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OSHA Issues Updated Guidelines for Preventing Healthcare Workplace Violence

In 2013, the Bureau of Labor Statistics reported more than 23,000 significant injuries due to assaults in the workplace. More than 70 percent of these assaults were in health care and social service settings. Health care and social service workers are almost four times more likely to be injured as a result of violence than the average private sector worker. To reduce the risk, the Occupational Safety and Health Administration released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. The publication includes industry best practices, and highlights the most effective ways to reduce the risk of violence in various health care and social service settings.

The revised Guidelines — which update OSHA's 1996 and 2004 guidelines — incorporate research done in the last decade regarding the causes of workplace violence on health care and social service settings, risk factors that accompany working with patients or clients who display violent behavior, and the appropriate preventive measures that can be taken, amid the variety of settings in which health care and social service employees perform their duties. The Guidelines also stress the importance of developing a written workplace violence prevention program. The program should include management commitment and employee participation, worksite analysis, hazard prevention and control, safety and health training, recordkeeping and program evaluation, as well as handy workplace violence program checklists.

The Guidelines point out that work-related assault and other occurrences of workplace violence primarily result from violent behavior involving patients, clients and residents in health care and social service settings.  Working directly with the public, relatives of patients or people who have a history of violence or who have abused drugs or alcohol increases the risk that an employee can be subject to workplace violence.   Other factors that employers should consider in assessing whether their employees are at risk for workplace violence include:

  • Working directly with people who have a history of violence, abuse drugs or alcohol, gang members, and relatives of patients or clients;
  • Transporting patients and clients;
  • Working alone in a facility or in patients’ homes;
  • Poor environmental design of the workplace that may block employees’ vision or interfere with their escape from a violent incident;
  • Poorly lit corridors, rooms, parking lots and other areas;
  • Lack of means of emergency communication;
  • Prevalence of firearms, knives and other weapons among patients and their families and friends; and
  • Working in neighborhoods with high crime rates

Additionally, the Guidelines point out certain organizational risk factors that include:

  • Lack of facility policies and staff training for recognizing and managing escalating hostile and assaultive behaviors from patients, clients, visitors, or staff;
  • Working when understaffed—especially during mealtimes and visiting hours;
  • High worker turnover;
  • Inadequate security and mental health personnel on site;
  • Long waits for patients or clients and overcrowded, uncomfortable waiting rooms;
  • Unrestricted movement of the public in clinics and hospitals; and
  • Perception that violence is tolerated and victims will not be able to report the incident to police and/or press charges

The Guidelines emphasize the critical importance of training, which can: (1) help raise the overall safety and health knowledge across the workforce, (2) provide employees with the tools needed to identify workplace safety and security hazards, and (3) address potential problems before they arise, ultimately reducing the likelihood of workers being assaulted. Any training program should involve all workers, including contract workers, supervisors, and managers. Workers who may face safety and security hazards should receive formal instruction on any specific or potential hazards associated with the unit or job and the facility. Such training may include information on the types of injuries or problems identified in the facility and the methods to control the specific hazards. It should also include instructions to limit physical interventions in workplace altercations. Moreover, every worker should understand the concept of “universal precautions for violence”— that is, that violence should be expected but can be mitigated, or even, through adequate preparation. In addition, workers should understand the importance of a culture of respect, dignity, and active mutual engagement in preventing workplace violence.

The Guidelines recommend that new and reassigned workers receive an initial orientation before being assigned their job duties, as well as mandatory annual training. In high-risk settings and institutions, refresher training may be needed more frequently, perhaps quarterly or even monthly, to effectively reach and inform all workers. Visiting staff, such as physicians, should receive the same training as permanent staff and contract workers. Effective training programs should involve role-playing, simulations and drills.

More information on violence prevention in all workplace settings is available on OSHA's Workplace Violence Web page.  Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions by setting and enforcing standards, and providing training, education and assistance.

Employers need to recognize the critical importance of these requirements and act accordingly, as the Guidelines will be used to establish a baseline standard of workplace violence prevention for health care and social service workers.  

This article is not offered as, and should not be relied on as, legal advice. You should consult an attorney for advice in specific situations.