Protect employees from
violence and injury to reduce liability
Listen to employees who express fear or worry
(Editor’s note: This is the second of a two-part article on employee safety
in home care. Last month’s article addressed a comprehensive safety program implemented by an agency in Cincinnati to address violence toward nurses. This month, the liability issues associated with employee safety are examined.)
Making sure your employees are safe at work is essential for many reasons. When employees feel safe, a home health agency can recruit and retain qualified people more easily — and a high employee satisfaction level translates to better patient relations.
Another byproduct of a good employee safety program is a reduction in your risk of workers’ compensation claims and legal liabilities, says Elizabeth E. Hogue, Esq., a Burtonsville, MD, attorney.
"I think that home health agencies are doing a great job to promote safety and protect employees from dangerous situations," she says. But even with a safety program in your policy book, there are certain steps a home health manager must take to ensure the program is effective from a risk management point of view, Hogue warns.
"Home care employees are courageous and caring," she explains. While these attributes are admirable, they also may make it difficult for a home care aide or nurse to express fear when talking about a patient’s home, Hogue points out.
The most important thing a manager or supervisor can do is to listen to employees when they say they don’t feel comfortable in a home, she notes. "A supervisor should take any mention of fear or discomfort seriously, even though the employee may not be able to name specific incidents or reasons for the fear," Hogue says.
Talk with employees face to face to let them know you take their sense of danger seriously, she suggests.
"The employee may say something as nonspecific as, I feel creepy when the father is in the room,’ but that feeling is a warning that something’s not right," Hogue adds.
"Before we enhanced our employee safety program to include education, discussions of safety, and an escort program, many of our long-term nurses believed that it wasn’t worth mentioning discomfort with a situation, because there was nothing that could be done to change it," says Carrie Krueger, RN, BSN, clinical director for home care services at Cincinnati Children’s Hospital Medical Center
Discussions with nurses uncovered situations that included patients’ family members cleaning guns in the home while the nurse was there, fistfights between family members and neighbors, and a variety of other frightening occurrences, she explains.
"We reassured employees that we trust their instincts, and if they feel threatened in any way — even if there is no specific incident or action — we make their safety our priority," Krueger adds.
Discontinue service when nurse feels fear
One of the reasons cited by Krueger’s nurses for not reporting feelings of unease was their concern about abandoning their patients.
"We reassured them that we did not want to place them in danger and that we could discontinue services without abandoning the patient," she continues.
Abandonment is terminating services without appropriate notification or without ensuring the patient is referred to another caregiver if care still is needed, Hogue points out.
"A home health agency can definitely discontinue services to a family if the environment is not safe for the home health employee without abandoning the patient," she says.
When Krueger’s agency determines that it is necessary to discontinue services due to safety concerns, the referring physician is notified that services can no longer be provided in the home, and an alternate location for services is identified.
"Depending on the child’s needs, we can have the family and patient go to outpatient clinics, physician offices, or even the hospital if necessary. If the family is unable or unwilling to take the child elsewhere for care, Child Protective Services is called into the situation," she points out. If the child is placed in a foster home that is safe, home health can resume if the physician orders it, Krueger adds.
Teach employees how to avoid injury
While violence in a home health employee’s workplace is frightening, don’t forget to address other threats to an employee’s health, Hogue notes. "The cost of workers’ compensation claims can be tremendous as premiums increase with the numbers of claims filed."
An agency also can be at risk for legal liability for the injury if supervisors and managers were aware of the risk but did nothing to prevent it, she says.
"The most common workers’ compensation claims for home health employees are back injuries and injuries from automobile accidents," Hogue explains.
"Teach proper body mechanics for lifting and moving patients, and make sure that nurses have the proper equipment in the home to help them move patients without injuring themselves," she says.
Be sure to address safe driving issues in staff meetings, and keep traffic patterns in mind when scheduling nurses so that they don’t feel the need to speed or to drive unsafely to the next visit," Hogue suggests.
"We also provide handouts related to safety in different types of weather for our employees," Krueger notes. Making sure that employees are prepared for all situations is important, she adds.
The key to reducing your liability is to show you have identified the risks to your employees and taken steps to protect them, Hogue explains.
One step that Krueger’s agency takes is not to schedule visits into high-risk areas late at night, she says.
"There’s never a need to send a nurse into an unsafe area at 11 p.m. Our role as home health nurses is to teach families how to care for their children with special needs — not to provide
the care 24 hours a day," Hogue notes. "In most cases, a nurse can use the telephone to talk the family member through the situation, or send the family to the emergency room," she adds.
"Make sure employees understand that reporting their fears and concerns to their supervisors or managers is an important part of any employee safety program," Hogue continues.
"Typically, a home health nurse or aide will just decide to hang in there and put up with the situation so the patient gets the care he or she needs," she adds. "A manager has to emphasize that employees won’t get into trouble for expressing fears, and that the real danger is being aware of or suspecting a problem and not reporting it."
[For more information about employee safety programs, contact:
- Elizabeth E. Hogue, Esq., 15118 Liberty Grove, Burtonsville, MD 20866. Phone: (301) 421-0143. Fax: (301) 421-1699. E-mail: [email protected].
- Carrie Krueger, RN, BSN, Clinical Director, Home Care Services, Cincinnati Children’s Hospital Medical Center, MLC 5017, 3333
Burnet Ave., Cincinnati, OH 45229-3039.
Phone: (513) 636-4663. Fax: (513) 636-7152.
E-mail: [email protected].]
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