1. WORKPLACE VIOLENCE IN HEALTH CARE FACILITIES PPT-046-01 1 PA Training for Health & Safety (PATHS)

2. What We Will Talk About PPT-046-01 2 Definition of workplace violence Examples of workplace violence Who is at risk Effects of workplace violence Risk factors Prevention strategies What to do

3. Workplace Violence- Definition PPT-046-01 3 “A violent act (or acts) including physical assaults or threats of assaults directed towards a person at work or while on duty” -CDC/NIOSH, Occupational Hazards in Hospitals, 2002

4. Facts PPT-046-01 4 More than 18 million health care workers today are at high risk to experience workplace violence (80 percent are women) - CDC National Institute for Occupational Safety and Health (NIOSH) Of all non-fatal and violent acts that occurred in the workplace, about 60 percent occurred in the health care and social assistance industry - Bureau of Labor Statistics, 2010

5. Examples of Workplace Violence PPT-046-01 5 Threats – intent to cause physical harm Verbal (in person or by telephone) Written (by letter, by fax or by telephone )

6. More Examples PPT-046-01 6 False Malicious Disparaging Derogatory Rude Disrespectful Abusive Obnoxious Insubordinate With intent to hurt other’s reputation Intimidation/Harassment: Psychological – making statements that are:

7. More Examples PPT-046-01 7 Intimidation/Harassment: Physical – Holding Impeding Blocking one’s movement Following Stalking Touching Any other inappropriate contact/advances

8. Examples PPT-046-01 8 Assault – causing physical or emotional injury, pain or distress Hitting, slapping, punching, pushing, poking and kicking Also shouting, name calling, use of derogatory language May include use of a firearm, bomb or knife

9. Who Is At Risk? PPT-046-01 9 In general, anyone who works in a hospital or health care setting (nursing home, assisted living, health clinic, etc.) Specifically, nurses and aides with the most direct contact with patients, during: Meal time Visiting hours Patient transportation Administering care, including bathing

10. Who Is At Risk? PPT-046-01 10 Others at risk include: Emergency response personnel (police, fire, ambulance, volunteers) Hospital safety/security officers Other health care providers

11. Where It Occurs PPT-046-01 11 Waiting rooms Emergency rooms Psychiatric wards Patient rooms Geriatric units Outside facility (parking lots)

12. Direct Effects of Violence PPT-046-01 12 Minor or major physical injuries Temporary or permanent physical disability Psychological trauma Death

13. Indirect Effects of Workplace Violence PPT-046-01 13 Low worker morale Increase in job stress Increase in worker turnover Reduced trust of management/co-workers A hostile work environment

14. Risk Factors PPT-046-01 14 Working with volatile people (e.g., those who are under the influence of alcohol/drugs, have a history of violence or are diagnosed as psychotic) Working when understaffed or working alone Transporting patients Long waits for service Overcrowded waiting rooms Poorly-lit areas (parking lots, corridors) Inadequate security Unrestricted movement of the public

15. Violence Prevention PPT-046-01 15 Develop a comprehensive prevention program that includes: Zero tolerance policy Management commitment/enforcement Employee participation Hazard identification Training Hazard prevention Accurate and timely reporting

16. Prevention Strategies PPT-046-01 16 Engineering Including installation of: Emergency alarms Signaling and monitoring systems Security devices (metal detectors, cameras) Better lighting Enclosed nurses’ stations Bullet-proof/shatter-proof glass enclosures at reception areas

17. Prevention Strategies PPT-046-01 17 Changing Behavior Create “buddy system” Provide security escorts to parking lots Prevent personnel from working alone Restrict movement of public using controlled-access cards

18. Prevention Strategies PPT-046-01 18 Training in hazard awareness, resolving conflicts, recognizing potential signs Make counseling available to reduce workers’ fear Have open communication with workers Changing Behavior

19. Prevention Strategies PPT-046-01 19 Administrative Controls Comprehensive, written procedures for reporting and for responding to occurrences Enforce zero-tolerance policy Update program as necessary (continuous improvement)

20. Signals PPT-046-01 20 Verbally-expressed anger or frustration Body language or threatening gestures Signs of alcohol or drug use Presence of a weapon (firearm, knife, etc.)

21. What to do PPT-046-01 21 Present a calm, caring attitude Don’t match the threat Don’t give orders Acknowledge what the person feels Avoid aggressive behavior

22. What else PPT-046-01 22 Evaluate each situation Be vigilant Do not isolate yourself Always keep an open path for exiting

23. Unable to Diffuse PPT-046-01 23 Remove yourself from the situation Call security for help Report any violent situations to management

24. References PPT-046-01 24 OSHA 3148 – Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers (2004) www.osha.gov CDC/NIOSH – Workplace Violence – Healthcare Workers www.cdc.gov

25. Commonwealth Reference PPT-046-01 25 House Bill 1992 - Health Care Facilities Workplace Violence Prevention Act - Submitted to State Assembly in November 2011 by State Representative Nicholas Micozzie (R- 163); joint effort with Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) - Pending in House Committee (Health) as of Nov. 16, 2011

26. Questions PPT-046-01 26