2008 International Workplace Violence Conference MNA Abstract

Workplace Violence Prevention in Healthcare - Awareness and Education Programs of the Massachusetts Nurses Association (USA)

Evelyn I. Bain, M Ed, RN, COHN-S, FAAOHN Rosemary O’Brien, RN, Chairperson MNA Workplace Violence and Abuse Prevention Task Force

The Massachusetts Nurses Association (MNA) took a stand against Workplace Violence in Healthcare Settings before the turn of the 21st century. MNA members reported being assaulted at work and being denied the process for holding the perpetrators accountable in the court system. Their attempts to open a dialogue with their employers to initiate violence prevention activities were largely ignored.

In 1999, actions by the MNA Cabinet on Labor Relations and Board of Directors created a Task Force to draw attention to the problem of Workplace Violence and Workplace Violence Prevention. The Task Force was charged with assisting nurses injured by violence, learning the true nature of violence in their works settings, and developing contract language and a position statement for nurses to use when confronting their employers about violence prevention. Additionally, legislative initiatives were proposed to address violence prevention in healthcare settings.

With the creation of the Task Force, a very dedicated group of nurses came together to begin the dialogue, support the activism and further the concept that violence at work in healthcare settings is unacceptable. Many of these nurses were survivors or witnesses of violent attacks at work. They continue to be ready at a moment’s notice to talk with others who have been victimized and to support them through their recovery.

Task Force members developed a mission statement that has continued to ring true as their work continues almost ten years later. The mission statement reads: In order to eliminate violence, there must be awareness that the problem exists. Education of nurses, healthcare workers and administrators is necessary. Prevention programs that address the violence continuum are essential. Efforts must be directed at legislators, members of the judiciary and society at large to assure the safety of all healthcare workers. The Task Force advocates a Zero Tolerance Policy for violence in health care settings.

An early initiative of the Task Force members was to meet personally with key members in the Massachusetts Judicial system. Judges and court administrators spoke openly that “violence was part of the job” when nurses filed criminal charges against patients who had assaulted them. The judges believed the perpetrators were helpless victims of illness and could not be held accountable due to their medical and psychiatric conditions. In truth, MNA learned that many of these acts of violence were targeted against specific nurses or their colleagues. The perpetrators purposely waited until few other staff members were available to help the victim before carrying out their well planned crimes. Other assaults were the result of patient’s drug or alcohol use, actions that would have been considered crimes if they had happened on the street or in other locations. Additionally, visitors and family members were involved in many of these assaults. Over time, attitudes changed in many judicial minds. An early initiative of the task force members was to meet personally with key members of the Massachusetts judicial system to address workplace violence in healthcare settings. Judges and court administrators spoke openly that “Violence was part of the job”. They believed that the perpetrators were helpless victims of illness and could not be held accountable due to their illness. In truth, MNA learned that of many of these acts of the violence were targeted against specific nurses and others and then carried out by perpetrators who waited until few staff members were available or the nurse was alone in the work area, before carrying out their well planned crimes. Other assaults were the result of patients’ drug and alcohol use, actions that would have been considered crimes if they had happened on the street or in other locations. Additionally, visitors and family members were involved in many of these assaults. Over time, attitudes changed in many judicial minds.

MNA believed the same standard of accountability for criminal behavior should apply in any setting, including healthcare. Thus, the MNA slogan was born: In Healthcare or Anywhere: Violence is NOT part of the job.

An educational session with the same title In Healthcare or Anywhere: Violence is NOT part of the job was developed by the MNA staff and Task Force members and presented to more than 60 nurses and others. Speakers at this event included a local District Attorney and a nurse who was working at the time as a Lieutenant in the Massachusetts State Police. She had been a victim of workplace violence during her clinical work. The information from this session empowered several nurses to involve the police with a patient who had long been abusive and violent to the staff in the hospital where he was receiving care and had injured several nurses and others. The patient was soon transferred to a prison hospital unit, an action the nurses had requested of their employer on many previous occasions.

This Workplace Violence Prevention educational event and others have been chronicled in the local and national media, including television, radio and print. MNA staff and members have brought educational sessions, participated in labor negotiations to promote violence prevention and provided support for injured workers in local bargaining units, insurance companies, other unions, nursing schools and professional organizations.

Local District Attorney’s across Massachusetts have been strong supporters of the rights of nurses and other healthcare workers to be safe from violence at work. These men and women and their competent staff members, have been frequent speakers at educational events on workplace violence prevention. One District Attorney in particular, William R. Keating, of Norfolk County, MA convened a community response team including representatives from hospitals, hospice and home care agencies, local police and the nurses union to look at the need for an organized response to protect all healthcare workers from violence. A booklet entitled Protecting Our Caregivers from Workplace Violence was developed by the group. The booklet addresses the criminal behavior aspect of workplace violence and the value of involving local police in prevention as well as being called at the time of the crime.

This community group and their publication emphasizes the importance of educating workers to recognize the potential for violence by reporting all events including offensive and violent gestures and verbal threats to their employer. These early warning signs often result in more serious acts of violence that can be prevented when nurses and their colleagues at work are trained and work in supportive environments. Protecting Our Caregivers from Workplace Violence includes sample forms for worksite safety assessments and for reporting violent incidents at work. A sample police reports for filing criminal charges against a perpetrator is included. Information on locating the sex offender registry in local communities is provided as a safeguard for nursing personnel who must enter private homes to provide care. Many of the materials contained in this booklet were obtained directly from Massachusetts public documents, U. S. Department of Labor, Occupational Safety Administration (OSHA) guidelines and Centers for Disease Control (CDC) National Institute of Occupational Safety and Health (NIOSH), as well as forms and policies from local hospitals. The District Attorney and his staff repeatedly emphasized that the police must be involved in these violent events to assure that perpetrators are held accountable and workplace safety is improved.

Task Force members determined that there must be readily available written materials for use by victims of violence at work. These materials would also be use by union representatives, lawyers for injured workers and even by managers to implement violence prevention strategies and programs. The first document developed was the pamphlet entitled Workplace Violence – Prevention and Intervention: Being assaulted is not part of the job no matter where you work. Thousands of these pamphlets have been distributed during educational sessions and when requested by victims and/or their advocates.

The next document developed by the Task Force members was the MNA Position Statement on Workplace Violence which can be used to develop a recognition and prevention program in healthcare and other settings. The Position Statement references the U. S. Department of Labor, OSHA, Guidelines on Preventing Workplace Violence for Healthcare and Social Service Settings. Additionally, those using this policy are encouraged to support workers injured by violence with words such as “this was not your fault”, “you did not cause this to happen” and “you did not deserve to be treated like this”. This is in direct opposition to the phrase most often used by employers and workers’ compensation insurance companies “what did you do to cause this to happen” or “what would you do next time so this would not happen”. Victims of violence in healthcare are often blamed for the behavior of their attackers and thus hold fast to the concept that maybe they are to blame or “violence is part of the job”.

The next document developed addresses Model Labor Contract Language related to workplace violence and violence prevention. This model language has been used by many MNA units to bring violence and violence prevention to the table in labor contract negotiations. In one unit, negotiations resulted in metal detectors being installed at the entrance to methadone treatment clinics where weapons had been detected. In the first several days of use, more than thirty seven (37) sharp instruments such as knives, screw drivers and box cutters were detected and confiscated by security personnel. It was not surprising that other clients were the most satisfied by the use of the metal detectors and shared that they felt safer coming for treatment with this technology in place. Telephone calls to a multitude of other methadone treatment clinics could find no other facility in the state using this protective technology to improve workplace safety.

Several other documents have been developed and provided to members and others. 10 Steps a Nurse Should Take if Assaulted at Work and How to Recognize and Respond to Bullying at Work/ How Bullies Pick their Targets. Labor union representatives and local union committee members as well as victims of violence and their legal representatives use these documents.

A survey of violence in local hospitals where nurses are represented in collective bargaining by the MNA and violence prevention activities by their employers was conducted in 2004. When results were reviewed, it was learned that violence is common and when incidents were reported, although managers were sympathetic, nothing changed in the work settings. Weapons including hypodermic needles, blood soaked dressings and bodily fluids were used as weapons by patients against nurses who cared for them. The MNA survey tool has been requested for use by nursing organizations and other groups across the United States.

In 2006, the MNA began on-line continuing nursing education programs and the initial offering was Workplace Violence. To date, more than 450 nurses and others have learned about Workplace Violence from this on-line offering. Comments from participants after completing the program which prove the value of this educational offering include “I will be more careful at work”, “I will recognize violence and report these incidents,” and “I am more aware of the dangers now”.

At present, the MNA is involved with two legislative initiatives to protect healthcare workers from violence at work. One proposed law would require that all healthcare employers in the state develop Workplace Violence Prevention Programs that include Post Traumatic Stress Debriefing (PTSD) and psychological counseling for nurses and other workers injured by violence at work. The second proposed law will increase penalties for perpetrators who assault any healthcare worker and require that criminal charges will be filed by the police rather than the victim.

The MNA Task Force on Workplace Violence and Abuse Prevention is currently in its ninth year of activity, advocacy and assistance to victims of violence. Until, it becomes the law of the land that perpetrators are held accountable, that all workers are trained to recognize the potential for violence in the situations where they are working and employers improve working conditions to include assessment and prevention of violence, the Task Force will continue to advocate on behalf of nurses and their colleagues at work in healthcare settings.

All documents, surveys, survey results and on-line continuing nursing education are available on this Web site. Their use and reprint is encouraged with acknowledgement of the Massachusetts Nurses Association. There is currently no charge to anyone who utilizes any of the on-line continuing nursing education programs.