By Ellis Brasch
In Oregon, accepted workers' compensation claims in the health care and social assistance sector increased 78 percent between 2007 and 2013. Although many factors could explain that trend, the increase is a cause for concern (accepted claims for all workplace injuries decreased by 25 percent over the same period). And in 2014, half of all accepted claims for violence-related injuries in this state came solely from healthcare providers.
More disturbing is the fact that many workplace violence incidents - verbal abuse and physical assaults - go unreported because of a longstanding cultural assumption that violence is part of the job for health care workers. That assumption still exists among many health care providers, and law enforcement officials are sometimes unwilling to intervene in reported violence unless a worker is very seriously injured or killed. Most health care violence incidents are not fatal; however, many are serious enough to require medical attention.
Health care workers most at risk for physical assaults in Oregon are nursing aides, orderlies, attendants, registered nurses, counselors, social workers, and health support technicians. These workers filed 64 percent of the 275 accepted claims for assaults in the health care industry in 2014. Nearly all of the assailants were patients or clients, who hit, kicked, beat, or shoved their caregivers.
Inpatient and acute psychiatric services, geriatric long-term care settings, high-volume urban emergency departments, and residential and day social services present the highest violence risks for health care workers.
When people talk about workplace violence, they may be referring to a range of hostile acts - from threats and intimidation to homicide. The National Institute for Occupational Safety and Health defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty."
An effective violence prevention program is key to undermining the culture of indifference to violence at health care facilities. The best programs take time to build and require commitment from managers and staff but the investment is worth the effort. In the long run, fewer injuries mean lower costs for compensation claims, the reduced risk of lawsuits, and better working conditions for stressed-out staff.
Earlier this year, federal OSHA updated its 2004 Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, which describes the key elements of a violence prevention program and the most effective ways to reduce the risk of violence in healthcare settings. The guide notes that effective violence prevention programs have clear goals for preventing violence, they are suitable for the size and work performed at a facility, and they are adaptable to changing situations. The key elements require:
Do they look familiar? They should. They are similar to the key elements of traditional safety and health programs that safety professionals recommend for all workplaces.
The Oregon Safe Employment Act [ORS 654.412 - ORS 654.423] requires hospitals and ambulatory surgical centers to conduct periodic safety assessments to identify violence-related hazards, develop a violence prevention program based on the assessments, and provide regular assault prevention and protection training to employees.
Hospitals and ambulatory surgical centers must also keep an ongoing health care assault log of all assaults against their employees. Each record must be maintained for at least five years after the assault was reported. Oregon OSHA has an online health care assault log that employers can use to record assaults.
Oregon OSHA can cite employers who do not protect their employees from workplace violence under the provisions in the Oregon Safe Employment Act. Inspections may be conducted in response to complaints, from referrals by other agencies, and when there is a violence-related fatality or an overnight hospitalization.
Introduced in January with broad support of the health care community, Oregon Senate Bill 132 would have made it a class C felony to assault a hospital worker. However, the measure was stalled in the Senate Judiciary Committee when the legislature adjourned July 6. Senate Bill 132 was endorsed by a number of health care organizations, including Legacy Health, Oregon Health and Science University, PeaceHealth, Salem Health, St. Charles Health System, the Oregon Association of Hospitals and Health Systems, the Oregon Nurses Association, the Oregon Emergency Nurses Association, the Oregon College of Emergency Physicians, and the Oregon Medical Association. The Service Employees International Union and the American Federation of State, County and Municipal Employees also supported the measure. ◼︎
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