Saving lives isn’t easy, but it’s rewarding. That’s one reason why so many people choose healthcare as an occupation. The U.S. Department of Labor’s (DOL) Occupational Outlook Handbook projects 14% growth in healthcare employment from 2018 to 2028. Unfortunately, along with the usual dangers of the job, workplace violence in healthcare is a serious issue.
Why is there such an epidemic of violence against healthcare workers, especially nurses?
The National Institute for Occupational Safety and Health (NIOSH) estimates 71% of the 18,400 reported incidents of workplace violence in the private industry occurred in healthcare and social assistance recovery. Most of the victims were female and 18% required 31 or more days off work to recover.
According to the American Nurses Association (ANA), 25% of nurses have been assaulted on the job. That’s one out of every four nurses.
It’s such a problem that the Centers for Disease Control and Prevention (CDC) created CDC Course No. WB2908 to help the 35,000 healthcare workers who deal with workplace violence.
These incidents are commonplace, but reported numbers don’t always reflect the scope of the problem.
Let’s examine workplace violence in healthcare from all angles to see how a resolution can be found.
The Health of the Healthcare Industry
People live longer than in prior generations. The World Health Organization (WHO) reports global life expectancy at birth increased 5.5 years, from 66.5 to 72, between 2000 and 2016.
Women outlive men, and conditions like heart disease, road injury, lung cancers, pulmonary disease, and stroke top the list of reasons why. Men are more likely to suffer from hospitalizing conditions, and John Hopkins reports medical errors as the third-leading cause of death, after heart disease and cancer, causing anywhere from 250,000-440,000 deaths each year.
Still, the presence of trained medical professionals during childbirth, combined with vaccination coverage and healthier lifestyles, is attributed by the WHO as reasons for our longer life expectancy.
However, not everyone has access to proper healthcare.
The U.S. Census states 28.5 million Americans (8.8% of the population) didn’t have health insurance in 2017. Most (67.2%) use private health insurance, and the American Heart Association estimates the costs of cardiovascular disease and stroke were $351.2 billion.
Hospital expenses in the U.S., according to the American Hospital Association (AHA), top $1 trillion per year, divided between the country’s 6,210 hospitals. Deloitte estimates this number will grow 5.4% annually between 2017 and 2022. The total admissions in 2017 were $36,510,207, and only 7.9% of patients stay overnight, according to the CDC. The relationship between patients and providers is changing.
The AHA reports telehealth usage in hospitals is rapidly growing, from 35% in 2010 to 76% in 2017. Access to improved remote healthcare is a focus of the Federal Communications Commission (FCC) Rural Health Care Program. This pilot program is spending $571 million a year establishing better broadband services in rural areas to promote better telemedicine.
Public records are available to bring transparency to the FCC’s efforts in telehealth. This can help reduce much of the violence occurring in hospitals, but some areas are more prone to exposure to violence in the workplace than others, including:
● Emergency Room Staff
The U.S. National Library of Medicine National Institutes of Health (NLM NIH) reports Emergency Departments (EDs) are experiencing increasing instances of workplace violence. Physical and nonphysical attack rates against ED nursing staff are 52 per 100 people each year. Emergency room staff is consistently exposed to workplace violence-induced anger, frustration, fear, stress, and irritability, and 13% of ED staff report long-term difficulty in dealing with after-effects.
● Correctional Hospital Staff
Little information is known about attacks on healthcare workers in correctional facilities, but prison staff in general experience 254 work-related injuries per 10,000 full-time employees. The NLM NIH notes the average across all industries is seven per 10,000 FTEs, making a 60x risk multiplier.
● Psychiatric Care Staff
A study published by the NLM NIH found nearly one of every five admitted psychiatric patients may commit violence. Schizophrenia, substance abuse, and history of violence are high-level risk factors. Long-term effects of exposure to this workplace violence caused fear, post-traumatic stress disorder (PTSD), decreased job satisfaction, and lowered personal health quality.
Identifying the most likely areas of violence is only half the battle. The overall health of the healthcare industry itself depends on protecting these high-risk employees. Not doing so has fatal consequences.
Operational Security in the Operating Room
Hospitals have two forms of operational security (OPSEC) necessary to remain safe – digital and physical. Both play an important role in reducing instances of workplace violence, so they must be addressed.
1. Digital Security in Healthcare
Cybersecurity in healthcare is a major concern – HIPAA Journal reports more patient and health records were stolen in 2015 than the previous six years combined. This is despite the Health Insurance Portability and Accountability Act (HIPAA) being introduced in 1996.
The Office of Civil Rights (part of the U.S. Department of Health & Human Services) strictly enforces regulations to protect health-related data. Breaches in privacy could get a hospital hit with fines up to $250,000, as well as imprisonment of up to ten years for some offenses.
Meanwhile, financial incentives offered by the FCC are steadily increasing the ability of patients to interact with medical information and professionals electronically. The Office of the National Coordinator for Health Information Technology reports over 50% of hospitals let patients view, transmit, and download health info, along with offering secure messaging and VDT health info, online.
Still, media reports show hospitals and physicians are grossly unprepared to handle today’s cybersecurity threats. Malicious botnets like WannaCry hijacked computers, holding necessary digital records hostage in exchange for Bitcoin ransom. This caused the cancelation of 20,000 patient appointments.
The Mayo Clinic explains how these cancellations can trigger angry reactions in people. When they do come in, they often come in already amped up. Compromised digital security increases the risks of responding to in-house violence.
In addition, the country’s 200 million 911 calls require emergency responders with immediate access to detailed information about the nearest hospital. Everyone coming into the emergency room has high stress on both sides of the desk.
2. Physical Security in Healthcare
Physical violence is only one of the crimes committed against hospitals around the country. The International Association for Healthcare Security and Safety’s Crime and Incident Survey reports the following crimes per 100 beds:
- Disorderly Conduct: 34.1
- Assault: 9.3
- Theft: 8.0
- Vandalism: 3.0
- Violent Crime: 1.0
- Burglary: 0.6
- Motor Vehicle Theft: 0.4
- Total Crimes per 100 Beds: 56.4.
Ensuring physical hospital security requires technology-based solutions. Video cameras, duress alarms, and electronic access control systems are all employed. Employee training is also a vital facet, and color-coded emergency signals are often listed on the back of ID cards for quick reference.
All hospital staff, from the medical teams to administration, should be thoroughly trained in security precautions. Employee-only areas should have risk management procedures in place, and as recommended by the nursing advocacy group above, security personnel can go a long way in protecting the safety of everyone in the hospital.
Open communications between police and fire personnel and hospitals create a 360-degree protection plan with immediate response available in emergency situations.
Unhealthy Relationships with Health Professionals
NIOSH collects and analyzes workplace violence reports data. The agency admits that official data doesn’t provide a clear picture of the problem since it’s estimated most incidents are unreported. There are four types of violence the agency recognizes:
Type 1: Criminal Intent
Criminal violence includes incidents like a doctor being assaulted in the parking lot or a home-care nurse being mugged in the field. This type of violence occurs in the process of committing another crime, like robbery or trespassing. However, for these types of crimes, hospitals are not targeted as often as retail stores and financial institutions, so Type 1 violence is infrequent in healthcare.
Type 2: Customer/Client
Customer/Client violence is by far the most common in healthcare. Patients in waiting rooms, geriatric facilities, psychiatric, and emergency treatment centers are most likely to attack their providers. At-risk workers and violence-prone patients must be proactively identified and immediately attended to. It’s very easy for a situation to escalate in a hospital environment – drugs, needles, and other life-saving equipment can quickly become deadly.
Type 3: Worker-on-Worker
Coworker violence involves a wide array of actions. It’s typically directed at those lower on the corporate ladder (although peer-to-peer violence also occurs). Type 3 violence manifests as bullying, verbal and emotional abuse, offensive/vindictive/humiliating behavior, and even murder. It creates a toxic work environment, where employees may not feel safe reporting incidents.
Type 4: Personal Relationship
The National Coalition Against Domestic Violence reports an average of 20 people – one in four women and one in nine men – are physically abused by an intimate partner every minute in the U.S. This abuse can turn into stalking, and it often spills into the workplace, especially for women. People aren’t always open about experiencing domestic violence, and it’s up to employees to keep an eye on each other for warning signs.
Each of these violence categories must be addressed with a proper security protocol.
The Occupational Safety and Health Administration (OSHA) doesn’t have regulations that require precautions against workplace violence. It, however, does provide information to identify risk factors and facilitate prevention programs. Courts have also included workplace violence under OSHA’s General Duty Clause in determining an employer’s legal obligation to the negative impacts on an employee.
Some state laws, like California and Washington, require employer-run workplace violence programs. Others, like Arizona and Virginia, have assault laws singling out nurses, while Florida and other states have laws focusing on assaults on emergency and mental health personnel.
According to OSHA data, workers’ compensation insurance typically pays the cost of hospital violence. One system with 30 violently injured nurses paid nearly $100,000 in direct treatment costs annually. Indirect costs include lower job performance leading to lowered quality of care for patients, and lowered job satisfaction.
The cost of replacing a nurse – which OSHA says includes separation, recruitment, hiring, orientation, and training – is anywhere from $27,000 – $103,000. Improving the safety of hospital workers directly improves the quality of healthcare that facilities can provide. Unhealthy workers make mistakes that lead to costly malpractice lawsuits and worse.
It’s that simple.
Creating a Safer Hospital
Modern hospitals need to mitigate the damage caused by workplace violence, wherever the source. OSHA identifies common risk factors as:
- Drug users
- Moving/transporting patients
- Working alone
- Poor lighting
- Presence of firearms
- High-crime location
- Lack of training
- Unrestricted public access
- Perception violence is “part of the job.”
There are cultural factors unique to healthcare that increase the underreporting of workplace violence. The first is the Hippocratic Oath, which originally required physicians to swear an oath to all the healing gods. Doing no harm is still a part of modern healthcare, and many professionals consider it their duty to put their lives at risk for their patients’ health.
It’s not – no one in a hospital should have a reason to fear for their personal safety due to performing their job duties.
Hospitals are not a safe place to work, but access to vital information – like occupancy rates, entry/exit locations, location of special needs patients, and location of fire extinguishers – goes a long way in protecting everyone. This information needs to be easily accessible by internal hospital staff and transferable to other emergency services, like police and fire personnel.
When police and fire services can access hospital data, they can better understand workflows to get patients the right care, without overburdening hospitals. Special accommodations can be put into place to secure potentially dangerous patients, and more secure protocols can be put into place.
Be Safe Technologies understands knowledge is power, and accurate data reporting is at the core of its technology. This emergency response system enables the rapid distribution of building information to first responders, empowering them to respond faster to escalating situations.
1. Digital Floor Plans
Using interactive, digital floor plans, emergency personnel can plan routes through the building. Navigating through controlled-access areas in an emergency requires this precision. Real-time data helps operational command find the safest route for EMTs and law enforcement to access the area. This saves precious time normally spent finding knowledgeable staff or using paper blueprints during incident response.
2. Secure Communications
Municipal and state agencies rely on secure communications during emergency response situations. Hospital staff can be both on-site and remote, leading to complications. An emergency room can already feel chaotic upon arrival, and the ability of agencies to centrally coordinate response as a cohesive unit can make the difference between life and death. An effective communication platform unlocks full agency cooperation in all aspects of healthcare security.
3. Proactive Risk Assessment
BeSafe conducts a comprehensive visual screening of all client sites. Security experts perform full visual inspections to identify risk levels and develop effective safety protocols. They then provide a detailed visual report that explains the associated risks and solutions needed for each situation. Everything into one set of policies and procedures that can save the lives of both healthcare workers and patients.
Governments on the local, state, and federal levels provide an array of resources to identify and manage workplace violence in healthcare. It’s a problem that has the attention of regulators, the media, healthcare professionals, and BeSafe Technologies.
Be Safe in Health Care
While hospitals serve a wonderful purpose in caring for the ill and injured, they can also be hazardous to the health of everyone working there. Along with the risk of staff contracting infectious diseases in a hospital setting, workplace violence is also a serious issue.
Healthcare workers are also more prone to workplace violence than the average profession. People who dedicate their lives to saving the lives of others deserve respect and admiration. Instead, they’re often met with distrust, indignation, and violent outbursts.
Emergency rooms and psychiatric facilities have the highest rates of violent attacks. Elevated stress factors and frustration, combined with the perception of declining services, can quickly escalate out of control. It’s not unusual to hear stories of nurses being attacked by patients.
It’s an epidemic that’s negatively impacting all involved and helping to contribute to the ever-increasing healthcare price tag of U.S. $3.5 trillion per year.
Contact BeSafe Technologies to schedule an on-site visual risk assessment of your healthcare facility today. It’s time to put an end to violence against healthcare workers.
