Managing Workplace Violence

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Confronting violence in the hospital requires coordination and communication among all staff members.

Working in a hospital can be hazardous to your health. Bureau of Labor Statistics data for 2008—the latest figures available—show 2,890 work-related assaults at hospitals. That doesn't tell the whole story, because the data reflect only assaults that are serious enough to inflict injury and force the victim to miss at least one day of work.

Other BLS data show that for every 10,000 hospital workers, there were eight workplace assaults that resulted in missed work days. By comparison, in the overall private sector, there were only 1.7 workplace assaults resulting in missed work for every 10,000 workers.

Last year, more than half of the 3,465 respondents to an Emergency Nurses Association online survey said they've been spit on, hit, pushed, shoved, scratched, or kicked while on the job.

Diane L. Gurney, RN, president of the 37,000-member ENA, says too many nurses still accept violence as "part of the job."

"It wasn't long ago that I was in that same environment," Gurney says. "We need to talk about it. It needs to be front and center. We need to empower our nurses to report assaults."

Bonnie S. Michelman, director of police, security, and outside services at Massachusetts General Hospital in Boston, says hospitals provide unique and challenging security problems. "The common denominator is that it's an unpredictable, high-tension environment that is open to all, 24 hours a day," she says. "It's an environment that is heavily female in terms of the workforce, which can create some higher levels of risk with respect to sexual assault and domestic violence. It's an area with easy provocation to violence because people are medicated or in pain or impaired by narcotics or psychiatrically impaired."

Kennedy Health System, a three-hospital system serving Southern New Jersey, adopted a zero-tolerance policy toward all forms of workplace violence two years ago after seeing a slight increase in violent incidents.

"While the trends weren't large, we were seeing an increase in the number of assaults, attempted assaults, and code grays [security emergencies]," says Francis White, corporate director of security at Kennedy.

Instead of issuing a boilerplate staff memo from security or HR about the dangers of workplace violence, Kennedy's leadership sought input from a range of perspectives within the health system. The goal was not to simply identify the extent or cause of the violence, but to create a comprehensive and coordinated response.

"We put a committee together and involved people from high-risk sites, such as ambulatory services, the ED, and the ICU and behavioral health, and also people from HR because at some point that process is going to go through HR," White says.

The 25-member committee examined assaults, conducted risk assessment and training reviews, and expanded its definition of workplace violence to include not just physical violence or threats of violence, but harassment and intimidation.

After establishing an expanded zero-tolerance policy, the health system installed an electronic reporting system to ensure consistent reporting and statistics. "Everything we did before was manual, so everybody had a different set of numbers of violent incidents," White says.

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