153
6
Health Care Workplace
Violence Prevention
Strategies for Risk Reduction
and Prevention
Eugene Schmuckler, David EdwardMarcinko,and
Hope Rachel Hetico
CONTENTS
Introduction ....................................................................................................................................154
Denition of Health Workplace Violence ...................................................................................... 154
Effects of Workplace Violence ....................................................................................................... 154
Understanding the Risks ................................................................................................................ 155
Hospital Risks ........................................................................................................................... 156
Contributing Risk Factors ......................................................................................................... 158
Haddon Matrix for Injury Prevention ............................................................................................ 158
Establishing a Violence Prevention Committee for Guidelines ..................................................... 160
Eliminate At-Risk Behaviors ..................................................................................................... 160
Establish a Prevention Policy .................................................................................................... 160
No Weapons Policy ................................................................................................................... 161
Dene Entities at Risk ............................................................................................................... 161
Facility Assessments ................................................................................................................. 161
Organizational Assessments ...................................................................................................... 161
Individual Threat Assessment ................................................................................................... 162
Enhance Physical Security ........................................................................................................ 162
Synchronize Personnel, Security, and Safety Policies .............................................................. 162
Develop Crisis Response Procedures ........................................................................................ 162
Emergency Police Protocol ....................................................................................................... 163
Enhance Hiring Procedures ....................................................................................................... 163
Promote an Employee Assistance Program ............................................................................... 163
Train Managers, Supervisors, Doctors, Nurses, and Employees .............................................. 163
Involve Employees in Prevention Efforts ..................................................................................164
Assessment ..................................................................................................................................... 164
Conclusion ..................................................................................................................................... 165
OSHA Publications ........................................................................................................................ 173
Acknowledgments .......................................................................................................................... 173
Bibliography .................................................................................................................................. 173
Further Reading ............................................................................................................................. 174
154 Hospitals & Health Care Organizations
Violence is a serious problem in many countries, and research by the World Health Organization
indicates that violence in the health care workplace is actually a global phenomenon. Crossing
borders, cultures, work settings, and occupational groups, violence in the health care workplace is
ata very high level. New research shows that more than half of the health sector personnel surveyed
had experienced at least one incident of physical or psychological violence in the year previous to
the study.
INTRODUCTION
Domestically, the impact of workplace violence in the United States became widely exposed on
November 6, 2009, when 39-year-old Army psychiatrist Maj. Nidal M. Hasan, MD, a 1997 graduate
of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed
Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident,
and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage
100-round shooting spree and rampage that killed 13 people and injured 32 others. In April 2010,
he was transferred to Bell County Jail in Belton, Texas. An Article 32 hearing, which determined
whether Hasan would be t to stand trial at court martial, began on October 12, 2010. Hasan was
subsequently deemed t and was arraigned on July 20, 2011, and his trial was scheduled for March
2012, but reset for August, 2012.
DEFINITION OF HEALTH WORKPLACE VIOLENCE
Having established the reality of violence as an issue in the health care industry, Barry W. Nixon,
MS, of workplaceviolence911.com, denes the meaning of workplace violence as violent acts
including assaults and threats which occur in, or are related to the workplace and entail a substan-
tial risk of physical or emotional harm to individuals, or damage to an organizations resources or
capabilities.” More specically, it includes
Actual violence that causes or is intended to cause injury or harm to a person or property
Threatening remarks and/or behavior in which intent to harm is stated or implied or indi-
cates a lack of respect for the dignity and worth of an individual
Verbal abuse
Mobbing, bullying, or emotional abuse
Possession of a weapon while working or on company property.
EFFECTS OF WORKPLACE VIOLENCE
The effects of workplace violence are pervasive, and the health care sector continues to lead all
other industry sectors in incidents of nonfatal workplace assaults. For example, in 2000, 48% of
all nonfatal injuries from violent acts against workers occurred in the health care sector. Nurses,
nurses’ aides, and orderlies suffer the highest proportion of these injuries. Nonfatal assaults on
health care workers include assaults, bruises, lacerations, broken bones, and concussions. These
reported incidents include only injuries severe enough to result in lost time from work. Of signi-
cance is that the median time away from work as a result of an assault or other violent act is 5 days.
Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite
costly to the facility as well as to the victim.
A study undertaken in Canada found that 46% of 8780 staff nurses experienced one or more
types of violence in the last ve shifts worked. Physical assault was dened as being spit on, bitten,
hit, or pushed.
Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical
assaults in intensive care, emergency departments, and general wards. A study in Florida reported

Get Hospitals & Health Care Organizations now with O’Reilly online learning.

O’Reilly members experience live online training, plus books, videos, and digital content from 200+ publishers.