But it's also a generational thing. Years ago it was thought to be part of the job. ‘If I am going to work in the ED I expect I am going to be spit on and cursed at.' You are seeing a generation gap where people are saying that is not part of the job and it's unacceptable," Warren says. "You are seeing a rise in the number and acuity of incidences but at the same time I think that a proportionate number of that increase is due to the simple fact that people are reporting it more often, as they should have all along."
Everything is complicated and laced with qualifiers in the hospital setting, even the definition of workplace violence. "Does it mean physical contact? Does it include psychological intimidation? Does it include physical violence without intent? If you have a patient coming out of anesthesia and they flail their arms and strike someone is that workplace violence? These are the questions that are difficult to answer and haven't been addressed when you look at these studies," Warren says.
Because of the complex nature of hospital violence, Warren says individual hospitals should be allowed organizational discretion to set parameters and use discretion. "It has to be looked on at a case-by-case basis," he says. "But each facility should have some hard and fast bright lines about what the criteria should be. They should have some process policies and procedures in writing so they have an idea of when they are going to prosecute and when they are not."
For healthcare clinicians and executives contemplating security issues at their hospitals, Warren offered several links to free services and guidelines.