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Workplace Violence
Prevention & Intervention
Being assaulted is NOT part of
the job no matter where you work.
Mission Statement
The Mission of Task Force: In order to eliminate violence, there must be awareness
that the problem exists. Education of nurses, health care 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 health care workers. The
task force advocates a Zero Tolerance Policy for violence in health care settings.
MNA Workplace Violence Task Force Members Recognize
more:
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patients
under the influence of drugs and alcohol
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children
and adolescents presenting with aggressive behavior
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weapons
seen in the emergency department
fewer placement options for:
Workplace Violence Is Not Uncommon In Health Care
Settings:
From 1992 to 1996 non-fatal assaults on nurses, others in health care and
mental health settings were similar in frequency to those in law enforcement,
well over 200,000 annually. Annual average assaults in health care settings
included 69,500 nurses, 24,000 technicians, 56,000 other health care workers
and 10,000 physicians. In mental health settings 50,300 assaults were reported
on professionals, 43,500 on other workers and 8,700 on workers in custodial
positions1.
Workplace Violence IS A Crime
Nurses and other health care workers who are assaulted at work, have the same
rights as workers assaulted on the job in any other work setting. You are
entitled to file a police report to assure that the incident is investigated
by police with follow-up in the courts when indicated.
The victim may file a report at the police department or the
District Court of jurisdiction. According to the Massachusetts Office of Victim
Assistance, cases come into the criminal justice system in several ways, including
police complaints, citizen complaints and indictments. Police complaints are
issued by a clerk magistrate in District Court based on information supplied
to them by police officers. Citizen complaints are also issued by a clerk
magistrate in District Court but are based on information provided to them
by both the victim and the defendant.
Definition of Workplace Violence
Violence in the workplace is best described as existing on a continuum from
verbal/emotional abuse to physical assault and homicide2. In health
care settings, workplace violence can be perpetrated by patients, families,
friends, visitors, co-workers, physicians, supervisors and managers.
Myths that nurses believe about Workplace Violence
in healthcare settings:
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"The
nurse must have done something to provoke the attack."
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"It
can’t happen here, or it won’t happen to me."
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"It’s
part of the job."
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"Patients
aren’t responsible for their behavior."
Recognizing a Violence Prone Workplace3
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prevalence
of handguns as weapons among patients, their families or friends
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increasing use of hospitals by police and the criminal justice system for
criminal holds
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care of acutely disturbed, violent individuals
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unrestricted
movement of the public in clinics and hospitals
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long waits in emergency or clinic areas
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low staffing levels during times of specific increased activity
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isolated work with clients
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solo work in remote locations
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lack
of training in recognizing and managing hostile and assaultive behavior
The Result Of Workplace Violence -
Critical Incident Stress -
Tragedies, deaths, serious injuries, sexual assault, hostage situations and
threatening situations are all common to workplace violence. These events
are known as “Critical Incidents”. Sometimes an event is so traumatic
or overwhelming that significant stress reactions occur. A process known as
critical Incident Stress Debriefing (CISD) is specifically designed to prevent
or mitigate the development of post-traumatic stress.
Recognizing Critical Incident Stress4
You may see signs and symptoms of critical incident stress in those who have
experienced or witnessed workplace violence. Symptoms occur as physical, cognitive,
emotional and behavioral and can be noted as:
| Physical |
Cognitive |
Emotional |
Behavioral |
| chills |
confusion |
fear |
withdrawal |
| fatigue |
uncertainty |
grief |
inability
to
rest |
| nausea |
hyper-vigilance |
panic |
intensified
pacing |
| weakness |
poor
abstract
thinking |
depression |
hyper-alert
to
environment
|
Actions Following An Assault
Steps to follow:
While there is no clearly defined process for the victims of violence, the
Task Force has identified certain steps that should take place. The sequence
of these steps depends on the individual situation.
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Report
any impending and actual acts of violence at work to your supervisor, regardless
of who is the victim and whether or not there are injuries. Reports must
be written as well as verbal.
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Call the police immediately if necessary, file a police report as soon as
possible. Take someone with you when you file the police report. Preferably
co- workers who are familiar with the event.
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If the assault is from a patient, document the patient’s behavior
in the nursing notes. This is the most essen- tial legal documentation.
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Seek
medical attention even if there are no “obvious injuries,” be
sure to document any physical injuries and your emotional state. Follow
the health care provider’s recommendations for treatment and work
restrictions.
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Request and participate in Critical Incident Stress Debriefing (CISD). CISD
is essential following a violent episode.
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Co-workers
who witness assaults must be included in CISD.
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Keep a diary of the progress of treatment, discussions related to your injuries
and the progress of any claims for Workers’ Compensation
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Ask for and retain copies of all Workers’ Compensation, incident,
medical, injury and insurance reports that relate to the event and your
treatment.
Show That You Care
Encourage the assaulted co-worker to:
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report the incident
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talk about the incident
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deflecting
self blame
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providing non-judgmental listening
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helping with police reports
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keeping in contact by phone or visiting
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assuring that the Steps in Actions are followed
What Can The Union Do To Help Victims Of Workplace
Violence
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Plan a system for addressing Workplace Violence. Use the Actions Following
an Assault steps in this brochure as the basis for planning your system.
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Help your co-worker through the steps
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Advocacy
may be needed to obtain copies of reports.
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Designate
someone to keep in caring and concerned contact with your injured colleague.
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Use the buddy system if available or develop your own
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Don’t carry keys, pens, jewelry or other items that could be used
as weapons.
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Don’t
wear items around your neck that could be used against you in confrontational
situations.
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Make
sure that nurses and physicians are not alone when performing intimate physical
exams on patients.
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Attend
classes in self defense and crisis intervention whenever they are available.
What Can the Union Do to Prevent Workplace Violence
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Promote zero tolerance for workplace violence
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Create
and maintain a safe work environment as well as the prevention and response
for workplace\violence.
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Make
workplace safety and health a priority and standing item for committee and
labor management meetings.
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Maintain union presence on hospital safety committees.
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Learn
the employer’s policy and procedure for violence and harassment and
educate self and members
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Accompany victims when they are filing police reports. Accompany them during
police and court proceedings.
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Introduce the OSHA Guidelines for Preventing WorkplaceViolence for Health
Care and Social Service Workers to management as the basis for violence
prevention activities.
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Identify a Critical Incident Stress Debriefing Resource that can be accessed
whenever needed. ASAP is a formalized support system that can be implemented
in a facility.
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Develop
a buddy and escort system to protect workers in remote areas and parking
lots.
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Anticipate “slip ups” in the Workers’ Compensation process
and advocate for the injured worker.
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File grievances.
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Encourage the development of support groups for injured workers.
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Report on activities in local unit newsletters, especially the progress
toward prevention.
Resources
For Nurses And Other Workers
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In the Aftermath of Crime - A Guide to Victim Rights and Services in Massachusetts.
Cambridge Street, Boston, MA 02201 617.727.5200
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Guide for Victims and Witnesses - William R. Keating, Norfolk County
District Attorney, 781.830.4800
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Local
Police Departments - local numbers
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County District Attorney - local numbers
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Victim’s Bill of Rights, Massachusetts General Laws Chapter 258-B
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Resources for union committees or employers who are developing workplace
violence prevention programs
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Critical Incident Stress Management - Western Massachusetts Emergency Medical
Services 413.586.6065
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Assaulted Staff Action Program - Massachusetts Department of Mental Health,
Raymond Flannery, PhD, 617.626.8117 or MNA contact margaret Corrigan, 617.626.3039
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Guidelines for Preventing Workplace Violence in Healthcare and Social Service
Setting, U.S. Department of Labor, OSHA, available at www.osha.gov
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Violence at Work - A Training Workbook, The Labor Institute 853 Broadway,
Room 2014, New York, NY 10003, 212.674.3322
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Massachusetts Division of Occupational Safety in the Department of Labor
and Workforce Development. A state agency that utilizes OSHA Guidelines
to address safety and health concerns, including workplace violence, to
protect workers in state facilities. 617.969.7177
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Bureau of Justice Statistics, Special Report: National Crime Victimization
Survey, Workplace Violence, 1992-96, Revised 7/28/98 - www.ojp.usdoj.gov
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Illinois Nurses Association Position Statement on Workplace Violence,
Illinois Nurses Association, 1995
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Guidelines for Preventing Workplace Violence in Healthcare and Social
Service Setting, U.S. Department of Labor, OSHA, available at www.osha.gov
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