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Reference
This page frequently refers to MNA's Workplace Violence Booklet. This document is available to download for FREE in pdf format by clicking MNA Booklet - Workplace Violence. |
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The Massachusetts Nurses Association Experience
Workplace Violence Prevention in Healthcare
For presentation at the International Conference on Workplace Violence in the Health Sector on 22–24 October 2008,
De Meervaart,
Amsterdam, Netherlands
Workplace Violence Prevention at the Massachusetts Nurses Association
A multifaceted approach to educate nurses, employers, legal and legislative representatives about workplace violence prevention
Who are we?
Evelyn I. Bain, MEd, RN, COHN-S, FAAOHN
Associate Director/Coordinator Health and Safety Division
340 Turnpike Street, Canton, MA 02021
781-821-4625 x 776
eviebain@mnarn.org
Rosemary O’Brien, RN, Chairperson Workplace Violence and Abuse Prevention Task Force, MNA Board of Directors
340 Turnpike Street, Canton, MA 02021
Why are we here?
- To share nearly 10 years of learning about the problem of violence directly from nurses who have been injured, disabled and/or have left the profession as a result of violence.
- To share the materials we have developed to address the concern.
- To provide those materials for others to use.
- Resource: The booklet Workplace Violence
Injuries sustained by a nurse at work
1999 MNA Takes a Stand
- RN assaulted by a patient in a behavioral health setting goes to court to file criminal charges against her patient.
- Clerk Magistrate said “What did you expect working there?”
- MNA believed “In Healthcare or Anywhere, Violence is NOT part of the job”.
U. S. Bureau of Labor Statistics (BLS) 1993 – 1999 and 2005
Workplace violence in healthcare and social service settings
Non-fatal assaults
Select occupations with largest number of violent victimizations, average/ year
Workplace Violence, National Crime Victimization Survey
Every Year:
- More 1.7 million Americans are assaulted at work
- 6 million are threatened
- 16 million workers are harassed
1993 - 1999 U.S. Bureau of Justice, Workplace Violence
Healthcare specific
- 325,000 aggravated assaults
- 36,500 rapes/ sexual assaults
- 70,100 robberies
1993 - 1999 U.S. Bureau of Justice, Workplace Violence
10 years later
2005 U. S. Bureau of Labor Statistics (BLS)
Not much has changed
Establishments reporting an incident of workplace violence in the 12 months prior
- Private Industry establishments – 7,144,950
- By any act of violence – 4.8%
- Health Care/Social Service establishments – 5,920
- By any act of violence - 8.8% Health Sector 2X the incidence as Private Industry
2005 BLS - Table 1
Violence by Customer or Client
- Private Industry establishments - 7,144,950
- Employees reporting yes - 1.9 %
- Health Care/Social Service establishments. - 5,920
- Employees reporting yes 31.2 % 2005
2005 BLS - Table 1
Criminal Violence*
- Private Industry Establishments – 7,144,950
- By acts of criminal violence – 2.1
- Health Care/Social Service Establishments – 5,920
- By acts of criminal violence - 2.7 %
* Criminals who receive care in healthcare institutions are considered patients with very few constraints that criminals are controlled/observed with in other settings. This includes criminals being held for psychiatric evaluations.
2005 BLS - Table 1
BLS Survey of Workplace Violence Prevention Actions
“Nearly five percent of private industry establishments experienced an incident of workplace violence in the last year. While one-third (33 percent) reported a negative impact on employees, Only 11 percent changed their policy after the incident and 9 percent had no program or policy.”
2005 BLS
In agreement
- Almost ninety percent of establishments did nothing to change the environment or protect workers from violence.
- MNA Survey Data - 2004 “Although managers and supervisors appear sympathetic, nothing changes.”
Underreporting is acknowledged
- Mangers do not ask. Workers do not tell.
- Why workers do not report:
- No reporting process
- Fear of retaliation
- Fear of poor performance reviews
- Fear of blame for causing the incident
- Time consuming
- Nothing changes “anyway”
Task Force on Workplace Violence and Abuse Prevention
2000 - present
Task Force
- MNA members and others - volunteer to participate
- Some are survivors of violence - some are not
- Attend meetings and activities
- Discuss violent events to members and others as well as employer response
- Advocate for injured nurses
- Support injured nurses
- Suggest topics and assist in developing educational events and printed materials
- Provide testimony at legislative hearings
- Staff member assists
Commitment to the Task Force
- Some members have been involved for 10 years
- Others only attend an occasional meeting
- Members are reimbursed for travel to meetings
Mission Statement of Task Force
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.
Printed in MNA Booklet – Workplace Violence
Task Force Events
- Met with the Chief Justice of the Court system – “Workplace violence is NOT part of the job.”
- Educational event for 2001 Worker Memorial Day (AFL-CIO) - “In Healthcare or Anywhere: Violence is NOT part of the job”
- TV and radio interviews with affected nurses
- Injured workers and OSHA representative presented
- District Attorney who said: “Workplace Violence is a Crime”
- State Police Lieutenant, also an RN, said “Call the Cops”
Publications of the Task Force
- Brochure on Workplace Violence – information for union representatives to assist injured workers and develop prevention programs and strategies
- Position Statement on Workplace Violence and Abuse Prevention Pg. 11
- Fact Sheet - Ten Things a Nurse Should Do If Assaulted at Work Pg. 18
- Fact Sheet - How to Recognize and Respond to Bullying at Work Pg. 19
- Sample Contract Language on Workplace Violence Prevention Pg. 15
Printed in MNA Booklet – Workplace Violence
Position Statement on Workplace Violence and Abuse Prevention
Provided a rationale and process for violence prevention
- Healthcare and Social Service Workers have the highest incidence of injuries from workplace assaults.
- Steps for developing violence prevention programs.
- OSHA Guidelines – Management commitment and employee involvement
- Support for victims of violence at work. Support nurses injured by violence
- Provide non-judgmental listening
- Deflect self blame
- Help with police reports
- Keep in touch by phone or visiting
Printed in MNA Booklet – Workplace Violence
Post traumatic stress – many nurses never return to work after an assault
Violence affects nurses and their patients
- Nurses and patients who are victims or witness violence frequently experience post traumatic stress disorder (PTSD)
- ICD 9-309.81 Post traumatic stress
- Experienced, witnessed or were confronted with an event or events that involve actual or threatened death or serious injury or a threat to the physical integrity of self or others
- Person’s response involved intense fear, helplessness or horror
Helping the victim (survivor)
- “You did nothing to cause this to happen”. vs. “What would you do differently next time?”
- ”I’m sorry this happened to you.” vs. no communication from managers or co-workers.
- “You did not deserve to be treated like that.” vs. silence from managers or co-workers.
Prevention Resources
- U. S. Department of Labor, Occupational Safety and Health Administration (OSHA) Guidelines for Preventing Workplace Violence to Health Care and Social Service Settings – www.osha.gov
- Policies that address harassment and bullying
- Methods for detection, confiscation and control of firearms and weapons from anyone except trained police officers
- Security officers trained to a national standard
What the union/co-workers can do to help victims
- Contract Language
- Encourage victims
- To report the incident to all who will listen and those who will not
- To talk about the incident – especially to trained counselors
- Follow the 10 Actions a Nurse should Take if Assaulted at Work
- Support
- Provide non-judgmental listening Deflect self blame Help with police reports Keep in touch by phone or visiting
Model Contract Language
- Preventing - Workplace Violence and Abuse
- Policies and procedures for violence prevention
- Trained Response Teams
- Accept and File Injury reports
- No last names on ID badges
- Assisting - Nurses are victims of workplace violence
- Police protection
- Hold perpetrators of INTENTIONAL violence accountable
- Provide medical and psychological services
- Bring reports to safety committee
- Initiate change
Printed in MNA Booklet – Workplace Violence
Model Contract Language
- Provide a safe environment
- Develop labor/management committees to address violence
- Conduct surveys to identify problems
- Establish reporting systems
- Provide support and medical attention for injured workers
- Evaluate program continuously
Contract Language Accomplishments
- Eleven individual MNA union contracts now address Workplace Violence and Abuse Prevention
- Metal detectors in 2 methadone clinics
- Post traumatic evaluations and follow-up assured
- Escorts and well lighted parking lots
- Assisting nurses filing criminal charges against perpetrators
MNA 2007 Hazards to Nurses and other Health Care Workers Conference Pg. 21
- Input from staff nurses, who are the front line health care workers and believe that:
- Restraint reduction policies increase risk of injuries for other patients and staff
- Vicarious trauma can occur in those who witness violence – staff and patients
- Good practices in place already:
- Early intervention training – de-escalation
- Shuttle services to parking lots
- Culturally sensitive competency programs
Printed in MNA Booklet – Workplace Violence
Staff nurses recommend to their employers
- Concrete steps to address health and safety, particularly violence:
- Organize a team to look at the problem
- Collect and analyze data
- Consider patient safety as well as staff safety when addressing violence
- Work with local police, District Attorney (DA) and patient advocates
- Utilize external resources
- OSHA Guidelines and other on line resources
The ultimate price paid by a healthcare/social service worker just doing her job.
Photo courtesy of the New York State Professional Employees Federation (NYS-PEF)
A tragedy happens: but Judy Scanlon had left a message
- She recognized the danger she was in from this client (patient)
- She brought her fears to her employer
- Her concerns were not addressed
- Judy Scanlon was killed by the client
- Judy left a note for her family telling them of her fears and her employer’s disregard for her safety
- NYS-PEF worked to develop laws in New York State (USA) to address Workplace Violence Prevention
Involving Law Enforcement
- William R. Keating, Norfolk County (MA) District Attorney
District Attorney Keating and the Partnership Guidelines include:
- Concept of the Broken Glass Theory in violence prevention
- Sex offender registry information
- Workplace Violence Prevention Checklist - OSHA
- Disruptive Patient Policy
- Safety precautions for Home Health Care Staff
- Sample statement on Firearms
- Violence Incident Report Form - OSHA
District Attorney’s across Massachusetts
- Eleven other District Attorneys have work with the MNA
- Participated in educational events for local bargaining units, in communities and at conventions
- Provided expertise and support from Massachusetts Office of Victim Assistance to nurses holding perpetrators accountable
- Equate Workplace Violence cause and effect on victims/survivors with Domestic Violence cause and effect on victim/survivors
MNA Legislative initiatives
- Two Laws Proposed 1.It will be a felony to assault a healthcare worker would result in greater penalties to perpetrator
- Workplace violence prevention programs in hospitals to include education and training and care for injured workers (PTSD)
- 2006 and 2008: Hearings held but no final vote
- Nurses and police provide testimony
- Re-file expected for the 2009/2010 Legislative Session
Printed in MNA Booklet – Workplace Violence
Barriers to Legislation
- Coalition to Protect the Mentally Ill
- Believed the mentally ill community would be at greater risk of prosecution
- Perceived expense of implementing educational programs vs. cost care and replacing injured nurses and others
- Workplace Violence and Abuse Prevention program development and training time
- Denial in the industry that the problem exist
- No systematic reporting process
- No data - no problem
MNA Workplace Violence Prevention Educational Events
- U. S. Department of Labor, OSHA/MNA Alliance Workplace Violence: Healthcare is Not Immune;
134 attended – staff nurses, managers, supervisors State Police Lieutenant, also an RN, repeats - “Call the Cops”
- Suffolk University School of Law – Bullying in the health care system;
MNA Convention educational program Fact Sheet “How Bullies Pick Their Targets”
MNA Task Force and Congress on Health and Safety Conducted Survey - 2004
- Survey of violence in three hospitals where MNA members work
- 172 respondents
- Nurses report:
- Assaults common
- Verbal assaults most common
- Weapons used
- Managers sympathetic
- Reports made but nothing changes
Printed in MNA Booklet – Workplace Violence
- Majority of violent acts are committed by patients
- 25 – 30 % of nurses frequently pinched, scratched, spit on or had hands or wrist twisted
- 8 sexually assaulted
- 2 intentionally stuck by dirty (contaminated) needles
- Weapons include furniture, pencils, pens, medical equipment – needles, knives, scissors, and guns (2%)
- Most nurses continue to work after reporting incidents of violence
MNA 2004
Workplace Violence Survey results
- 50% reporting violence at work within the past two years resulting in:
- Difficulty concentrating on their job after violence
- Fear, headaches, flashbacks
- Impairment resulting from physical injuries
MNA 2004
Workplace Violence Survey Nurses suggest to employers:
- 88% Safe Staffing levels need to be increased
- 52% Training on legal rights related to violence be provided
- 51% Adequate time needed to assess and intervene to prevent crisis
- 51% Unit based protocols addressing violence are essential
- 48% Policy and Procedures addressing violence communicated to staff
MNA 2004
MNA Workplace Violence and Abuse Survey Tool Pg. 39
- Questions developed by Task Force members from their experiences at work.
- University of Massachusetts, Amherst, prepared the survey tool and analyzed the results.
- Survey Tool has been used by nurses’ organizations and by university nursing education programs to conduct additional research.
Printed in MNA Booklet – Workplace Violence
The goal has not been reached.
Nurses and others are still injured by violence at work
Photo courtesy of the New York State Professional Employees Federation (NYS-PEF)
MNA members continue to receive support
- MNA responds to individual members concerns and events of workplace violence using the guidelines that we and others have developed.
- Prevention planning occurs through labor/management meetings.
- Collaboration and communication with staff and Task Force members helps injured nurses.
MNA continues to educate nurses and other front line workers
- Assure that nurses and others understand:
- Criminal violence in healthcare IS a police matter.
- Violence against healthcare workers IS a crime.
- “Violence is NOT part of the job”. “
- you did not do anything to cause it”.
- Report to anyone who will listen and those who will not!
MNA Continuing Education On-Line Pg. 46
- Workplace Violence
- Visit Continuing Education, proceed to register.
- 0.8 Continuing Nursing Education - contact hours earned by anyone who completes the program and receives 80% or better on the test.
- Free to anyone, anywhere in the world.
Printed in MNA Booklet – Workplace Violence
All Materials available on line
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