Workplace Violence and Corporate Policy for Health Care Settings

Paul T. Clements; Joseph T. DeRanieri; Kathleen Clark; Martin S. Manno; Douglas Wolcik Kuhn

Nurs Econ. 2005;23(3):119-124.

Incidence of Violence in the Workplace

Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace. According to estimates of the Bureau of Labor Statistics, 2,637 nonfatal assaults on hospital workers occurred in 1999 (8.3 assaults per 10,000 workers). This rate is much higher than the rate of nonfatal assaults for all private-sector industries, which is 2 per 10,000 workers (USDHHS, 2002).

In 2001, the American Nurses Association released its Bill of Rights for Registered Nurses, which set forth the tenet that nurses have the right to work in an environment that is safe for themselves and their patients. However, studies have shown that between 35% and 80% of hospital staff have been physically assaulted at least once and that nurses are at great risk for violence while on duty (Arnetz & Arnetz, 2001; Bruser, 1998; Kinross, 1992; Lanza, 1996; Shepard, 1996; Whitehorn & Nowland, 1997; Williams & Robertson, 1997). Workplace violence in health care settings is not limited to physical assault. NIOSH (2003) has defined workplace violence as any physical assault, threatening behavior, or verbal abuse occurring in the workplace. The definition includes, but is not limited to, such events as beatings, shootings, rape, suicide or suicide attempts, and psychological traumas, such as threats to harm, obscene phone calls (also known as scatalogia), intimidation, or harassment, including being followed or sworn at.

Chavez (2003) reports that workplace violence continues because some employers simply fail to adequately address the problem. He posits:

This has not been purposeful but instead rather to a lack of awareness of the problem coupled with everyday workplace and industry pressures. It is conceivable that workplace violence prevention has not been given the priority it rates. This has resulted in employers being oblivious to some of the most obvious organizational factors that have contributed to scenes of unimaginable horror across the country. Some of those factors include:

A weak or nonexistent policy against all forms of violence within the organization;

Inadequate employee ac quisition, supervision, and retention practices;

Inadequate training on violence prevention at all levels;

No clearly defined rules of conduct;

Failure to introduce em ployees to antiviolence policies and prevention strategies;

Inability of managers and supervisors to adequately assess threats;

A nonexistent or weak mechanism for reporting violent or threatening be havior;

Failure to take immediate action against those who have threatened or committed acts of violence (p. 1).

The frequency and severity of aggressive incidents have not been well documented in the past. The stigma of victimization, such as shame, isolation, fear, or threat of further violence, has often deterred victims from reporting violent behavior (Hoff, 1992). Other variables, including underreporting of violent events, are correlated with lack of support from administration and management or the fear of reprisal, poor reporting mechanisms, excessive paperwork, and poor documentation and/or followup by hospitals (Arnetz & Arnetz, 2001; Kinross, 1992).

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Table 1. Common Risk Factors for Health Care Agency Violence
Working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses. Working when understaffed, especially during meal times andvisiting hours. Transporting patients. Long waits for service. Overcrowded, uncomfortable waiting rooms. Working alone. Poor environmental design. Inadequate security. Lack of staff training and policies for preventing and managing crises with potentially volatile patients. Drug and alcohol abuse. Access to firearms. Unrestricted movement of the public. Poorly lit corridors, rooms, parking lots, and other areas.

Source: USDHHS, 2002

Table 2. Suggestions for Facilitating Adaptive Coping After a Violent or Traumatic Event
Accept the fact that what you are feeling is real and may be painful. Remember that fear of the event or subsequent events might manifest in many different ways (physically, emotionally, or spiritually). Do not allow yourself to go into a state of isolation by avoiding those who care about you or who are attempting to be supportive. Do not allow guilt or fear to set you back. We often feel that we could have or should have done something to prevent the event from happening and may begin to worry about future losses. Experience your thoughts and feelings 1 day at a time. If you feel that you need help and are worried about your well-being or safety, contact your human resources department, a grief counselor, or other health care provider who will help to validate your feelings and plan strategies for appropriate assistance.

Sources: Clements et al., 2003; Clements & Henry, 2001

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