Early in the morning on Easter Sunday, a man strode past the weapons screening area of Olive View-UCLA Medical Center in Los Angeles and, without warning, began stabbing a nurse in the torso. She survived, but was in critical condition. Seven hours later, at Harbor-UCLA Medical Center elsewhere in Los Angeles, another man evaded screening and approached a group of nurses. He stabbed one in the ear with a pencil.
Those incidents may have been fresh in the minds of safety regulators when the California Occupational Health and Safety Standards Board voted unanimously to accept the petitions of two unions and begin work on a workplace violence standard.
A Cal-OSHA advisory committee began the rulemaking process in September, after the Standards Board concluded that "[v]iolence against health care workers is a serious and ongoing problem." Current regulations aren’t adequate, the board said, agreeing with the unions’ contention.
"This has become an emergency," says Richard Negri, health and safety director of SEIU Local 121RN in Pasadena. "It’s not an isolated issue in one part of California, or with one class of worker. It’s happening so regularly, and the agencies that are charged with enforcing it have their hands tied because they don’t have the [necessary] regulation."
California currently enforces a workplace violence rule through the state’s Department of Public Health, which doesn’t have inspectors geared toward worker safety violations, Negri says. The state’s Injury and Illness Prevention Program rule also isn’t adequate to address this hazard, he says.
Although they had denied two previous petitions, the Standards Board agreed, stating that "the necessity for improved workplace violence prevention standards has been established."
Violence grows nationally, states pass safety laws
Twelve states have laws or regulations that address workplace violence in hospitals. Violent incidents in hospitals capture the nation’s headlines and continue to attract concern.
The rate of injury from workplace violence in hospitals actually rose from 2011 to 2012, according to the U.S. Bureau of Labor Statistics. The General Accounting Office is reviewing the effectiveness of the voluntary guidelines of the U.S. Occupational Safety and Health Administration.
In that context, California can provide a framework for addressing the issue, says Jane Lipscomb, PhD, RN, FAAN, professor in the University of Maryland School of Nursing and Medicine in Baltimore and an expert on workplace violence.
"California has a long history of leading the way around a lot of progressive policies. I really think [the new standard] is going to have implications far beyond California," she says. "If it’s successful, there will be a better model out there for the rest of us to emulate."
Staffing, security and training are all important components of workplace violence prevention, says Lipscomb. But enforcement is necessary to ensure compliance, she says.
The Standards Board is convening stakeholder meetings to draft the regulation, listening to both the employer and worker perspectives.
The SEIU has compiled more than a hundred stories of health care workers injured in violent incidents. "Health care workers are among the highest victims of [workplace] violence. All of the statistics and studies are proving that this is an issue that needs to be regulated," says Negri.
He is hopeful that a new regulation will spur hospitals to take a more proactive approach to preventing violence. "Health care workers are on the frontlines of this violence that we can regulate by looking at the predictability of the incidents and bringing on mechanisms of prevention," he says.
