Nearly two million U.S. workers are injured on the job each year as a result of workplace violence. According to the National Institute for Occupational Safety and Health (NIOSH), healthcare workers, especially those providing emergency and psychiatric care, have a particularly high risk of work-related assault, with nurses being in the most precarious position, as they administer direct patient care. In fact, NIOSH reports an average of 69,500 assaults against nurses annually. The rate of assault injuries to psychiatric nurses in particular (16 victimizations per 100 employees) exceeds the annual rate of all injuries reported in most high-risk occupations.
Several studies indicate that violence often takes place during times of high activity and interaction with patients, such as at meal times and during visiting hours and patient transportation. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a healthcare worker attempts to set limits on eating, drinking, or tobacco or alcohol use. Furthermore, in a recent workplace violence survey conducted by HCPro, Inc., respondents reported an alarming lack of restricted entrances and exits within their respective facilities.
What are the risk factors for violence?
Although the risk factors for violence vary from hospital to hospital depending on location, size, and type of care, common risk factors for hospital violence include the following:
- Working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses
- Working when understaffed, especially during meal times and visiting hours
- Transporting patients
- Long waits for service
- Overcrowded, uncomfortable waiting rooms
- Working alone
- Inadequate security
- Lack of staff training and policies for preventing and managing crises with potentially volatile patients
- Unrestricted movement of the public
To terminate violence in hospitals, nurse managers should develop safety and health programs encouraging staff involvement in hazard prevention. Although risk factors for violence are specific for each hospital and its work scenarios, managers can follow general prevention strategies, such as developing emergency alarms, monitoring systems, and security devices. Furthermore, NIOSH recommends establishing administrative controls to restrict the movement of the public throughout the hospital and to prevent personnel from working alone.
How to deal with the consequences of violence
In spite of preventive measures, violence may still occur. Managers should be prepared to deal with the consequences of this violence by providing an environment that promotes open communication and by developing written procedures for reporting and responding to violence. Counseling should be offered and encouraged whenever a worker is threatened or assaulted.
All hospitals should develop a comprehensive violence prevention program. Although no universal strategy exists to prevent violence, individual nurses and other healthcare workers should always be alert and cautious when interacting with patients and visitors. Some helpful safety tips are as follows:
- Watch for signals that may be associated with impending violence, such as anger expressed verbally and threatening gestures
- Maintain calm behavior that helps defuse anger
- Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor
- Don't isolate yourself with a potentially violent person
- Don't let a potentially violent person stand between you and the door
- Call security for help