Health-care workers at risk.
Author: Arbury, Sheila Brown. Source: Job Safety and Health Quarterly v. 13 no2 (Winter 2002) p. 30-1 ISSN: 1057-5820 Number: BBPI02109612 Copyright: The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibited. To contact the publisher: http://www.osha.gov/.
Last spring, a Florida nurse with 20 years' experience in psychiatry died of head and face trauma at the hands of a patient, a former wrestler, who had arrived at 1:45 a.m. for involuntary admission to a private mental health-care facility. On duty in the Intensive Treatment Service unit were two women: the nurse who died and a mental-health technician who was on break when the incident occurred. Other staff members realized there was a problem when the patient appeared outside the unit with the nurse's keys. They found the nurse on the floor bleeding from her injuries, initiated CPR, and transported her to a hospital, where she died.
The preliminary investigation revealed that the facility did not have a specific policy on workplace violence, although the administrators stated that they were in the process of writing one. There also were no written policies on staff breaks and no communication devices except the unit telephone and overhead paging system to summon help in an emergency. In response to this tragic event, the facility made plans to purchase two-way communication systems and personal alarm systems, hire a security guard, and add a "floating" staff member to relieve personnel going on break so no staff member works alone on the unit.
Homicide in health-care settings is part of the larger picture of workplace violence in health care. According to the Bureau of Justice National Crime Victimization Survey, 69,500 nurses were assaulted at work from 1992 to 1996. The National Institute for Occupational Safety and Health reports that 9,000 health-care providers are attacked on the job every day. Bureau of Labor Statistics figures for 1999 show that 43 percent of all non-fatal assaults and violent acts resulting in lost workdays across all industries occurred within health-care services. The incidence rate for non-fatal assaults and violent acts in health services in 1999 was 9 per 100 full-time equivalent workers, compared with the national average of 1.8. Of almost 5,000 nurses who responded to the American Nurses Association Health and Safety Survey last September, 17 percent had been physically assaulted and 56.9 percent had experienced threats or verbal abuse on the job during the previous year. As high as these percentages may be, there is strong speculation that workplace violence is underreported because of the victims' fears of blame or loss of their jobs. There also exists an unfortunate and persistent perception that within the health-care industry, assaults are part of the job.
OSHA's publication, Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers (OSHA 3148), addresses the problem and can help employers establish effective violence prevention programs adapted to the needs and resources of their workplace.
In response to the Florida nurse's death, OSHA's Atlanta Regional Office staff recently presented a conference on "Reducing Workplace Violence in Psychiatric Facilities: Cost-Effective Strategies That Succeed." The conference attracted 137 participants: administrators, nurses, security personnel, risk managers, and OSHA staff, all interested in strategies for decreasing workplace violence in psychiatric facilities by decreasing worker risks and lowering costs, both human and financial.
Speakers at the conference came from OSHA area, regional, and national offices, the American Psychiatric Nurses Association, the American Nurses Association, the Bureau of Labor Statistics, the Joint Commission on Accreditation of Healthcare Organizations, the Center for Violence Prevention and Control at the University of Minnesota, the University of Maryland School of Nursing, the Cape Cod Community Mental Health Center, and the New York State Office of Mental Health.
The speakers described the problem of violence in health-care facilities, presented relevant statistics, and offered strategies to decrease workplace violence in psychiatric facilities. Kevin Murrett, an architect in Buffalo, NY, who serves as a consultant to the New York State Office of Mental Health, discussed building design elements that discourage workplace violence. Nurses Ellen Farley and Anne Schuler described the successes of Massachusetts' Assaulted Staff Action Program. This volunteer peer help and crisis intervention program has resulted in decreased symptoms of acute trauma and post-traumatic stress disorder among assaulted health-care workers.
"OSHA's off to a good start," commented a participant in the Florida conference. "I hope this is just the beginning of great things to come." The agency plans to explore other activities on workplace violence based on regional partnerships among OSHA offices and state branches of national organizations such as the American Nurses Association.
OSHA believes that cooperative efforts with its stakeholders will help to reduce workplace violence and its harmful effects. For more information about workplace violence, visit the OSHA website at www.osha.gov.
The American Nurses Association Health and Safety Survey is online at www.nursingworld.org/surveys/.
Arbury is a health scientist in OSHA's Office of Occupational Health Nursing, Washington, DC.
NIOSH reports that 9,000 health-care providers are attacked on the job every day.
RISK FACTORS FOR WORKPLACE VIOLENCE IN HEALTH-CARE FACILITIES* Prevalence of handguns and other weapons among patients, their families, and friends.
* Increasing numbers of acute and chronically mentally ill patients released from hospitals without followup care.
* Situational factors such as unrestricted movement of the public in health-care settings, the increasing presence of drug and alcohol abusers, and long waits for services, resulting in patient and family frustration.
* Low staffing levels at night and during times of increased activity such as meals, visiting hours, and transport of patients.
* Isolated work with patients during examinations or treatment.
* Lack of staff training in recognizing and managing hostile and assaultive behavior.
* Lack of specific safety and health program to address workplace violence.