Workplace violence in healthcare is an issue that has exacerbated by the challenges of COVID-19, according to National Nurses United.
An union survey done in November 2020 shows that, of the 15,000 registered nurses nationwide who responded, 20% reported they were facing increased workplace violence. That's according to Michelle Mahon, assistant director of nursing practice for the professional association of registered nurses, which has more than 170,000 members nationwide. Most of the violence, both physical and verbal, is from patients to staff.
Mahon puts the blame squarely on health system staffing shortages.
"Increases under COVID-19 are happening due to decreasing staffing levels – the number one thing," Mahon said. "The union has been pushing for increased staffing levels."
Not all nurses report an assault, because of fear retaliation from employers who focus on whether the RN has followed proper de-escalation-training protocols, said Mahon. She painted a picture of a divisive workplace culture in which cutbacks and outsourcing of security personnel contribute to an unsafe work environment.
"The key here is prevention," Mahon said. "Workplace violence is preventable."
The cost of covering violence-preventing security measures, whether in the form of hiring security staff, installing security infrastructure and providing training for staff, is a big expense, according to an American Hospital Association 2017 Cost of Community Violence to Hospitals and Health Systems report by Milliman.
Milliman analyzed the financial statements of 178 California hospitals and found that approximately 0.5% of total expenses were dedicated to security costs. This suggests that hospitals spent $4.7 billion on security in 2016 and that $847 million of this cost addresses violence.
The number of hospitals with workplace-violence-prevention programs increased between 2016 and 2018 – from 47.1% in 2016 to 53% in 2017 and 55.5% in 2018, according to another AHA report called the 2020 Environmental Scan.
The AHA report said hospital administrators understand the higher-than-average potential for security threats or violent events that can occur in the workplace.
In a 2015 report the Occupational Safety and Health Administration stated that "healthcare and social assistance workers experienced 7.8 cases of serious workplace violence injuries per 10,000 full-time equivalents in 2013. Other large sectors such as construction, manufacturing, and retail all had fewer than two cases per 10,000 FTEs."
Workers in inpatient facilities, ERs and psychiatric units are five to 12 times more likely than in other fields to experience physical violence, according to Mahon.
The rate of intentional injuries by others in 2017 showed as 9.1 per 10,000 for healthcare and social assistance workers and 1.9 per 10,000 for all private industry, according to the 2020 Environmental Scan.
One statistic that stands out is that nearly half of ER physicians said they've been physically assaulted at work and 71% have personally witnessed others being assaulted during their shifts. Since the most recent data is from 2017, the effect of COVID-19 is not included in these figures.
In one incident recently reported in Colorado Springs, Colorado, on January 9, police responded to a disturbance at Cedar Springs Behavioral Health Services Hospital regarding juveniles. When officers arrived on the scene they were advised that multiple patients were "rioting, overriding the facility, destroying property, and overtaking the staff," according to the police report.
Officers identified five instigators, who were taken into custody and arrested on multiple charges – including second-degree assault, third-degree assault and harassment. Several members of the Cedar Springs Hospital staff suffered minor injuries.
Hospital personnel declined to comment. Colorado Springs Public Information Officer Lieut. Jim Sokolik said he could give no further information or the motive behind the incident. Sokolik was asked about the prevalence of health worker assaults in Colorado Springs, a 200-square mile area that includes at least four large hospitals.
"It's not so unusual that it is shocking," Sokolik said. "It's not an everyday occurrence."
National Nurses United wants federal prevention standards that mirror California legislation, which is considered the gold standard, according to Mahon.
In 2019, after seven years of effort, HR 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act, proposed by Representative Joe Courtney (D-Ct.), passed in the U.S. House of Representatives with bipartisan support. It was never passed by the Senate. Mahon is hopeful that a companion Senate bill will go forward under President Biden.
The proposed federal legislation pertains, not only to hospitals, but also to facilities such as Veterans' Affairs, the Indian Health Service and home-based hospice. The law would require OSHA to develop workplace-violence-prevention standards that would include, among other mandates, that IV poles be stationary so they're not able to be used as weapons.
The bill directs OSHA to issue new standards requiring healthcare and social service employers to write and implement a workplace-violence-prevention plan to prevent and protect employees from violent incidents and assaults at work.
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