NJ targets workplace violence in hospitals |…

NJ targets workplace violence in hospitals

New law requires assessment, training

Verbal abuse, threats, assaults from combative or disoriented patients or emotionally distraught family members those occurrences are so common in hospitals that many nurses seem to feel it's just "part of the job."

Not in New Jersey. That state passed the landmark Violence Prevention in Healthcare Facilities Act, which requires hospitals to take steps to reduce the hazard of workplace violence. It is only the third state (after California and Washington) to enact a law that specifically addresses workplace violence in hospitals.

The bill requires hospitals to set up a committee of managers and frontline workers to conduct an "annual comprehensive risk assessment" and to develop a violence prevention plan. "They recognized that every hospital is different and must tailor their program to their own setting," says Corinne Peek-Asa, PhD, an expert on workplace violence who is professor of occupational and environmental health and director of the Injury Prevention Research Center at the University of Iowa in Iowa City.

Violence Prevention Act At a Glance

The New Jersey violence prevention law requires hospitals to:

establish a employee-management committee composed of at least 50% frontline health care workers by June 30, 2008 (all other provisions must occur by January 2009);
conduct an annual risk assessment, including the facility's layout; access restrictions; crime rate in surrounding areas; lighting, and communication and alarm devices; adequacy of staffing levels, including security personnel; the presence of individuals who may pose a risk of violence; and a review of any records relating to violent incidents at the facility;
identify violence prevention policies;
specify methods to reduce identified risks, including training and changes to job design, staffing, security, equipment and facility modifications;
conduct annual training, including training on policies; techniques to de-escalate and minimize violent behavior; appropriate responses to workplace violence, techniques, reporting requirements and procedures; location and operation of safety devices; and resources for coping with violence;
have a trained, in-house crisis response team;
maintain detailed records on violent workplace incidents;
refrain from retaliating against employees who report violent incidents.

New Jersey hospitals also are required to conduct annual training, including techniques to de-escalate violent behavior, respond to violence, and report violent incidents. "They have to take specific steps to reduce the violence," says Jeanne Otersen, public policy director of Health Professionals and Allied Employees (HPAE) of Emerson, NJ, which represents 12,000 nurses and health care workers in the state and helped draft the bill. "I think that mandate is important."

While violence often is recognized as a hazard in emergency departments and mental health units, incidents can happen throughout the hospital, she notes. "We need to make our health care facilities safer for workers and patients," she says. "Patients and workers share the same environment. If you have workers at risk, you have patients at risk."

The risks of workplace violence in hospitals are well documented in New Jersey. HPAE conducted a survey of nurses, including some who were randomly selected from licensure lists and may not be HPAE union members. More than a third said they had been a victim of an episode of violence in the workplace, Otersen says.

That, along with other hazards such as patient handling, is turning nurses away from the profession, says Otersen. More than half of the nurses said they were considering leaving the profession because of workplace hazards.

"You see a very direct link between the workplace hazards and the nursing shortage," she says. "The more hazardous they view their workplace, the more they want to get out. It really speaks to the need to make our health care workplace safer."

Last fall, the New Jersey Department of Health and Senior Services released a report on "Workplace Violence and Prevention in New Jersey Hospital Emergency Departments," which compared New Jersey hospitals to those in California. The study revealed gaps in reporting, including a lack of communication and coordination between employee health and security personnel.

"We found that even very large events weren't on the OSHA [U.S. Occupational Safety and Health Administration] logs at all," says Peek-Asa, who authored the report, which was sponsored by the National Institute for Occupational Safety and Health.

Training also was inconsistent. Some Emergency Department personnel, such as physicians, clerical workers and contract employees, often were not included in training, Peek-Asa found.

Psychiatric hospitals and substance abuse treatment facilities have the highest rates of workplace assaults, according to Bureau of Labor Statistics data.

In the Emergency Department, the New Jersey study showed that patients were the "perpetrators" in 85% of incidents, and nurses were the employees most likely to be assaulted (43%). Incidents were most likely to occur when employees were trying to restrain or subdue a patient or with combative patients, but 30% of the incidents occurred during medical care or nursing functions.

In three-quarters of the cases, an emergency department employee suffered a strain, sprain or spasm, and about two-thirds involved a bruise or contusion. In one-third (32.9%) of the cases, an employee missed at least one day of work due to injury from the incident.