1. Amber Hart Brandy Hopkins Susan Swords
Workplace Violence
Amber Hart
Brandy Hopkins
Susan Swords

2. Workplace Violence Physical or verbal assaults
Threats of assaults towards persons on duty at their place of employment
Problem
Many people believe that it’s just “part of the job”
Cases of workplace violence often are not reported, therefore it’s not recognized as a true problem
Workplace violence consists of physical or verbal assaults and threats of assaults towards persons on duty at their place of employment.

3. Why Healthcare Workers Are At Risk
High incidence of weapons on patients and families
Increasing number of mentally ill and criminal patients
Slow service in emergency rooms and clinics
Increasing number of patients under the influence of drugs or alcohol
Isolated work due to poor staffing
Lack of training in recognizing and managing violent situations

4. Workplace Violence
160 deaths due to workplace violence in healthcare and social services from
Healthcare leads all other industries with 45% of all nonfatal assaults against workers resulting in lost work days
OSHA currently has a set of guidelines to prevent workplace violence for healthcare workers
Only guidelines and more regulations are needed to reduce workplace violence among those working in health care
(ANA, n.d.)

5. Statistics
765,000 assaults occurred in healthcare resulting in lost work days from
8 nurses were fatally injured at work from
4 RNs received GSWs resulting in their death
4 RNs received other fatal injuries
2,050 assaults & violent acts were reported by RNs resulting in an average of 4 days away from work in 2009
1,830 were inflicted with injuries from patients/residents
80 were inflicted by visitors or people other than patients
520 RNs were kicked, hit or beaten
130 RNs were squeezed, pinched or scratched requiring days off work
30 RNs were bitten
In 2009, the ENA reported that more than 50% of ED nurses had experienced violence by patients and 25% had experienced 20 or more violent incidents in the past 3 years
(ANA, n.d.)

6. Lateral Workplace Violence
Also referred to as horizontal violence or bullying
Problem among nurses for decades
Nurses inflict psychological injury on each other
Can be overt or covert acts of verbal & non-verbal aggression that causes enough psychological distress for nurses to leave the profession
53% student nurses report being put down by staff nurses
Threatening body language & strong verbal abuse has been reported by 48% of nurses, pharmacists and others
56.9% of nurses report being threatened or experience verbal abuse at work
(ANA, n.d.)

7. Background

8. Social
Employees may experience psychological trauma, fear of returning to work, effects on relationships with coworkers and family, feelings of powerlessness or incompetence, and fear of criticisms by superiors
When employees experience any of these symptoms, it can adversely effect their work and the patients they care for
Support needed for employees who encounter workplace violence may decrease negative effects they experience afterwards

9. Economic
Victims miss on average 3.5 days of work and up to 6 weeks depending on extent of assault
Witnesses to the traumatic events are also at risk for developing psychological issues and missing work
Workplace violence can add up to $55 million in lost wages and that total doesn’t include annual sick leave or paid time off
Leads to decreased productivity affecting company’s bottom line
Estimated 20-40% turnover rate after a violence event
Costs approximately $22,000 to $64,000 to replace a nurse
(OJIN, 2007)
(Workplace Violence, n.d.)

10. Economic (continued)
Victims can have psychological and physical issues after the violent incident including
Insomnia Hypertension Depression GI issues
Unexpected medical expenses due to injuries from workplace violence
Medical expenses may occur more frequently in those who’ve experience lateral violence compared to those with physical injuries from violent acts
(ANA, 2012)

11. Economic (continued)
Employees who are victims are more liable to sue, especially where no policies are in place to prevent or prepare for workplace violence
Average cost to settle lawsuit outside court: $500,000
Average amount awarded by juries: $3 million
If homicide occurs, it will bring negative attention and decrease in number of patients who may seek care at that facility
(Workplace Violence, n.d.)

12. Ethical Confidentiality
Ethical dilemma: should healthcare professionals disclose information of patients who may be seen as a threat or danger to their communities?
May include terminated employees who pose a threat
Usually a confidentiality clause preventing employer from disclosing information about terminated employee
Employers may also be concerned to warn future employers of employee’s conduct for fear of being sued over defamation of character or privacy
(NetCE, 2009)
(U.S. Department of Justice, n.d.)

13. Ethical
Duty of Care
Employers and Employees have the responsibility to provide a safe work environment
Employers must provide safe work environment and adequate training
Employees must follow safety instructions and report any safety concerns

14. Legal Policies in place at individual healthcare facilities
Only California has mandates that requires victims of assault/battery resulting in injury from firearms or other weapon must be reported to law enforcement within 72 hours
17 states have increased penalties for violent acts against nurses
NY made it a felony and put nurses in the same category as police officers, firefighters and emergency responders
(Crowley, C.F., 2010)
(ENA, n.d.)

15. Political
13 states have mandated laws regarding violence in the workplace specific to healthcare facilities
Most of those laws involved training and developing security plans
18 states have advocated and legislation was passed aimed at preventing workplace violence
Most states are lacking in passing legislation to protect healthcare workers from workplace violence
If hospitals do not enact policies aimed at workplace violence prevent, they can be held liable
Advocates needed at state and federal level to lobby for nurses and healthcare worker’s rights for protection against workplace violence

16. Stakeholders Employees in health care profession Employers
Insurance companies
Government Officials
Families of those working in health care due to the psychological effects the victims experience after being a victim of workplace violence

17. Issue Statement
How should the federal government regulate guidelines and programs to decrease workplace violence among healthcare workers?

18. Policy Objectives, Alternatives & Recommendations

19. Objectives
Workplace violence legislation would ensure awareness and preparedness in the event of a workplace violence incident would occur
Acknowledge frequency and effects of workplace violence in healthcare field
Develop policies and legislation to mandate employers to implement programs to address incidents and complaints of workplace violence
Develop regulations to assess risk of workplace violence and measures to control that risk

20. Alternatives Do Nothing Option Violence Prevention Training
Currently workplace violence laws are enforced created and enforced state by state with no federal mandate
Kansas has no laws
Violence Prevention Training
Mandate federally employers must educate employees on definition of workplace violence and their rights
Security and Safety Plan
Mandate federally employers must follow OSHA’s recommendations to prevent workplace violence

21. OSHAs Recommendations
Management commitment and employee involvement
Worksite analysis
Hazard prevention and control
Safety and health training
Recordkeeping and program evaluation

22. Evaluation Criteria Size and availability of funding stream
Ability to meet current and future demand
Political feasibility

23. Analysis of Do Nothing Option
Criterion 1: Size and availability of funding stream
Pros
Nothing required so no funding needed. If do create policy can create to own budget
Will ensure states won’t have additional financial burden and have to cut funds from other areas
Con
May result in hidden costs
Work comp claims
Loss of work time
New hirer training
Legal services
Investigation of incident

24. Analysis of Do Nothing Option
Criterion 2: Availability to meet current and future demands
Pro
14 states have recognized need and passed legislation
Allowing states to pass own laws allows them to make policies to address their individual needs
Con
Large incidence of workplace violence
Needs are not being met and no policies exist to enforce workplace violence programs and prevention; healthcare facilities may not address problem
As of 2009, only 13 states had enacted workplace violence laws (ENA, 2009). Since then only one more state has enacted legislation to address workplace violence in the healthcare industry (Bruce, 2011)

25. Analysis of Do Nothing Option
Criterion 3: Political Feasibility
Pro
Nurse associations such as KSNA can represent nurses/healthcare workers and lobby for efforts to enact legislation
Lobbying efforts can help to create legislation unique to individual need of particular state
Con
Many states only enact laws after tragic workplace violence has occurred
Political figures may not realize how widespread the issue is and it’s effects on healthcare workers
If unaware, less likely to promote workplace violence legislation efforts

26. Analysis of Training & Education Program
Criterion 1: Size and availability of funding stream
Pro
Cost Effective
May use OSHA’s prevention training program available on their website
Con
Training may not be comprehensive enough
May result in hidden costs to employees and employers

27. Analysis of Training & Education Program
Criterion 2: Ability to meet current and future demand
Pro
Simple start may lead to more legislation in future
Con
May not be best prevention program
OSHA recommends more

28. Analysis of Training & Education Program
Criterion 3: Political Feasibility
Pro
Simple
Cost Effective
Met with little resistance
Con
Legislators may be resistance re: economic situation
States have only enacted after tragic event

29. Analysis of Comprehensive Safety Assessment
Criterion 1: Size and availability of funding stream
Pro
More costly in the beginning but will save in the end
Con
Costly
Difficult re: recurrent economic status

30. Analysis of Comprehensive Safety Assessment
Criterion 2: Ability to meet current and future demand
Pro
Best Option per OSHA recommendation
Con
May need to re-evaluate healthcare and direction its heading and what is best for its needs
Should we do more? Should we pass laws that would breach confidentiality to better protect from dangerous people?

31. Analysis of Comprehensive Safety Assessment date
Criterion 3: Political Feasibility
Pro
Use KSNA for lobbying and
All healthcare workers unite
Proven to be effective so policy makers may be least resistant
Con
Policy makers may think other needs more important especially because more costly alternative
Reluctant to see problem of violence until tragedy occurs

32. Comparison of Alternatives
Criteria
Do Nothing
Education/ Training
Comprehen.
Assessment
Funding
Stream + ++
Ability to Meet
Demand -
Political
Feasibility
Total
Score 1 4

33. Recommendations Third Policy Option
Management commitment and employee involvement
Worksite analysis
Hazard prevention and control
Safety and health training
Recordkeeping and program evaluation

34. When Is This Okay & Just A Part Of The Job?