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How to Prevent Workplace Violence in Healthcare

Reducing workplace violence protects patients and caregivers, improves patient outcomes, produces a more comfortable work atmosphere, decreases staff turnover, and saves healthcare institutions and, by extension, taxpayers money. So how do you reduce workplace violence in healthcare?

A study from the US Bureau of Labour Statistics shared that nonfatal workplace violence against healthcare professionals occurred at a rate of 10.4 per 10,000 workers in 2018. The rate the year before was 6.4 per 10,000. In 2018, the rate for all industries was only 2.1.

Healthcare worker sitting on couch

When we hear about workplace violence, most think of inherently dangerous jobs like police work or armed security. Alternatively, we recollect horrific situations in the past that made headlines involving dissatisfied employees harassing their employers or coworkers. The fact that healthcare and social service employees are among the most regular victims of workplace violence may come as a surprise. But it’s not a surprise for the nurses and physicians that have experienced workplace violence frequently. Therefore, how can we solve this issue? How can the healthcare sector help and support workers to ensure their safety? This blog will provide a complete focus on workplace violence in healthcare, discussing the impacts and strategies the industry can make to ensure the safety of its workers.

Defining Workplace Violence

What is workplace violence?

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “the act or threat of violence directed toward persons at work or on duty, ranging from verbal abuse to physical assaults.” Other organizations broaden the definition of workplace violence to include acts of aggression, physical assault, or threatening behaviour in the workplace that endangers customers, coworkers, or managers.

Despite differences in definition from one organization to the next, they have common themes. Ultimately, workplace violence in healthcare settings refers to various violent acts committed by patients, visitors, and employees/workers that cause actual physical harm or cause concern for personal safety.

Why are healthcare workers at risk from workplace violence?

Physical violence against healthcare workers is a weed with deep roots that continues to grow. Almost every experienced nurse has a story about a patient or someone connected to a patient making aggressive or unwanted physical contact. During patient care, nurses are frequently injured with cuts, bruises, sprains, fractures, head injuries, internal injuries, suffocation, and even death. 

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Patients’ extreme behaviour frequently causes workplace violence in healthcare. Because diagnoses vary and do not always result in aggressive behaviour, the situations are unpredictable. Patient agitation is caused by various factors, including pain, a dismal diagnosis, and disease progression. As a result, they act out, resulting in assaults and attacks on healthcare workers.

When healthcare workers witness these incidents, they are more likely to experience emotional distress, which may lead to their resignation. The organization will incur high turnover costs as a result of this. That doesn’t even consider the costs of those who miss work due to the violence. So why don’t the healthcare workers report such violence and ask for greater security? 

Lack of Reporting

Survey data highlights the underreporting of violent incidents in healthcare settings, even in facilities with formal reporting systems. According to a survey of over 4,700 Minnesota nurses, only about two-thirds of physical assaults (69%) and non-physical assaults (71%) were reported to a manager. Bullying and verbal abuse are more likely to go unreported than physical assaults. 

The GAO report noted, “Healthcare workers may not always report such incidents, and there is limited research on the issue, among other reasons.” Research has found that only 20 to 60 percent of nurses report incidents of violence. That being said, to address a problem, one must first understand its full scope, according to the ANA position statement on incivility, bullying, and workplace violence. As a result, to address the violence of health healthcare, notably among Registered Nurses, the causes of underreporting must be identified and addressed. Because workplace violence is difficult to prove with physical evidence, a systematic reporting mechanism is required.

Reasons for Underreporting

The absence of reporting is a significant impediment to effective research and regulatory or legal action. Here are some common reasons for not reporting violent incidents:

  • A healthcare culture that accepts workplace violence as part of the job.
  • A widespread belief that violent occurrences are commonplace.
  • A lack of consensus on definitions of violence; for example, does it encompass verbal harassment?
  • Fear of being accused of poor performance or being blamed for the occurrence, as well as fear of reprisal by the perpetrator and employer.
  • Inadequate understanding of the reporting mechanism.
  • A belief that reporting will not affect current processes or reduce the likelihood of future occurrences of violence.
  • A belief that the event was not severe enough to warrant reporting.
  • The practice of not reporting unintended violence, such as situations involving people living with Alzheimer’s.
  • Lack of Manager and Employer support.
  • Lack of training on reporting and handling workplace violence.
  • Fear of reporting supervisory workplace violence.

The lack of underreporting is unlikely to force any change. When these obstacles are considered together, they provide significant disincentives for Registered nurses to report workplace violence incidents. Here, a holistic strategy can help overcome these obstacles and create cooperation between Registered Nurses and their employers.

Preventing Workplace Violence

Using Occupational Safety and Health Administration’s strategy

OSHA’s workplace violence prevention program is designed to:

  • Improve the working conditions and quality of the working environment.
  • Eliminate or minimize potential physical or psychological injuries.
  • Limit financial losses for employers and employees both
  • Ensure that the organization follows and upholds institutional workplace violence prevention programs.

Most states require healthcare facilities to develop violence prevention plans; luckily, guidelines are available to assist. OSHA advises developing a programme that includes the five essential aspects listed below:

Management Commitment and Employee Participation

Recognizing workplace violence as a safety and health threat is a critical first step toward successful management leadership. Managers of healthcare facilities can show their commitment to reducing workplace violence by:

  • Creating violence prevention programmes with well-defined aims and objectives
  • Providing appropriate funding for the programme
  • Appointing leaders who have received adequate training to facilitate the programme
  • Providing continuing assistance to guarantee the program’s success

Employees (who have firsthand knowledge of difficulties that occur in the workplace) should be included in all phases of the programme; employees should be encouraged to report concerns and offer feedback without fear of retaliation.

Workplace Analysis and Hazard Identification

Following an initial workplace study to identify risks and hazards, management should create policies and processes for the ongoing identification of workplace hazards and risks and perform periodic reassessments and evaluations.

Hazard Prevention and Control

Management should develop measures to remove workplace dangers and strive toward the goals and objectives specified in their violence prevention programme.

Safety and Health Training

Give Employees the training to recognize dangers and respond appropriately to aggressive conduct displayed by patients/clients, visitors, coworkers, and others. They should know what to do in an emergency (e.g., active shooter, natural catastrophe, etc.) and where and how to report problems/hazards.

Record Keeping and Program Evaluation

A critical component of workplace violence prevention programmes is accurate and complete documentation. Facility managers should keep records of dangers, assaults, injuries, and illnesses, remedial measures taken, and staff training, all of which can assist employers in identifying patterns and trends and developing solutions to recurring problems.

Including these aspects in a violence prevention programme takes time and organizational support. It is critical for every healthcare professional working for an institution that lacks a comprehensive programme to demand change. However, another option is available if any employee is hesitant to quit the firm and is prepared to battle this matter.

Workplace Prevention Strategies for Nurses

Actively engage in your facility.

Employee engagement, according to OSHA, is critical to the success of any workplace violence prevention programme. They suggest that nurses accomplish the following if possible:

  • Learn about the company’s workplace violence prevention programme and procedures.
  • Participate in the organization’s safety training programmes.
  • Participate in committees for safety, health, and security.
  • Participate in employee grievance or suggestion procedures.
  • Report violent situations as soon as possible and as precisely as possible.

Dress for safety

The way healthcare workers dress can assist in increasing their safety. NIOSH suggests:

Three smiling nurses dressed in blue, pink, and red scrubs from left to right
  • Removing anything that may be used as a weapon or stolen
  • Hair should be held back so it cannot be readily pulled out.
  • Avoid wearing earrings or necklaces that can be pulled.
  • Wearing clothing that isn’t too big or too little; too big clothing might get snagged on anything, while too small clothing can hinder movement.
  • Use breakaway safety cords or lanyards for name tags, keys, and other small items.

Be conscious of your work environment.

Knowing our surroundings, like any other area we visit, may significantly increase our safety.

Be mindful of static (room arrangement, doors, lights, and workstations) and changeable (weather, noise levels, and personnel levels) threats.

NIOSH specifically advises healthcare personnel to be cautious of the following:

  • When switching workplaces, take note of exits and emergency phone numbers.
  • Confusion, background sounds, and congestion can increase stress levels.
  • Meal times, shift changes, and patient transportation are when disruptive behaviour is at its peak.

Be aware of patient behaviour. 

Because patients are responsible for an estimated 80% of violence against nurses, being aware of patient behaviour that might lead to violence is crucial.

The following are some probable symptoms of violence:

Verbal cues.

  • Screaming or speaking loudly
  • Threatening tone

Nonverbal signals and behavioural cues.

  • Physical characteristics (neglected clothing, hygiene)
  • Arms crossed across the chest.
  • Fists clenched
  • Excessive breathing
  • Agitation, pacing
  • A terrified expression denotes dread or severe anxiety.
  • A fixed gaze
  • Pose that is aggressive or menacing
  • Hurling items
  • Intoxication: Indicated by sudden changes in behaviour (alcohol or drugs)

Awareness is key.

Being conscious of our sentiments and reactions to various events might have an impact on the result. NIOSH suggests that you pay attention to your intuition. For example, a “fight or flight” reaction might be an early warning indication of impending danger and a signal to seek assistance or flee.

The understanding that how we express ourselves and our own experiences may influence how others respond to us is critical for violence prevention. For example, a history of abuse may influence how someone responds to a potentially frightening scenario.

NIOSH also advises being conscious of your own body. Overtiredness can significantly impact how you respond to a complex scenario.

Check your socio-cultural biases.

Recognizing how our cultural background influences how we perceive the world is another vital part of self-awareness. These perspectives can control how we respond to patients and coworkers and how they respond to us.

According to NIOSH, misconceptions caused by language limitations, for example, might escalate a patient’s anxiety to the point where violent attacks are their only method to express dissatisfaction or suffering.

Use violence risk assessment tools. 

Healthcare organizations can examine individuals using violence risk assessment instruments. These tools offer healthcare workers a consistent frame of reference and knowledge, reducing the possibility of misinterpreting a person’s capacity for violence.

NIOSH cites three examples:

  • Triage Tool: used to assess a patient’s potential risk to others or themselves.
  • Indicator of Violent Behavior: a list of five observable behaviours that suggest risk to others.
  • Danger Assessment Tool: To assess the danger of an individual demonstrating possibly aggressive behaviour to nurses and other workers.

Safety in non-institutional healthcare settings

Healthcare organizations are responsible for establishing safeguards for employees working outside the hospital, such as in-home care settings.

For non-institutional healthcare settings, NIOSH recommends the following safety checklist:

  • Examine agency files to perform a background check on the patient.
  • Examine whether a patient’s family member has a history of violence or arrest.
  • Suppose you enter a situation that has already been classified as potentially dangerous over the phone. In that case, you should be accompanied by a team member with de-escalation and crisis intervention training.
  • Always keep a mobile phone on hand.
  • Make sure that someone knows where you are.

A Comprehensive Violence Prevention Program for the Win

“Two steps forward, one step back is still one step forward”

Rosa Diaz, Brooklyn Nine-Nine

Workplace violence is a serious problem worldwide, particularly in the healthcare industry. If a patient is ill, they usually become irritated and act out in a medical setting.

Reducing workplace violence protects patients and caregivers, improves patient outcomes, produces a more comfortable work atmosphere, decreases staff turnover, and saves healthcare institutions and, by extension, taxpayers money. 

Registered nurses, other healthcare employees, and their employers must participate in creating, implementing, and improving workplace violence prevention programmes and adequately responding to its aftermath. Employee and employer participation is vital to the success of any workplace violence prevention programme. Only by taking these actions will Registered Nurses be able to address the issue of workplace violence.

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