Seeking safety from patient assaults
NY law targets public employers
Hospitals take precautions to prevent the spread of infections from patients to health care workers. But what about when the danger is physical — and the health care worker is at risk of assault?
"Everybody's facing this challenge of how to keep their staff safe," says Jane Lipscomb, RN, PhD, FAAN, professor at the University of Maryland Department of Family and Community Health Nursing. "We need to have a mentality of universal precautions [against workplace violence]."
Lipscomb has consulted with state agencies to implement the violence prevention guidelines of the U.S. Occupational Safety and Health Administration. She sees particular concerns when units are short-staffed and are likely to encounter unstable patients, such as the mentally ill or drug- or alcohol-addicted.
The New York State Violence Prevention Act, which became effective in October, provides a framework for implementing a program, she says. It applies not only to public workplaces, but covers many public hospitals and nursing homes in the state. It requires employers to evaluate the workplace for risks, develop and implement a written workplace violence prevention program, and provide training to employees.
"The bill is probably the most sweeping antiviolence workplace bill in the country," says Jonathan Rosen, MS, CIH, director of the occupational safety and health department at the New York State Public Employees Federation in New York City. "It covers just about every type of public-sector workplace."
Health care workers in mental health facilities face the greatest risk of assault, says Rosen. But emergency department staff also suffer from assaults. In 2004, more than 6,700 hospital workers suffered lost-work-time injuries because of assaults, according to statistics compiled by the Bureau of Labor Statistics.
"The culture is that it's part of the job," says Rosen. "[Workers feel that] you should expect it if you work in a hospital emergency room or in a psychiatric hospital or with the mentally retarded. [They should be educated] that no one should be assaulted, yelled at, threatened, kicked, spit on. That's not part of anyone's job."
Begin with risk analysis
As with other safety and health measures, an effective violence prevention program begins with visible commitment from management, says Lipscomb.
When she works with hospitals, she begins by involving frontline staff as well as managers in a worksite risk analysis. She asks about incidents of physical and verbal abuse, what measures have been taken, and what employees and managers believe can be done to reduce the risk.
"One of the strongest predictors of whether or not someone was assaulted was how they rated the management commitment to safety," she says. "Those staff that work in clinical settings where they feel their management is committed to safety generally fare better."
While security experts can offer guidance on building design and other measures, the employees often have a keen understanding of the hazards, she says.
For example, the hospital should have a clear policy regarding the transfer of patients from police custody to emergency room care, says Rosen. They also may want to tackle the difficult problem of patients who are responsible for repeat assaults, he says.
"We've got to experiment with ways of stopping that cycle of harm," he says.
Preventing violence also may require a close look at the cause of increased tension and anxiety among some patients. For example, a staff shortage not only affects the delivery of care, but also may leave workers alone to handle difficult patients, Lipscomb says.
"If there are units that are very poorly run, you might have patients who are not normally moved to violence or assault but can be aggravated," she says.
Training is an essential component of an effective violence prevention program, she says. That includes information on how to communicate concerns about patients and the importance of reporting threats as well as assaults, she says.
Finally, it's important to continually evaluate your violence prevention efforts, she says.
Ultimately, a good violence prevention program benefits patients as well as staff, says Lipscomb. "If you make a work environment safe for staff, you inevitably improve the environment for the client."
(Editor's note: OSHA's Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers is available at www.osha.gov/Publications/OSHA3148/osha3148.html.)
Hospitals take precautions to prevent the spread of infections from patients to health care workers. But what about when the danger is physical -- and the health care worker is at risk of assault?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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