As violence against healthcare workers occurs with greater frequency than in any other industry, the state of Texas is requiring healthcare facilities to adopt workplace violence prevention plans by September 1, 2024.
The measure, Senate Bill 240, was proposed by Sen. Donna Campbell, MD (R-New Braunfels) and adopted by the Texas legislature in 2023.
“What led to it is there’s this assumed acceptance of abuse that healthcare workers are going to take,” says Will Fullerton, Senior Vice President of Government Affairs for Centegix, a safety technology company. “It was awful during the pandemic and it hasn’t gotten much better. They signed up to save lives, not put their own in danger every day at work when somebody’s aggressive or mad or whatever it might be.”
Texas isn’t the only state taking action against workplace violence. According to a Government Accountability Office report, there are nine states with workplace violence prevention requirements: California, Connecticut, Illinois, Maine, Maryland, New Jersey, New York, Oregon, and Washington.
And the Occupational Safety and Health Administration is working on the first federal workplace violence standard, which also focuses on healthcare. The agency plans to publish a notice of proposed rulemaking in December for workplace violence prevention in healthcare and social assistance.
“States can do more to help hospital and healthcare workers plan right and assess their own security. It’s the natural role of government to create this structure of accountability, and that’s really what SB240 is,” says Fullerton.
The first few years, the state of Texas “will be understanding if there are growing pains,” he added. “You’ll come out of the gate and start pushing everything. You’ve got to start somewhere, and I think that’s what Texas is doing and it’s a great start.”
Workplace violence in healthcare is underreported
The key is for Texas facilities is to have a plan, says Ashley Blanke, Centegix’s vice president of healthcare. “It’s essentially putting a plan together, finding where the loopholes are, figuring out how they’re going to train and communicate what it is that they’re doing, and then how they’re going to report it.”
There are many reasons that workplace violence is underreported, Blanke says. There’s the perception that dealing with violence is part of the job, fears of repercussions if they do report, and the belief that organizational leadership would prefer not to know about such incidents.
“I think that what is kind of nice in putting this package together is you’re showing the importance from leadership down,” she adds.
This law is not just significant for large health systems, but also for behavioral health facilities, Blanke says. “It is showing that from a leadership standpoint, you need to make this decision and you need to drive it through.”
The law is in line with what the American Hospital Association is recommending in terms of workplace violence prevention, but also reflects the fact that Texas has experienced several active shooter incidents, she notes. This includes one in January 2021 in which a man entered a physician’s office in Austin, held a doctor and several employees hostage at gunpoint, and then killed the physician and himself.
“It is time to step up and I think it’s great that there’s a push from a federal standpoint and there are states, especially Texas, coming to forefront and saying, ‘Let’s do this’ and putting dates around it,” says Blanke.
“This isn’t just an emergency department scenario. This isn’t just a behavioral health scenario,” she adds. “This is an everything scenario and there’s really this massive progression happening right now in healthcare where they have to start thinking out of the box about how they’re going to take care of it.”
Violence against medical professionals was an issue before the COVID-19 pandemic, but the level of agitation among patients and families toward healthcare workers has only increased since then. In Texas, there’s an additional factor, says Blanke.
“Texas has the highest number of rural hospital closures in the U.S., so if you’re a patient, your access to patient care is changing. And so you’re getting a different patient walking into that hospital,” she says. “That is universally the voice of so many clients that I’ve talked to is we’re not treating the same kind of patient. They’re coming in agitated, irritated.”
Positive reaction
Reaction to the new law has been positive so far, Blanke says.
“You have some organizations that already have a workplace violence committee in place,” she says. “From there, it’s kind of figuring out who’s involved and what everyone’s role is.”
In healthcare, there has been more attention paid to workplace violence in recent years thanks to efforts from The Joint Commission, the voluntary healthcare standard-setting organization, and Press Ganey. The Joint Commission published new workplace violence prevention standards for healthcare in 2022.
“I think that there is more reporting,” says Blanke. “It’s kind of pushing people to say, ‘I have to make a change.’ Where there becomes almost a slight hesitation is when [organizations ask], ‘What is this really going to cost?’ That to me is directly correlated to ‘What do I have to do?'”
One of the most critical elements of SB 240 is the definition of workplace violence, she notes. The law says a facility’s workplace violence prevention plan must adopt a definition of workplace violence that includes “(A) an act or threat of physical force against a health care provider or employee that results in, or is likely to result in, physical injury or psychological trauma; and (B) an incident involving the use of a firearm or other dangerous weapon, regardless of whether a health care provider or employee is injured by the weapon.”
Blanke says having that definition is helpful and will get healthcare organizations to focus on developing their plans.
“I love that facet of this bill so much, and it being such a driver and getting to the point of that underreporting,” she adds. “The other thing is there’s a lot of zero tolerance policies out there and they don’t work. It is basically somebody sees a little copied piece of paper taped to the wall and they walk by it.”
Next steps in Texas
The next step for healthcare facilities is to do an assessment of where they stand with workplace violence prevention, says Blanke.
“Figuring out what they do have and surveying their people, finding out how their people feel, is going to be important,” she notes. “It’s the whole institution. It’s not just your nurses. It’s your physicians, too, because sadly, when we look at the rates of gun violence in healthcare, it’s [against] physicians and the nurses with them.”
Fullerton says the state legislature will get feedback over the next few months about how the law is being implemented and determine what’s working and what isn’t. Then in January after the holiday break, the legislature will decide if adjustments to the law are needed.
Meanwhile, in California
On July 1, a new workplace violence prevention law went into effect in California, requiring nearly all employers to implement a workplace violence prevention plan. This is for all industries, not just healthcare, but it’s still taking some time for businesses to become aware of the new requirement.
“There’s a lot of industries that are simply unaware,” says Hector Alvarez, MSPSy, CTM, president of Alvarez Associates. “Industries that didn’t have a regulatory footprint seem to not be very knowledgeable. I talk to people on a regular basis and they’re a little shocked that there’s something they’re supposed to do.”
California still has no workplace violence standard for general industry, he adds. “The legislature passed a law and said, ‘Hey, Cal/OSHA, you can use the information in this law for your compliance tool until you come up with your own standard.’ And so Cal/OSHA has almost two years to finalize their standard. So that’s coming and we’re in this weird limbo stage.”
Alvarez says the organizations that have a health and safety component to them, like construction, are better prepared to comply with the law, even if they still need to learn about workplace violence prevention. In construction, they already have the infrastructure to do hazard assessments, mitigation, and incident reporting.
“It’s people who don’t have this as a discipline and are trying to figure it out. I think that’s the struggle,” he adds. “That’s where people are a little taken aback.”
(You can hear the full interview with Alvarez in EHS On Tap E214: Complying with California’s New Workplace Violence Prevention Law.)