Health systems, hospitals, and critical access hospitals will soon have new workplace violence standards to add to their safety and compliance library. The Joint Commission announced four new accreditation standards focusing on workplace violence, effective January 1, 2022.
But that’s not all that’s occurring on the patient safety regulatory front.
Other laws and regulations are also in the works to address healthcare safety and workplace violence in particular, including the following:
- A pending federal law called the Workplace Violence Prevention for Health Care and Social Service Workers Act that is making its way through Congress
- Proposed new Occupational Safety and Health Administration (OSHA) requirements
- State legislatures that are addressing these issues by, for example, imposing stricter penalties for assault of nurses
Unacceptable workplace conditions for nurses
According to OSHA, nurses are four times more likely to experience workplace violence than other private-industry employees. Consider that hospitals are required to provide treatment to anyone seeking care—and as a result frontline nurses are frequently targeted. In addition, the COVID-19 pandemic has become a powder keg of increased tension as bed shortages and arguments over vaccine mandates and mask mandates persist. As a result of these and other issues, nurses are placed in contact with angry and sometimes violent patients and families, exacerbating exhaustion and burnout among them
Numerous factors, including overall dissatisfaction with the lack of safety in the healthcare workplace, are piling up and causing nurses to leave the profession in droves. The American Organization for Nursing Leadership (AONL) conducted a study of nearly 2,500 nurse leaders in February 2021 and sent a follow-up survey in August 2021, finding that:
- In August, roughly 17% of nurse leaders said they’re considering leaving nursing and roughly 3% have indicated they plan to leave, up from 8% and 2%, respectively, in February.
- Nurse managers are more likely to leave nursing than higher-level nurse administrators. Of the managers in the August survey who said they intended to leave, 58% said they were not sure when, 20% said within one year, 9% within the next six months, and 5% within one month.
- In August 75% of nurse managers cited emotional health and well-being of staff as their top challenge, up from 67% in the February study.
Workplace violence and insecurity directly impacts the physical well-being of the healthcare worker and increases the risk for psychological distress. High turnover can negatively impact patient care, not to mention increasing costs to the healthcare organization—to the tune of $40,038 per nurse.
Four types of healthcare workplace violence
According to the National Institute of Occupational Safety and Health (NIOSH), workplace violence is defined as violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty. Healthcare workers potentially face four types of violence in their work environment:
- Criminal intent: In this workplace violence category, the perpetrator has no relationship with the victim, and the violence is carried out in conjunction with a crime. An example is a pharmacist held at gunpoint while two men steal oxycodone from the pharmacy.
- Customer/client: In the most common healthcare environment-based assault, the perpetrator is a member of the public with whom the healthcare worker is interacting during the course of their regular duties. For example, a distraught family member assaults an emergency room nurse because her spouse has been waiting a long time to be seen and is in pain.
- Lateral, or worker-on-worker: Often perceived as bullying, in this type of violent episode the perpetrator and victim work together, though not necessarily in the same role or at the same level. This type of workplace violence frequently results from a power imbalance. An example is when a surgeon throws an instrument at the circulating nurse for placing an incorrect object on the sterile table during surgery.
- Personal relationship: In this category, the victim has been targeted because of an existing exterior relationship with the perpetrator, with the violence taking place in the workplace. An example is an abusive boyfriend who comes to the hospital to confront and assault his girlfriend, who is a nurse.
New Joint Commission workplace violence prevention requirements
The following sections break down the new standards that The Joint Commission will start utilizing in January 2022 during surveys for accreditation and certification:
The hospital must manage its safety and security risks
To begin, the hospital must have a workplace violence prevention program. The program should be led by a designated individual and be developed by a multidisciplinary team. It should include policies and procedures to prevent and respond to workplace violence. The plan should include a process to report incidents and to analyze the trends. The plan should provide a means of support to victims and witnesses affected by workplace violence and include trauma and psychological counseling.
Further, the hospital must conduct an annual worksite analysis as part of its workplace violence prevention program. The worksite analysis should include the following items:
- A proactive analysis of the worksite
- An investigation of the hospital’s worksite violence incidents
- An analysis of the program’s policies and procedures, training, education, and environmental design
- How the plan reflects best practices and conforms to applicable laws and regulations
The hospital must then take actions to mitigate or resolve the workplace violence safety and security risks based on the findings from the worksite analysis.
The hospital must collect information to monitor conditions in the environment
The hospital must establish a process for continually monitoring, internally reporting, and investigating safety and security incidents involving patients, staff, or others within its facilities, including those related to workplace violence.
Hospital staff must participate in ongoing education and training
As part of the hospital’s workplace violence prevention program, it must provide training, education, and resources to leadership, staff, and licensed practitioners. The education should be provided at time of hire, annually, and whenever changes to the workplace violence prevention program occur.
The training should include the following information:
- What constitutes workplace violence
- The roles and responsibilities of leadership, clinical staff, security personnel, and external law enforcement
- Training in de-escalation, nonphysical intervention skills, physical intervention techniques, and response to emergency incidents
- The reporting process for workplace violence incidents
Hospital leaders must create and maintain a culture of safety and quality throughout the hospital
The workplace violence incident reporting process should include reporting of incidents to the hospital’s governing body. Of utmost importance in any incident reporting process is having effective lines of communication that allow employees to report safety concerns such as workplace violence without retaliation.
Maintaining a “culture of compliance” is echoed in the Department of Justice Evaluation of Corporate Compliance Programs document and in the U.S. Sentencing Guidelines, which we cover in our eBook.
Proposed federal legislation to protect healthcare workers
The proposed Workplace Violence Prevention for Health Care and Social Service Workers Act is pending Senate approval, having passed the House of Representatives in April 2021 and provides for:
- Healthcare employers to develop and implement a comprehensive workplace violence prevention plan to protect healthcare workers, social service workers, and other personnel from workplace violence
- OSHA to create enforceable safety standards related to workplace violence by 2025
State laws that address healthcare workplace violence
At the state level, too, there is change underway to stem and address the incidence of healthcare workplace violence. The following is a summary of some of the measures in progress nationwide:
- Relaxing of requirements for healthcare workers to use their full names on ID badges, allowing the use of first names only
- Establishing or increasing penalties for the assault of nurses
- Establishing Class C and D felonies for initial and subsequent offenses when an individual creates a disturbance inside a healthcare facility or interferes with an ambulance service
- Applying additional penalties to violence against specific healthcare workers and in particular settings, such as emergency department personnel, mental health personnel, and emergency and public health personnel
- Authorizing hospitals to post warnings regarding violent behaviors
- Urging healthcare employers to develop and implement standards of conduct and policies for managers and employees to reduce workplace bullying and promote healthful and safe work environments
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