Workplace Violence
Background
Workplace violence is a major public health concern that has increased in incidence and attention within the past decade. The National Institute for Occupational Safety and Health Administration (NIOSH) and the Occupational Safety and Health Administration (OSHA) define workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace. Violence includes overt and covert behaviors ranging in aggressiveness from verbal harassment to murder. Additionally, OSHA defines the workplace to include any location, permanent or temporary where employees perform work related duties. (NIOSH 1996, OSHA 1996).
The Bureau of Labor statistics state an estimated 1.7 million workers are injured each year during workplace assaults (2005); violent workplace incidents account for 18% of all violent crime in the US (Bureau of Justice Statistics 2001). In its annual Workplace Safety Index, Liberty Mutual cites assaults and violent acts as the 10th leading cause of nonfatal occupational injury in 2002, representing about 1% of all workplace injuries and a cost of $400 million. (Liberty Mutual 2004). The incidence of injury resulting from violent acts is more than twice the incidence for health care workers, compared to other workers. (Bureau of Labor 2005). The incidence of violence is likely far greater than that which is reported resulting from inadequate reporting mechanisms and victim fear of isolation, embarrassment, and reprisal.
Violence claims a significant toll on all. In addition to the physical, emotional and mental affects on the victim, other negative effects include: financial loss resulting from insurance claims, lost productivity, legal expenses, property damage, and possible staff replacement costs. Prevention is essential for creating a safe and therapeutic environment for patients and .a safer work place for health care workers. Health care workers who leave because of assaults and threats of violence contribute to a healthcare workforce shortage. It is possible to reduce and mitigate the effects of violence. One way is to establish a comprehensive program in the workplace, dedicated to prevention, collection of incidents and provision of support for those affected. Rather than wait for health care employers to volunteer to establish such programs, some states have enacted legislation
Enacted to date:
Legislation calling for a workplace violence prevention program, study of the issue or reporting of incidents has been signed into law in: IL, ME, NJ, NY, OR, and WA. HI passed a resolution urging 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.
States which enacted legislation to strengthen or increase penalties for acts of workplace violence affecting nurses include: AL, AZ, CO, IL, NV, NC, and NM.
Summary of State Approaches
Both NJand OR addressed workplace violence comprehensively in 2007. NJ passed the "Violence Prevention in Health Care Facilities Act", calling for select health care entities to establish violence prevention programs to protect workers. Essential provisions of the program include: creation of a violence prevention committee including a member of management, responsible for all levels of the program and with at least one half of the committee's membership to be that of direct care workers with the remaining members having relevant experience, expertise or responsibility at the facility; performance of an annual comprehensive assessment that includes facility layout, crime rate of the surrounding area, adequacy of staffing levels, presence of individuals who may pose a risk and a review of violent incidents at the facility at the very least; and development of a written violence prevention plan that identifies workplace risks and provides specific methods to reduce identified risks. OR's law requires a health care employer to conduct periodic security and safety assessments to identify existing or potential hazards for assaults committed against employees. The assessment shall include but not be limited to a measure of the frequency of assaults committed against employees that occur on the premises of a health care employer or in the home of a patient receiving home health care services during the preceding five years or for the years that records are available if fewer than five years of records are available; and identification of the causes and consequences of assaults against employees. Employers must also develop and implement an assault prevention and protection program for employees based on assessments conducted and provide assault prevention and protection training on a regular and ongoing basis for employees.
NY legislation enacted in 2006 is directed to public employers, requiring them to develop and implement programs to prevent and minimize workplace violence; allows any public employee or representative of public employees who believes that a serious violation of a safety or health standard exists, or an imminent danger exists, to request an inspection; provides for enforcement of such requirement by the commissioner of labor.
In 2006, IL enacted the "Healthcare Workplace Violence Prevention Act" designed as a 2-year pilot project beginning with violence prevention training in 2006 and expanding to adoption and implementation of prevention programs with maintenance of records of violent acts in 2007. The legislation specified the Governor will convene a task force to evaluate the pilot project and report findings to the General Assembly by January 1, 2008. The same year, ME legislation required the Department of Labor to coordinate a task force to study workplace safety issues and provide findings and recommendations for any proposed legislation to reduce workplace violence before a joint standing committee of the legislature.
In 2005, WA passed legislation requiring that, by September 1st of each year, a report shall be submitted to the house committee on commerce and labor and the senate committee on commerce and trade, or successor committees, on efforts to reduce violence in the "state" hospitals.
Legislation enacted in NC (2004) provides for civil no-contact orders to be filed by either the employee who is victim of unlawful conduct or by the employer on behalf of the employee. The law also provides for protections from employer discrimination of the victimized employee.
Other states have approached the issue of workplace violence by elevating the category for the offense and subsequent penalty: AL (2006), AZ (2007), CO applies to workers in mental health facilities only (2005); IL (2003), NV (2003), and NM (2006). States which have afforded protections for specific categories of employees, exclusive of nurses are not listed.
2008 Legislative Efforts
Thus far in 2008, 9 states and more than a dozen bills addressing workplace violence in some manner have been introduced. Most states are seeking to define aggravated assault and / or increase penalties for assaults on health care workers. Such initiatives have occurred in: AK (SB299); KY (SB45); NE (LB787); NY (AB6186/SB3441 adds RNs and LPNs to provisions for first responders); OH (HB183); TN (HB261/SB1162); and WV (HB4437/SB590).
Only two states have taken a more comprehensive approach during the 2008 session: HI (SB253) affording protection of healthcare workers from an abusive work environment and NY (AB2324) would require public health employers to implement a workplace prevention program.
Bill numbers have been provided to enable the reader to investigate specific provisions.
Given the few states that have been successful in enacting comprehensive legislation for health care workers, ANA created a model bill, “The Violence Prevention in Health Care Facilities Act” (attached providing for an employer program with emphasis on prevention and reporting and is currently crafting a model workplace violence analysis tool, expected to be completed by early summer.
Last updated 3/19/08