Model Contract Language

Preventing Workplace Violence and Assisting Nurses Who Become Victims of Workplace Violence

Congress on Health and Safety

Section D

Violence is aggressive and abusive behavior from patients, visitors, other workers, supervisors, managers, or even patient’s family members. Violence is defined as, but not limited to, physical and verbal assaults, battering, sexual assaults, or verbal or non-verbal intimidation.

The hospital will initiate strong violence and abuse prevention programs including:

  1. develop and implement policies and procedures for the prevention of violence or potential violence.
  2. provide training programs on violence prevention and verbal de-escalation.
  3. develop a trained Response Team, available 24 hours and 7 days a week that, similar to a code team, that can be immediately called to assist a nurse in any situation that involves violence.
  4. report the injury or illness to the appropriate agencies i.e., Department of Industrial Accidents, police, etc.
  5. provide the affected nurse(s) with medical and psychological services as necessary
  6. assure that ID badges will not reveal the nurse’s last name.
  7. develop and implement policies and procedures relating to the detection, removal, storage and disposition of any weapons found on patients, family members, visitors or others
  8. provide security surveillance of hospital grounds and parking areas. Both will be well-lighted. Upon request, the hospital will provide escorts to cars and physical protection to workers if necessary.
  9. provide workers injured by workplace violence with all necessary medical and psychological services.
  10. assure that all employees have the right to police protection (call 911) if an assault is being/has been committed. The employer will support the employee in this endeavor, and throughout the police/court process.
  11. assure that all affected employees are provided with copies of any documents relating to any incident of violence that affects them whether as victims or witnesses of the incident.
  12. assure that all incidents of violence will be reported to the facility Safety Committee for review and appropriate intervention.

    Existing contract language:

    Workplace Violence
    The Medical Center will initiate a policy and procedure for the prevention of violence or potential violence. It will also give training programs on how to safely approach potential assaults and prevent aggressive behavior from escalation into violent behavior. The Medical center will endeavor to form a trained Response Team, available 24 hours a day and 7 days a week that, similar to a code team, can be immediately called to assist a nurse in any situation that involves violence. The employers will report the injury or illness to the appropriate agencies, i.e. Department of Industrial Accidents, police, etc. The employee also has the right to notify the police if he/she is being physically assaulted. Incidents of abuse, verbal attacks or aggressive behavior which may be threatening to the nurse but not result in injury, such as pushing or shouting or acts of aggression towards other clients/staff/visitors will be recorded on an assaultive incident report. The incident will be reported to the Safety Committee for review and appropriate intervention. Copies of any documents relating to the incident will be given to the nurse affected. The employer will provide or make available to workers injured by workplace violence medical and psychological services. * * Mercy Medical Center, Article XI Section 11.03 3 Workplace Violence 2004

Information for This Proposal_____________________________________

  1. Definitions: Assaulted nurse: One who is reasonably put in fear of being actually or potentially physically harmed while at work from a patient, co-worker, or visitor. This includes menacing gestures. Battered nurse: One who experiences actual physical contact from another (whether or not a physical injury occurred.) Physical Assaults: Violent acts of unwanted physical contact towards others. This includes slapping, pushing, kicking, punching, biting, scratching, deliberately throwing an object at a staff member, drawing a potential or actual weapon on a nurse. Sexual Assault: Unwanted sexual acts toward a nurse. This includes unwanted embraces, touching, exposures, or rape. Verbal or non-verbal Intimidation: Verbal includes conversation, written, email, or voice mail communication that is meant to threaten, slur, harass or frighten. Non-verbal includes acts meant to frighten or threaten a nurse such as throwing an object at a wall, pounding walls or doors, stalking, tampering with data systems, stealing, etc.
  2. Workplace Violence is one of the most underreported crimes. Reasons include: 1. Lack of knowledge of what, where, how and when to report. 2. Fear of repercussions on self and perpetrator. 3. Tolerance at the workplace 4. Embarrassment 5. Blaming of self 6. Belief that they will not be taken seriously.
  3. In 2001, the American Nurses Association released its Bill of Rights for Registered Nurses, which set forth the tenet that nurses have the right to work in an environment that is safe for themselves and their patients. However, studies have shown that between 35% and 80% of hospital staff have been physically assaulted at least once and that nurses are at great risk for violence while on duty (Arnetz & Arnetz, 2001; Bruser, 1998; Kinross, 1992; Lanza, 1996; Shepard, 1996; Whitehorn & Nowland, 1997; Williams & Robertson, 1997). Workplace violence in health care settings is not limited to physical assault. NIOSH (2003) has defined workplace violence as any physical assault, threatening behavior, or verbal abuse occurring in the workplace. The definition includes, but is not limited to, such events as beatings, shootings, rape, suicide or suicide attempts, and psychological traumas, such as threats to harm, obscene phone calls (also known as scatalogia), intimidation, or harassment, including being followed or sworn at. (Nursing Economics, Workplace Violence and Corporate Policy for Health care Settings, Clements, DeRanierei, Clark, Manno, Kunn, 2005:23(3):119-124 – from Medscape)
  4. Legal: Employers can be held liable for negligent hiring, supervision, and negligent retention. Massachusetts Law, GL c.151, provides for the payment of benefits for work related injuries. These benefits include payment of medical expenses and lost wages. The extent of an employer’s obligation to address workplace violence is governed by the General Duty Clause (Section 5 (a) (1) or P.L. 91-596. “If there is a violence hazard in the workplace and employers do not take feasible steps...the employer can be cited.” (OSHA).
  5. OSHA identifies insufficient staffing as a risk factor for Workplace Violence including but not limited to:

    a. Low staffing levels especially during time of specific increased activity such as meal times, visiting times, and when staff are transporting patients.

    b. Isolated work with clients during examinations or treatment.

    c. Lack of training of staff in recognizing and managing escalating hostile and assaultive behavior.
  6. Elements of a Violence Protection Plan (OSHA). 1. Management commitment 2. Employee involvement 3. Written program 4. Worksite assessment 5. Prevention of hazards 6. Training and education 7. Prompt recognition, control and monitoring, 8. Record keeping 9. Evaluation. 10. a program to assist employees injured in violence. 7. To attract and retain RNs in the profession, it is necessary to assure an interpersonal work environment that is safe. “Violence in the workplace is a significant public health problem but one that can be addressed by recognizing the factors that put employees at risk and taking appropriate preventative actions,” CDC Director David Satcher, MD.

Resources

U. S. Dept. of Labor, OSHA Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers, Document, # 3148 (2003) www.osha.gov

U. S. Department of Justice, Federal Bureau of Investigation, Workplace Violence, Issues in Response, Pg, 53, A Special Case: Violence Against Health Care Workers

Medscape, www.medscape.com view article /508158 –Nursing Economics, Workplace Violence and Corporate Policy for Health care Settings, Clements, DeRanierei, Clark, Manno, Kunn, 2005:23(3):119-124 – from Medscape) Update 11/05

FPO