Physical assaults and threatening or violent behaviors are growing problems in the healthcare workplace, so the prevention of workplace violence in and around hospitals and healthcare facilities is an especially important issue.

The Occupational Safety and Health Administration (OSHA), indicates that healthcare and social service workers face a significant risk of job-related violence. According to the Bureau of Labor Statistics (BLS), 27 out of the 100 fatalities in the healthcare and social service industries in 2013 were due to assaults and violent acts. In addition, 70-74 per cent of all workplace assaults occurred in the healthcare and social service industries and assaults comprised 10-11 per cent of workplace injuries involving days away from work for healthcare workers.

Work-related assaults and other incident of workplace violence primarily result from violent behavior from patients, clients and residents in healthcare and social service settings. If your employees work with people who have a history of violence or who have abused drugs or alcohol, or if they work with the public and/or with stressed out relatives of patients, they may be at increased risk for workplace violence.

Increased Risk Factors

High risk situations can include:

• Working with volatile, unstable people
• Transporting patients, residents or clients
• Working alone in a facility or in a patient’s home
• Lack of emergency communication
• Working late at night or early morning hours
• Working in poorly lit corridors, areas, rooms, and parking lots
• Working in areas with high crime rates
• Availability of firearms and weapons
• Long waits for care and services
• Overcrowded or uncomfortable waiting rooms

Violence Prevention

As in any business, management commitment and worker participation are important when developing and maintaining an effective violence prevention program. Ensuring that both management and employees are involved in the creation and operation of a workplace violence program and that both participate in regular meetings/training is the key to making it work.

You should perform a job hazard analysis to identify specific tasks or jobs that may put your employees at risk, giving priority to those that require administering medicine and transferring patients or residents. Also, conducting employee surveys to assist in identifying potential risks may be helpful. Those on the front lines are uniquely equipped to articulate the risks they face and the dangerous behavior they encounter most often.

Workplace Violence Program

Here are some elements that should be part of your workplace violence program:

• Maintain a system of accountability for involving managers, supervisors, and workers.
• Establish a comprehensive program of medical and psychological counseling and debriefing of workers who have experienced or witnessed assaults and other violence incidents.
• Ensure that trauma-informed care is available.
• Establish policies for reporting, recording and monitoring of any incidents.
• Implement physical control measures to prevent or reduce workplace violence including:
  • physical barriers (such as enclosures or guards) or door locks
  • metal detectors
  • panic buttons or silent alarms
  • better or additional lighting
  • more accessible exits
  • closed circuit videos
  • parabolic mirrors
  • glass panels in doors/walls
  • lockable bathrooms, staff counselling and treatment rooms
• Implement administrative and work practice controls including log-in/log-out procedures.
• Research the behavioral history of new and transferred patients and residents.
• Communicate with staff about violent history or new incidents.
• Treat and interview aggressive or agitated patients in relatively open areas.
• Implement a buddy system when personal safety may be threatened.
• Provide responsive, timely information to people waiting for updates or care.
• Implement sign-in procedures for all visitors and guests.
• Use properly trained security officers and counselors to respond to aggressive behavior.
• Have contingency plans to treat clients who are being aggressive or are making verbal or physical threats or attacks.