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Violence can happen anywhere at any time. It's an unfortunate sign of our times, and the healthcare setting sees its fair share.
In fact, the Bureau of Labor Statistics found in 2006 that the healthcare sector led all other industries in workplace violence, with 45% of nonfatal assaults leading in loss of work days committed against registered nurses.
According to the American Nurses Association, workplace violence is one of the most dangerous occupational hazards facing nurses working in today's healthcare environment.
In a 2011 health and safety survey of more than 4,600 nurses, ANA found 11% of respondents had been physically assaulted in the previous 12 months while just more than 50% said they had been threatened or verbally abused. Additionally, about 1/3 listed on-the-job assault as one of their top three safety concerns.
"We now know that workplace violence is a prevalent issue," said Adam Sachs, communications and public relations representative for the ANA.
Prevalence & Settings
An article released in 2004 by the ANA in its Online Journal of Issues in Nursing - "Workplace Violence in Health Care: Recognized But Not Regulated" - noted the prevalence of workplace violence can be attributed to the exposure to violent individuals combined with the absence of strong violence prevention programs and protective regulations. Staff shortages and increased patient acuity further facilitate the problem.
And who are the aggressors?
"Agitated clients in mental health facilities and the emergency department, demented elderly patients in medical and geriatric wards, nursing homes and rehabilitation centers, and any patient with a history of assault in mental health, hospital care, and community health are common sources of verbal and physical violence against nurses and other healthcare providers."
Sachs told ADVANCE one of the riskiest settings for violence is the emergency department. The Emergency Nurses Association agrees, stating emergency nurses are particularly vulnerable to workplace violence.
A 2006 survey of 1,000 ENA members found 86% had been the victim of workplace violence in the preceding three years, with family members and visitors as likely to perpetrate abusive behavior as patients. Nearly 20% reported that they experience workplace violence frequently.
"In general, nurses should not be expected to accept or tolerate violence on the job as part of the job," Sachs said. "Maybe in the past it was accepted that certain patients will act out, but that should not be a part of the job and employers should take steps to ensure that the chances for violence are minimized."
 Steps Toward Prevention
According to Sachs, there are a number of things employers can do to prevent violence, including:
• Provide training and education for nurses on how to avoid situations for potential violence.
• Take environmental and security measures - have lockable areas for staff only (lounges, lockers rooms, bathrooms), adequate lighting both inside and outside, and have security guards in certain areas such as the emergency department.
• Have a good policy in place and laid out for the reporting of incidences and suspicious behavior. Employers need to be held accountable for studying the reports, analyzing the information and taking action.
• Flag the medical charts, or ID in some way, patients' records if they have past incidents.
Additionally, there are precautions nurses can take to ensure their own safety. Nurses need to:
• Make sure they aren't working alone, especially in certain areas such as the emergency department.
• Be aware of their surrounding environment.
• Be aware of their patient's history.
• Avoid being physically trapped in a room; keep themselves between the patient and the door.
• Have someone on staff nearby and aware that they are with a patient.
Legislative Solutions
As a result of increased risks to healthcare workers, Sachs said, there has been over recent years an increase in state laws designed to protect healthcare workers against violence. "About one-third of the states have laws now," he added.
HCA Healthcare shared with the ENA a state survey in 2006 of all the statutes for workplace violence and criminal laws that address the penalty for assaulting a healthcare worker. The survey showed that 39 states currently have criminal laws protecting health professionals.
Additionally, Sachs explained there are laws in nine states requiring employers to have workplace violence programs and report violence.
"Workplace violence in healthcare is being recognized in state legislators around the country as an issue that needs to be addressed legally," Sachs concluded.
Jessica LaGrossa is on staff at ADVANCE. Contact: JLagrossa@advanceweb.com.
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