Healthcare Workers: Problem with Workplace Violence

It seems every nurse, at some point in his/her career, is faced with workplace violence. Whether it is a slap, punch, or bite from a confused dementia patient, a threat by a drug-seeking addict who is being refused narcotics, or a full physical assault from an upset mental health patient, violence against healthcare workers is an all too often occurrence. Many nurses consider these events to be “just part of the job”. Current laws do not provide adequate protections to healthcare workers to not only provide consequences to offenders but to prevent these events from happening at all. The purpose of this paper is to provide perspective on current protections/legislation, determine what gaps in these protections are currently being seen, and suggest ways in which these protections can be improved. The research articles mentioned in this paper are derived from the Pasco Hernando State College Electronic Resource Library; specifically, CINAHL Complete (EBSCO), Nursing Collection (Ovid), and MEDLINE with Full Text (EBSCO). Key terms used are as follows: “violence against nurses”, and “healthcare violence legislation”. Other parameters used were articles dated within the last five years, and peer-reviewed articles only. Additionally, information from several articles found via web-based search is used such as those from Nursingworld.org and JointCommision.org.

Nursing Area of Interest

According to the National Institute for Occupational Safety and Health, workplace violence consists of physically and psychologically damaging actions that occur in the workplace or while on duty. Examples of workplace violence include direct physical assaults, written or verbal threats, physical or verbal harassment, and even homicide. Workplace violence can then be further divided into four basic types. Type I involves criminal intent, where the perpetrator has no prior relationship to the business or its employees. Type II involves a customer, client, or patient that becomes violent while receiving services. Type III involves worker-on-worker events. Type IV involves individuals who have a prior interpersonal relationship with the intended target, but no relationship to the business. In an article published in Nursing Forum, it was estimated that “nurses and other healthcare workers are assaulted more frequently than any other worker group in the United States.

A quick internet search on any given day will result in several news articles, blogs, and social media posts regarding violence against healthcare workers. Some of these events are verbal incidents in which a healthcare worker becomes nervous thereafter. One example of this can be found on the Joint Commission website, titled Sentinal Event 59. Lisa Tenny RN states “I’ve been bitten, kicked, punched, pushed, punched, shoved, scratched, and spat upon. I have been bullied and called very ugly names. I’ve had my life, the life of my unborn child, and of my other family members threatened, requiring security escort to my car”. Other events are more physical in nature. In an article in U.S. News dated May 2019, neuroscience intensive care nurse Allysha Shin describes an event in which a patient with a brain bleed lashed out, kicking and punching Shin in the chest and face. Finally, there are occasions in which violence against healthcare workers results in the death of the worker. According to Nurse.org, Lynee Truxillo RN, a nurse at Baton Rouge General Mid City Hospital was injured while intervening when a patient attacked another nurse. Days later, Truxillo was seen in the Emergency Room for difficulty breathing. An autopsy revealed that she had suffered from a pulmonary embolism as a direct result of the attack causing cardiac arrest.

Research Overview

In an article written in The Kansas Nurse, “the dominant sources of occupational violence and aggression were patients (79%) or relatives of patients (48%)”. The article also cited a study by Koller that was conducted supporting the idea of staff being proactive with their training and interventions when it comes to violent patients. It also emphasizes the importance of staff education and focuses on three specific aspects of education. Those include, “creating a safe environment, recognizing and evaluating the behaviors of potentially violent patients, and identifying nurses’ behaviors that may trigger patient violence”.

Nurses will often forgive the act of violence against them because they feel that the act was not intentional. This line of thought results in the total number of events that occur being flawed due to lack of reporting. The National Advisory Council on Nurse Education and Practice 5th report from Health and Rehabilitative Services Administration (HRSA) cite a survey of emergency room nurses in which 76% said their decision to report would be based on whether the patient was perceived as being responsible for their actions. An article in American Nurse Today states that “Nurses need to know when, how and where to report an abusive event or threat… Hospitals need to own this issue, they need to have policies that define workplace violence, support staff in preventing and reporting incidents, and ensure that there will be an investigation and follow-up to any incident”. The logic of internalizing workplace violence is one reason for the gross underestimation of its prevalence.

Using California's SB 1299 as a foundation, Congressman Joe Courtney (D–Conn) along with 21 co-sponsors introduced a new bill called Work-place Violence Prevention for Health Care and Social Service Workers Act (H.R. 7141) to Congress on November 16, 2018. Many healthcare organizations frown upon healthcare workers who involve outside agencies after incidents of workplace violence. The argument is that the involvement of agencies such as law enforcement can be detrimental to patient care in settings like psychiatric units. Some requirements of H.R. 7141 that will be imposed on health care facilities if enacted as law are:

• Develop, implement, and maintain an effective written WPV prevention plan that is specific to the hazards that employees will experience in the health care setting.
• Provide training and education to all health care employees, where employees have an opportunity to ask questions, give feedback on training, and request additional instructions, clarification, or other follow up.
• Keep records of all violent incident logs for at least 5 years. Each violent incident log must contain detailed information such as the date, time, and location of the incident; identification of the alleged individual who committed the violent act; and nature and extent of injury.
• Adopt policies prohibiting employees from discrimination or retaliation for exercising their right to report or seek assistance from outside agencies such as law enforcement, local emergency services, or government agencies.

Dissemination of Findings

Violence as “part of the job” should not be acceptable. Easier access to tools for healthcare workers to report incidents is a must. Additionally, policies that prevent workers from discrimination and retaliation for reporting these incidents need to not only be put in place but readily accepted practice. Healthcare workers should never have to fear reporting violence, nor should they have to fear for their lives while performing the duties of their positions.

Conclusion

Based on the above-mentioned research, the statistics show that while the majority of nurses and other healthcare workers experience some form of violence in the workplace during their tenure. Despite this, the number of reported incidents remains low. Workers cite perceived responsibility as well as an all-around feeling of these occurrences being “part of the job” as reasons for not reporting.

Lawmakers are working to enhance protections and impose tougher repercussions for offenders. Current legislation focuses on prevention measures as well as resources for easier access to reporting.