Workplace Violence Prevention in U.S. Healthcare Institutions

Following years of reports detailing incidents of violence committed against nurses in hospitals and health facilities, regulations instituted in California in recent years now mandate that health employers must have a workplace violence prevention plan in place and educate staff about the various aspects of the plan. With the 2014 passage of State Senate Bill No. 1299, California became the first state in the U.S. to institute such a law governing violence risk assessment in health facilities. 

Although no on-site inspections are held to ensure compliance, the California Division of Occupational Safety and Health is in charge of hearing complaints over any violations and determining if fines should be levied. The possibility of fines makes it important that organizations affected by this law institute a quality workplace violence prevention program that can pass muster in the eyes of the state of California.

Nurses and Workplace Violence

Nurses are generally on the receiving end of violence in hospitals and care centers, with over 20% of registered nurses and nursing students reporting that they have been physically assaulted on the job over a span of one year, according to the American Nurses Association (ANA). The forceable arrest of Utah nurse Alex Wubbels in July 2017 for following hospital protocol and not allowing police to draw blood from an unconscious patient led the ANA to begin the #EndNurseAbuse initiative, an effort to draw attention to and end workplace violence against nurses.

Such violence is not limited to the U.S., as there have been increasing cases of severe violence against nurses in Australia and worldwide. In a paper attempting to explain the violence occurring against nurses in healthcare facilities, researchers in the Israel Journal of Health Policy Research found that a staff reported a number of possible motivating factors, including staff,  patient and visitor behavior, organizational conditions, and wait times. Work overload, pressure, fatigue, and frustration are all highlighted as likely factors contributing to the occurrence of violent behavior.

Details of the “Violence Prevention in Health Care” Act

The law mandates a number of steps that hospitals and health facilities must now follow, from risk assessment procedures to staff training. In addition to hospitals that provide inpatient or outpatient care, the law also applies to intermediate care facilities, correctional treatment centers, and hospice facilities. 

Specific safeguards that employers of such facilities must provide include personal protective equipment, training, and medical services. The law also requires these healthcare facilities to maintain a log detailing every incident of workplace violence.

Many of the training requirements are common-sense, such as instructing employees how to recognize situations that could potentially escalate to violence, teaching strategies to avoid physical harm, and the proper manner by which to report violent incidents within the organization. Training should also cover the resources available to employees during or after incidents involving violence.

Risk Assessment and Post-Incident Procedures

Things become a bit more complicated when it comes to the actual procedures that the workplace violence prevention programs must include. According to the relevant subsection of the bill, procedures must be able to identify and evaluate environmental risk factors, patient-specific risk factors, and workplace violence hazards, among other requirements. 

Post-incident response must include providing medical care and trauma counseling for any injured employees. In addition, a post-incident debriefing must be held as soon as possible with any staff involved in the incident in order to evaluate if the corrective measures included in the organization’s incident prevention plan were effectively implemented.

Violent Incident Log

As mentioned earlier, the employer is now required to keep a violent incident log that tracks “every incident, post-incident response, and workplace violence injury investigation” undertaken in compliance with the new state law. Information for the log entries should come from employees involved and include a detailed description of the incident.

Incident reports should also include classifications of who committed the violence and the circumstances at the time of the incident. In addition, the location and style of the attack must be recorded, along with any consequences stemming from the incident.

Looking Ahead

California hospitals generally welcome this new regulation, although with some reservations about the vagueness of the law’s requirements and difficulty of enforcement. For example, since hospitals don’t employ doctors directly, it may be hard to ensure that all have received the appropriate training. 

In any case, the California Hospital Association will continue to communicate with the California Division of Occupational Safety and Health to iron out any lingering concerns. Their success will in large part determine this law’s success on the national stage, as California Representative Ro Khanna has advanced a bill to the House Subcommittee on Health with similar language and requirements.

How Resolver Can Help

Resolver’s Incident and Investigations Management software help organizations record, manage and mitigate workplace incidents. It also allows healthcare organizations to maintain a standardized record of all relevant incidents, but also identify trends and give you the information necessary to act early and prevent the escalation of violent incidents in the first place.

“Resolver knows what’s important for healthcare – the solution is fully customizable and allows me to report on what matters the most. It helps me provide a holistic view of our overall security operations to our stakeholders and make proactive data-driven decisions.”

– Mathieu Bissonnette, Manager Security and Parking Services, CHEO.