Category Archives: Workplace Violence

Nursing: One Of The Most Dangerous Jobs In America

 

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post’s Petula Dvorak shines a spotlight on the dangers in the nursing profession, specifically around the violence nurses encounter on the job. Citing a recent GAO report on violence in the healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

New Jersey is one of 26 states that have safety standards aimed at combating violence in health care facilities. The “Violence Prevention in Health Care Facilities Act,” enacted in 2008, lays out detailed requirements for hospitals (including psychiatric hospitals) and nursing homes. However, with more than 2,000 hospitals, nursing homes and health care facilities in New Jersey, there is ample opportunity for workplace violence to occur.

Notwithstanding the Act, at Work Comp Psych Net, our clinicians are asked  to treat healthcare workers who are victims of workplace violence or abuse. The mental health complications of these injuries can leave lasting damage, which, if untreated, will only worsen over time. We advise claims adjusters and nurse case managers to pay particular attention to the possibility of a mental health comorbidity complicating a workplace violence injury.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses, and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

Being A Mental Health Worker Can Be Hazardous To Your Health

Mental health workers face myriad challenges, both physically and psychologically, dealing with sometimes out-of-control people. Many are injured in the process, some die. Society doesn’t much notice and, sadly, society doesn’t much care.  The following piece was written six years ago by our friends at Workers’ Comp Insider. We bring it to you today, because in the intervening six years nothing has changed. Absolutely nothing. The tragedies described below happened in Massachusetts, but they could have happened anywhere in America (and have – many times). Yes, here in New Jersey, too, where in the first nine months of last year 50 mental health hospital workers were injured seriously enough to lose time from work.

Continuing budget cuts to New Jersey mental health services can be very hurtful – in more ways than one. Here’s the piece from the Insider.

Sometimes, system redress seems painfully inadequate.

Such is the case with the $7,000 OSHA penalty recently imposed for inadequate safeguards related to the case of murdered mental-health worker Stephanie Moulton. $7,000 is the maximum fine available for “a serious violation of the agency’s “general duty clause” for failing to provide a workplace free from recognized hazards likely to cause serious injury or death.” It’s not just that the dollar amount seems paltry in light of the loss of life – it simply doesn’t seem substantial enough to have any deterrent value.

And in truth, while the OSHA citation points to the employer, one could make the case that the employer is also a victim of an economic squeeze play, which has resulted in inadequate staffing and safety controls. State budget cutbacks worry mental health workers – a scenario that is no doubt playing out throughout the country – in mental health budgets, in public safety budgets, and in regulatory enforcement, just to name a few areas that affect the health and safety of workers — and of the public.

Stephanie Moulton was working alone at one of the North Suffolk Mental Health Association’s group homes in Revere, Massachusetts, when she was brutally murdered by a patient with a violent record. A week later and just miles away at the Lowell Transitional Living Center, a shelter for the homeless, a worker named Jose Roldan was also killed by person who had slipped through the cracks in the mental health system. Both these murders were discussed in-depth in stories that appeared in The New York Times: A Schizophrenic, a Slain Worker, Troubling Questions recounted Moulton’s death, and Teenager’s Path and a Killing Put Spotlight on Mental Care discussed the case related to Roldan’s death.

An investigation into Moulton’s death resulted in the issuance of a report in June: Report of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The report found that:

  • Years of budget cuts have negatively impacted service delivery and safety issues in the following areas:
    –Inadequate numbers of, and inadequate pay for, direct-care staff
    –Inadequate numbers of clinical staff with relevant training and experience
    –Deficiencies in the overall number of acute and intermediate hospital beds and community-based services and beds
    –Decrease in the role of psychiatrists and other highly-trained professionals in the care and treatment of individuals with the most serious mental illnesses
    –Requiring some staff to work under conditions that do not provide for adequate safety
  • There is an absence of system-wide use of a well-designed risk assessment process
  • There is lack of clarity in policies and procedures for incorporating risk variables into Individualized Action Plans
  • There is lack of sufficient access to and sharing of critical safety information
  • There is lack of adequate coordination of care across different components of the service system

OSHA’s citation includes recommendations the employer could take to address the workplace violence issue:

  • Creating a stand-alone written workplace violence prevention program that includes implementation of workplace controls and prevention strategies; hazard/threat/security assessments; a workplace violence policy statement outlining and emphasizing a zero tolerance policy for workplace violence; incident reporting and investigation; and periodic review of the prevention program.
  • Establishing a system to identify clients with assaultive behavior problems and train all staff to understand the system used.
  • Putting in place procedures to communicate any incident to staff so that employees without access to client charts are aware of previous violent or aggressive acts by a client.
  • Identifying the behavioral history of new or transferred clients, including conducting criminal and sexual offender records checks.
  • Conducting more extensive training so that all employees are aware of the facility’s workplace violence policy and where information about it can be found, including training employees to clearly state to clients that violence is not permitted or tolerated; how to respond during a workplace violence incident; recognize when individuals are exhibiting aggressive behavior and how to de-escalate the behavior; and identify risk factors that can cause or contribute to assault.
  • Installing and positioning panic buttons, walkie-talkies, recording security camera systems and smart phone GPS applications to better monitor employee safety and increase staff communication and support; implement and maintain a buddy system on at least the second and third shifts, based on a complete hazard assessment.

Mouton’s family is rallying for enactment of Stephanie’s law, which would mandate panic buttons in mental health facilities. A good start and one among recommendations issued by OSHA in their Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. But such measures may be woefully inadequate in the face of reduced staffing. In an ongoing climate of budget cuts and a strong public appetite for decreased regulatory controls, mental health workers are likely to continue being at greater risk — along with public safety workers such as police, firefighters, and healthcare workers, who also face dire staffing shortages.

Are Nurses And Health Care Workers Facing More On-The-Job Violence?

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse. In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

The issue of safety for nurses and allied health professionals was brought to the forefront after the deaths of two California healthcare workers in separate incidents in a single week. Psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.

While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. The Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.

And the Bureau of Labor Statistics reports:

Over the past ten years, healthcare workers have accounted for over half of the nonfatal workplace violence injuries involving days away from work across all industries.

The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence also visits the workplace.

It’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.

One organization trying to help is the Emergency Nurses Association, which has issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

Others are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place.

As far back as 2008, the New Jersey legislature passed and enacted the Violence Prevention in Health Care Facilities Act, which states in part:

Within 6 months of the effective date of this act, a covered health care facility shall establish a violence prevention program for the purpose of protecting health care workers.

Although, writing in 2015, Ann Twomey, president of Health Professionals and Allied Employees (HPAE), New Jersey’s largest union of nurses and health care workers, opined:

Shockingly, the NJ Department of Health has failed to conduct any outreach to either employers or employees to inform them of their rights and responsibilities under the law. No surprise then that an informal survey of hospital staff HPAE conducted in 2013 found fewer than 50% of the respondents reporting their hospital was in full compliance with the law.

A bit biased? Perhaps, but the issue of workplace violence in New Jersey’s health care settings continues to be real and palpable. At Work Comp Psych Net we have been privileged to assist a number of health care professionals  as they cope with PTSD and strive to return to work after suffering the trauma of a violent attack.

Sadly, we do not expect to see a rapid decline in that variety of patient.