Hospitals, clinics, and other healthcare facilities are places of mental and physical healing and pain relief. Yet, they are often sites of danger to staff, most often to frontline staff, such as nurses, aides, and receptionists.
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In 2013, the U.S. Bureau of Labor Statistics (BLS) reported a chilling finding: psychiatric aides experienced the highest rate of violent injuries that resulted in days away from work, with approximately 590 injuries per 10,000 full-time employees. This rate is more than 10 times higher than the next group, nursing assistants, who experienced about 55 such injuries per 10,000 full-time employees.
Registered nurses experienced about 14 violent injuries resulting in days away from work per 10,000 full-time employees, compared with a rate of 4.2 in U.S. private industry as a whole. Also, from 2002 to 2013, incidents of serious workplace violence (those requiring days off for the injured worker to recuperate) were four times more common in health care than in private industry on average. Violence includes both physical attacks and intimidation, threats, and bullying.
Intentional and Unintentional Injuries
In 2013, the most common causes of violent injuries resulting in days away from work across several healthcare occupations were hitting, kicking, beating, and/or shoving. Some of these injuries are unintentional—for example, a staff member injured while restraining a patient. But most injuries result from intentional attacks.
About 80 percent of injuries are the result of interactions with patients, typically those who are under the influence of drugs or alcohol or who are in extreme distress. Others committing violence against staff include family members and friends of the patients. There are many stressors in hospitals, including long waiting times and overcrowding in emergency rooms, understaffing, and the perception by visitors that violence will be tolerated in a healthcare facility.
Underreporting
OSHA notes that violence in such facilities is “vastly underreported,” even at facilities with formal incident-reporting systems.
“For example, a survey of 4,738 Minnesota nurses found that only 69 percent of physical assaults and 71 percent of non-physical assaults were reported to a manager, while one medical center found that half of verbal and physical assaults by patients against nurses were never reported in writing,” says OSHA. “Bullying and other forms of verbal abuse are particularly prone to underreporting. Reasons for underreporting include lack of a reporting policy, lack of faith in the reporting system, and fear of retaliation.”
A Culture of Reluctance
Also, violence in healthcare facilities is complicated by certain “cultural factors,” OSHA states.
“For example, caregivers feel a professional and ethical duty to ‘do no harm’ to patients. Some will put their own safety and health at risk to help a patient, and many in healthcare professions consider violence to be ‘part of the job.’ Healthcare workers also recognize that many injuries caused by patients are unintentional, and are therefore likely to accept them as routine or unavoidable. Another consideration is unwillingness among healthcare workers to stigmatize the perpetrators due to their illness or impairment.”
Another apparent contributor is reduced funding for mental health services.
“Severely ill patients with violent tendencies are increasingly using emergency departments rather than more specialized facilities for treatment,” notes OSHA.
While healthcare staff are the immediate victims of violence, other consequences include caregiver fatigue, injury, and stress, which are tied to a higher risk of medication errors and patient infections. Also, violence will drive some caregivers out of the profession, which can compromise service to patients. OSHA estimates the cost of replacing a nurse at $27,000 to $103,000.
Prevention Program
Federal OSHA does not have a standard that addresses workplace violence risks; however, the agency has put out guidelines for reducing violence in the healthcare facilities. The objective is a comprehensive prevention program comprising five clear goals or objectives:
- Management commitment and worker participation;
- Worksite analysis and hazard identification;
- Hazard prevention and control;
- Safety and health training; and
- Recordkeeping and program evaluation.