Workplace violence was four times more prevalent in healthcare than in the private industry from 2002 to 2013. And that’s just incidents severe enough to require time off work. There are less severe cases of physical assault, threats, verbal abuse, sexual harassment, and general hostility—all of which can lead to staff stress, trauma, burnout, and turnover.
The problem isn’t getting better either. According to a 2018 ACEP survey, nearly 70 percent of emergency physicians feel violence in the emergency department (ED) has increased in the last five years. However, there are things hospitals and clinics can do to prevent, address, and recuperate from workplace violence.
We’ve identified three primary areas to focus on when addressing workplace violence in healthcare: collaborating with staff, increasing security, and educating patients.
1. Listen to and Train Staff
In a Modern Healthcare article, Gerard Castro, Project Director for Patient Safety Initiatives at The Joint Commission, said the key to addressing safety issues starts with speaking to nurses, clinicians, and other staff who deal with workplace violence regularly, even daily. According to Castro:
“The organization has to work with them to come up with a plan to mitigate those risks associated with those problems, and it really takes a comprehensive and systematic approach to that particular issue.”
This approach not only brings relevant and innovative ideas to the table, but also helps staff feel heard. One study shows that only 40 percent of non-physical workplace violence and 57 percent of physical violence is reported. Of those reports, only 14 percent of incidents are actually written down. Reasons for underreporting include lack of support from management, fear of blame or reprisal, and difficult reporting mechanisms.
As a manager or administrator, creating clear instructions and methods for reporting incidents of workplace violence can encourage employees to file reports. Workers can support their colleagues in speaking up and adopt a “see something, hear something, say something” mentality.
2. Increase Security
According to nearly half of surveyed emergency physicians, increasing security is the most important thing hospitals can do to keep ED staff safe.
Depending on size and location, having security on site could be a possible solution to mitigating the effects of workplace violence. High-volume hospitals with histories of violent outbreaks benefit from having both uniformed and plainclothes security guards—ideally with law enforcement, DEA, military, or FBI backgrounds.
Even without a dedicated security team, there are a number of ways to increase security and decrease risks of workplace violence—such as:
- Using metal detectors and alarms
- Restricting card access
- Enclosing nurses’ stations
- Providing curved mirrors and adequate lighting
- Controlling access to reception areas or other workstations
3. Introduce a Zero-Tolerance Policy to Patients
Establishing a zero-tolerance policy with patients may seem contradictory to an ED’s charge to offer care to anyone who walks through its doors. However, implemented wisely, it can be effective in not only preventing workplace violence but improving the quality of care patients receive.
Ralph Nerette, Director of Security at Dana-Farber Cancer Institute, reported that inappropriate behavior compromises the staff’s ability to deliver quality care. When a patient becomes aggressive after preventative measures have been taken, Nerette has these patients sign a behavioral contract. In extreme situations, or if the patients do not abide by the behavioral contract, patients can be asked to see care elsewhere.
In the same ASH Clinical News article, Nathaniel M. Glasser, a healthcare labor and employment attorney, stated that outside an emergency situation, “a physician would be allowed to refrain from treating under circumstances in which a patient becomes violent and the physician does not believe it is safe or appropriate to treat.”
In emergency situations, collaborative tools like the Collective Platform can help emergency clinicians remain safe while providing care.
One California hospital had a patient present who assaulted seven different staff members within 72 hours and documented the incident in the Collective Platform. On his second visit, the platform notified staff i of the potential security risks the moment he arrived. A senior manager went over hospital rules with the patient and asked him to sign a behavioral contract. Simply speaking with this patient and educating him on the hospital’s zero-tolerance policy for violence helped keep everyone safe. The patient had no violent incidents during the following 96 hours he was at the hospital.
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