Risky Business
As workplace violence rises, nurses and facilities must put safety first

By Beth Ulrich, Ed.D, RN, South Central Editor
August 6, 2001

How dangerous is your work environment? In a recent NurseWeek.com poll, nearly 60 percent of the respondents said that they had been victims of violence in the workplace.

As the nursing shortage worsens and more emphasis is placed on recruitment and retention, health care organizations are looking for ways to make both nursing and their facilities more attractive. Nurses rarely ask how safe a facility is and organizations rarely see safety as a drawing card. Both are making a big mistake.

Workplace violence, like road rage, has steadily increased. The Occupational Safety and Health Administration says that more assaults occur in the health care and social services industries than in any other. The National Institute for Occupational Safety and Health estimates that every day more than 9,000 health care workers are injured or attacked, verbally or physically, on the job.

Employers have a moral and a legal obligation to provide safe work environments. Beyond that, safe work environments save money. Programs that effectively respond to unsafe situations and workplace violence decrease sick leave and turnover, as well as maintaining productivity.

Few employers would consciously want an unsafe environment and few employees would consciously choose to work in one, so why does the violence persist?

• Denial. Even when we hear stories about violence at another facility, it's often difficult to think about it happening at our place. It took an emergency room shooting in Southern California several years ago for many facilities there to beef up security and safety in their ERs.
• Patients first. Our efforts to protect the patients sometimes put our staffs at risk. As an example, none of us want to use excessive physical restraints on patients, but how many nurses have been injured while waiting for a restraint order or while restraining a patient? How do we better balance the safety and needs of the patients with the safety of the staff?
• Training (or lack thereof). How many orientation programs provide detailed information on preventing workplace violence? How many facilities require annual education and training on violence prevention? The Texas Mental Health Code requires initial and annual training on prevention and management of aggressive behaviors for mental health care. Although the program is designed to teach staff how to better work with consumers of mental health and mental retardation services, the techniques can be used with consumers, patients, family members and co-workers.
• Less hassle. Sometimes, things that can increase safety create hassles. Wearing ID badges and having to swipe through locked doors are hassles, but they also control access. Propping doors open may save time, but also may allow people into the facility or unit who shouldn't be there.
• Short staffing. Fewer staff, especially on evening and night shifts, increases the potential for violence. It's easier to get hurt and more difficult to get out of a violent situation when you're alone and there's no other staff within shouting distance.

What do we do? Organizations need to objectively review the potential for violence in their work environments, then act on the results.

In 1998, OSHA published guidelines for preventing workplace violence for health care and social service workers (www.osha-slc.gov/SLTC/workplaceviolence/guideline.html). Although these guidelines are not mandatory, they provide a good template for analyzing the work environment, developing measures to prevent workplace violence, providing for post-incident responses that help the staff and prevent recurrences, and creating effective training and education programs.

As nurses, it behooves us to investigate the incidence and potential of workplace violence at the organizations we work in or those we are considering working in. We also have an obligation to make our managers and administrators aware when we see potential for increased violence.

Universal precautions for workplace violence should be implemented across the board, just as we have implemented universal precautions for infection control. We know the conditions in which violence can more easily occur, just as we know where infections can thrive. Like infections, it's easier to prevent violence than to deal with the aftermath.

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