From the Massachusetts Nurse Newsletter
April 2004 Edition
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 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 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:
- "The nurse must have done something to provoke the attack."
- "It can’t happen here, or it won’t happen to me."
- "It’s part of the job."
- "Patients aren’t responsible for their behavior."
Recognizing a violence prone workplace3
- prevalence of handguns as weapons among patients, their families or friends
- increasing use of hospitals by police and the criminal justice system for criminal holds
- care of acutely disturbed, violent individuals
- unrestricted movement of the public in clinics and hospitals
- long waits in emergency or clinic areas
- low staffing levels during times of specific increased activity
- isolated work with clients
- solo work in remote locations
- lack of training in recognizing and managing hostile and assaulting 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
Weakness Poor abstract
Depression Hyper-alert to
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.
- 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.
- 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.
- If the assault is from a patient, document the patient’s behavior in the nursing notes. This is the most essential legal documentation.
- 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.
- Request and participate in Critical Incident Stress Debriefing (CISD). CISD is essential following a violent episode.
- Co-workers who witness assaults must be included in CISD.
- Keep a diary of the progress of treatment, discussions related to your injuries and the progress of any claims for Workers’ Compensation.
- 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:
- report the incident
- talk about the incident
You can also help by
- deflecting self blame
- providing non-judgmental listening
- helping with police reports
- keeping in contact by phone or visiting
- assuring that the Steps in Actions are followed
What can the union do to help victims of workplace violence?
- Plan a system for addressing Workplace Violence. Use the Actions Following an Assault steps as the basis for planning your system.
- Help your co-worker through the steps.
- Advocacy may be needed to obtain copies of reports.
- Designate someone to keep in caring and concerned contact with your injured colleague.
Personal safety tips
- Use the buddy system if available or develop your own.
- Don’t carry keys, pens, jewelry or other items that could be used as weapons.
- Don’t wear items around your neck that could be used against you in confrontational situations.
- Make sure that nurses and physicians are not alone when performing intimate physical exams on patients.
- Attend classes in self defense and crisis intervention when available.
What can the union do to prevent workplace violence?
- Promote zero tolerance for workplace violence.
- Create and maintain a safe work environment as well as the prevention and response for workplace violence.
- Make workplace safety and health a priority and standing item for committee and labor management meetings.
- Maintain union presence on hospital safety committees.
- Learn the employer’s policy and procedure for violence and harassment and educate self and members.
- Accompany victims when they are filing police reports. Accompany them during police and court proceedings.
- Introduce the OSHA Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers to management as the basis for violence prevention activities.
- 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.
- Develop a buddy and escort system to protect workers in remote areas and parking lots.
- Anticipate "slip ups" in the Workers’ Compensation process and advocate for the injured worker.
- File grievances.
- Encourage the development of support groups for injured workers.
- Report on activities in local unit newsletters, especially the progress toward prevention.
Resources for nurses
- In the Aftermath of Crime—A Guide to Victim Rights and Services in Massachusetts. Cambridge Street, Boston, MA 02201, 617.727.5200
- Guide for Victims and Witnesses, William R. Keating, Norfolk County District Attorney, 781.830.4800
- Local police departments
- County district attorney
- Victim’s Bill of Rights, Massachusetts General Laws Chapter 258-B
- Resources for union committees or employers who are developing workplace violence prevention programs
- Critical Incident Stress Management, Western Massachusetts Emergency Medical Services, 413.586.6065
- International Critical Incident Stress Foundation, Inc. www.icisf.org/cis.html
- Guidelines for Preventing Workplace Violence in Healthcare and Social Service Setting, U.S. Department of Labor, OSHA, available at www.osha.gov
- Massachusetts Division of Occupational Safety. 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
1. Bureau of Justice Statistics, Special Report: National Crime Victimization Survey, Workplace Violence, 1992-96, Revised 7/28/98 – www.ojp.usdoj.gov
2. Illinois Nurses Association Position Statement on Workplace Violence, Illinois Nurses Association, 1995
3. Guidelines for Preventing Workplace Violence in Healthcare and Social Service Setting, U.S. Department of Labor, OSHA, available at www.osha.gov
4. Western Massachusetts CISD Team, c/o WMEMS, 7 Denniston Place, Northampton, MA 01060, www.wmems.org/cisd.htm