situations. If all else fails, OSHA complaints can be filed for an employer’s failure to adhere to its general duty to provide employees with a safe workplace.

Regardless of the work setting, nurses are vulnerable to becoming a victim of workplace violence. The effects of such violence range from minor injuries and aggravation to extreme psychological trauma and death. Do not let an act of violence go unreported in your workplace. It is not just another part of the job that you must accept.

Strategies to Protect Against Workplace Violence
From ONA’s Nursing Practice Statement # 83: Position Statement on Workplace Violence

Individual Strategies

1). All threats should be taken seriously!!! All threats should be reported, and communicated to supervisors, other staff, security, and administration.

2) Local police can be involved in planning and evaluating incidents. Although Health Insurance Portability and Accountability Act (HIPAA) laws are recognized, there is no confidentiality when patients verbalize any suicidal/homicidal threats.

3) Employees working with high-risk patients should not do rounds alone; it is recommended staff be in pairs, especially on psychiatric inpatient units and in Emergency Rooms.

4) Home health nurses should avoid visits where there is a threat or danger. If a home health nurse feels endangered, there should be a policy regarding leaving immediately, and termination of services when there is a potential hazard.

5) Plan ahead and have security and all available staff nearby when volatile situations are possible.

Organizations

1) A team should be formed to review records of past incident reports, workers’ compensation claims, insurance records, grievance records, etc. That team should also do a walk-through of facilities to identify high-risk areas.

2) Each nursing position should be evaluated for risk of violence; procedures and locations that place the nurse at risk should be identified.

3) Focus groups can be encouraged to explore attitudes and issues of nurses regarding violence in the workplace and reporting of such.

4) Preventive tactics and best hiring practices: thorough orientation and mandatory updates about risk assessment, identifying escalation and intervention, violence and conflict resolution, constructive confrontation.

5) Policies for reporting and resolving complaints should be clearly stated and readily available.

6) Nurses should be encouraged to report any and all types of violence.

7) All persons in the facility should be held accountable for their behavior –patients, family, visitors, employees, and physicians. Nurses should pursue civil and criminal processes if necessary.

8) Reports of violence should be followed up immediately by administration with consequences to the perpetrators. Disciplinary action for employees should immediately follow thorough investigations so that harassments do not continue in the workplace repetitively and/or for an indefinite or elongated amount of time.

9) A post-incident evaluation and counseling plan for any violent incident should be in place.

10) Co-workers should be encouraged to address violence in their personal lives and conflict in the workplace. Provide support to co-workers to address violence in their personal lives and conflict in the workplace.

11). Length of wait time in Emergency Departments should be kept to a minimum.

12) Employee assistance programs should be available for staff members experiencing workplace violence.

Education Strategies

1) Nurses should be educated on assessing the workplace for potential occurrences of any type of violence.

2) Each employee should have violence prevention information as part of orientation and mandatory updates.

3) Nurses should be educated about awareness if initial signs of increased agitation, and signs of elevating agitation as well as interventions appropriate at each level of agitation.

4) Regular training sessions in recognizing potential violence, diffusing violence, and dealing with the aftermath of violence should be practiced regularly by staff with documentation of the training.

Strategies to Care for Violent Patients

1) A risk assessment should be completed on each patient, including past violence tendencies, and past history of violence.

2) Alert colleagues about patients with a known history of assaultive behavior and institute a system that protects patient confidentiality but alerts staff.

3) Supervise closely the movement of patients with a history of violence to other units in an in-patient facility.

4) Maintain a list of “restricted visitors” for patients with a history of violence as a victim or perpetrator.

5) Transfer patients to more restrictive care settings when indicated.

6) Interview and treat aggressive patients, families, and visitors in open areas.

Strategies to Deal with Horizontal Violence

1) Provide a mechanism for anonymous reporting of incidents of horizontal violence.

2) Increase awareness of the problems and effects of horizontal violence

3) Staff members should take responsibility for their own professional behavior

4) Create an infrastructure to support managers and staff

5) Develop a strong policy to deal with incidents of horizontal violence

6) Provide education to assist nurses in recognizing, identifying and intervening in horizontal violence situations.

Kelly D. Trautner, Supervising Director of Economic & General Welfare; Anne Steward, Labor Relations Specialist; and E. Gary Seigerst, Labor Relations Specialist, all contributed to this article. If you have any questions about workplace violence, please contact ONA at (614) 237-5414.

[1] OSHA’s Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers

[2] More than Half of Emergency Department Nurses Have Been Physically Assaulted at Work, New Study Finds (Emergency Nurses Association, July 2009)