Preventing Workplace Violence in the Health Care Industry

The U.S. health care industry employs more than 20 million individuals and I’m willing to bet that each and every one of us has a friend or family member who’s worked as a nurse, a doctor, a home health care worker, paramedic or other health care professional. For so many of us, the threat of workplace violence against health care workers is very real, and very personal. That’s why it’s so important that health care employers and occupational safety professionals do everything they can to protect workers from the rising level of workplace violence we’re seeing in the health care industry.

Workplace Violence Statistics

Data from the U.S. Bureau of Labor Statistics (BLS) and National Crime Victimization Survey (NCVS) shows that between 1993 and 2009, health care industry workers were 20 percent more likely to experience workplace violence than all other U.S. workers. In recent years that number has risen dramatically. By 2017, BLS data showed that despite representing just 12.2% of the country’s working population, health care and social assistance workers were the victims of nearly 75% of reported workplace assaults.

To help put the seriousness of workplace violence in the health care industry into clearer perspective, here are some additional statistics:

• Between 2011 and 2013, more than 70% of the approximately 25,000 workplace assaults reported annually occurred in healthcare and social service settings
• The World Health Organization (WHO) reports that between 8% and 38% of health care workers suffer physical violence at some point during their careers.
• 46% of nurses reported some form of workplace violence during their five most recent shifts.
• 61% of home health care workers report workplace violence each year.
• In 2014, BLS data showed that health care workers were more than four times more likely to experience an episode of workplace violence than workers in all other industries (8.2 incidents per 10,000 FTE compared to 1.7 per 10,000 FTE)
• An April, 2016 article in the New England Journal of Medicine reported that about 80% of ED (emergency) physicians and nurses had been assaulted during 2017.

With employment in the health care industry expected to represent nearly one-fifth of all new jobs by 2026, the number of health care workers exposed to the risk of workplace violence will continue to rise unless employers and regulators take serious action.

The Underreporting Dilemma

These workplace violence statistics are made even more alarming by the fact that a large number of workplace violence incidents go unreported. An April, 2018 issue of the Joint Commission’s Sentinel Event Alert cites a Michigan State University study which found that the actual number of reportable injuries to health care workers resulting from workplace violence was as much as three times the number reported by the BLS.

One possible reason for the high level of underreporting is that many health care workers find it difficult to determine what constitutes workplace violence, and whether or not an incident needs to be recorded under OSHA’s Injury & Illness Recordkeeping standard. In many cases this is due to a lack of training and awareness of workplace violence hazards, and the requirements for reporting them.

Health care workers also regularly encounter patients in severe distress due to injury, or who may be mentally ill or under the influence of drugs or alcohol. When workplace assaults occur, many health care workers do not report them because of the perception that these patients are not in full control of their faculties, and that dealing with workplace violence is simply “part of the job.” In fact, only 30% of nurses and 26% of emergency department physicians surveyed said that they reported incidents of workplace violence.

Another factor that contributes to underreporting is fear of retaliation. In the same New England Journal of Medicine article, nurses cited fear of retribution from supervisors, the complexity of the legal system, and disapproval of administrators as barriers to the reporting of workplace violence. This is in direct contradiction to the anti-retaliation provisions of OSHA’s “Improve Tracking of Workplace Injuries and Illnesses” final rule, which prohibits employers from discouraging workers from reporting an injury or illness.

Adding to the problem is that fact that many health care facilities rely on multiple systems and methods for documenting and reporting workplace injuries. This challenge is not unique to the health care industry, but information about health care workers injured on the job is often reported into various databases rather than one integrated database. This makes it difficult to recognize the scope of a workplace violence problem, or to track the effectiveness of efforts to prevent workplace violence.

OSHA’s Role in Preventing Workplace Violence Against Health Care Workers

The U.S. Occupational Safety & Health Administration (OSHA) has been grappling with the issue of workplace violence in the health care industry for more than 20 years. In 1996, OSHA published its first set of voluntary Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, and has twice updated those guidelines in both 2004 and 2016.

While OSHA has long acknowledged that workplace violence is a serious occupational hazard for employees in the health care industry, the Agency has taken little formal action on developing a regulatory standard that requires health care establishments to protect their employees from workplace violence — until recently.

In response to a July, 2016 petition from National Nurses United and a coalition of labor unions led by the AFL-CIO, OSHA has been steadily working towards the creation of a workplace violence standard for the health care industry. In December of 2016, OSHA issued an initial request for information (RFI) to health care employers, workers and other subject matter experts on the impacts of workplace violence. The RFI comment period concluded in April 2017, and the next stage in the rulemaking process will be to submit a proposed rule to the U.S. Small Business Administration (SBA) — as required by the Small Business Regulatory Enforcement Fairness Act (SBREFA) — to evaluate the economic impacts of the proposed rule on small businesses, and offer an opportunity for them to provide advice and recommendations on regulatory alternatives to minimize the burden on small entities. According to OSHA’s Spring 2019 Regulatory Agenda, the SBREFA review is currently scheduled to begin in October of this year, although it has been delayed in the past.

Recognizing the serious risk of workplace violence to health care workers, Congress has also recently weighed in on the issue with the introduction of H.R.1309 – Workplace Violence Prevention for Health Care and Social Service Workers Act this past February. The bill was specifically introduced to urge OSHA toward completion of its proposed standard, and lays out a number of provisions which, if signed into law, would likely be contained in the proposed standard. Health care providers would be wise to review the bill for indications of what their future requirements may be.

VelocityEHS Can Help!

Based on both OSHA’s existing guidelines for workplace violence prevention and the language of the House bill, it’s likely that health care facilities will be required to develop a written workplace violence prevention program that specifies the training, incident reporting & investigation, OSHA recordkeeping, job hazard analysis and workplace inspection procedures that health care facilities will use to implement that program.

If you don’t already have a workplace violence prevention program in your facility, VelocityEHS can help you get ahead of the requirements with intuitive, cost-effective EHS solutions that can help you easily manage virtually every aspect of a highly effective prevention program. We even offer expert-designed On-Demand Training courses in Workplace Violence Prevention and nearly 100 other EHS training topics.

To learn more how VelocityEHS can help you manage your workplace violence prevention program, Request a Demo Today or give us a call at 1.866.919.7922.