Recently workplace violence has gained recognition as a distinct category of violent crime that requires specific responses from employers, law enforcement and the community according to the Department of Labor, Federal Bureau of Investigation (2004). Presented by: Sheila Wilson RN, MPH : issues in response. Retrieved January 24, 2006 from http://www.fbi.gov/page2/march04/violence030104. Definition of According to the National Institute for Occupational Safety and Health (NIOSH), workplace violence is an act of aggression directed toward persons at work or on duty and ranges from offensive or threatening language to homicide. Workplace violence is commonly understood as any physical assault, emotional or verbal abuse, or threatening, harassing, or coercive behavior in the work setting that causes physical or emotional harm. What is Abuse? Abuse Definitions Abuse is a pattern of coercive control that one person exercises over another. Abuse Definitions Verbal abuse Verbal Abuse is form of abusive behavior involving the use of language. In its form of profanity, abuse can occur with or without use of expletives. Oral communication is its most common form. A victim is targeted by name calling, angry outbursts, screaming, rage, sarcasm, and cool indifference Abuse Definitions Physical abuse Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm. Includes: hitting, slapping, kicking, spitting and pinching. 1
Who is at risk? Everyone Studies have shown that the highest risk areas are: Emergency Departments Psychiatric Departments Nursing Homes Domestic and Global Workforce 1. Approx 900 DEATHS (15%)/yr. 2. 1.7 million nonfatal assaults REPORTED in the United States Crime Victim Survey s National Crime Victimization Survey (1993-1999) National Annual Nonfatal Violent Crimes 1. Nurses - 21.9/1000 workers 2. All occupations - 12.6/1000 workers Labor Statistics Bureau (2004) 1. 46% nonfatal assaults and violent acts that involved time off were against RN healthcare practitioners Crime Victim Survey Journal of Emergency Nursing 2002 study of ED Nurses: 1. 82% of ED nurses REPORTED that they were assaulted the previous year. ENA 2007 one month survey study of ENA RN s: 1. Sent to 32,000 ED ENA Nurses 2. Response: 3,465 RN s 3. 4% reported physical assault each shift (72% hit, 77% spit on, 56% pushed) 4. 27% experienced frequency >20 episodes of physical Violence/3yr. Period 5. 27% reported verbal abuse each shift 6. 70% experienced frequency >200 episodes of verbal abuse/3yr. Period (96% yelled/ sworn at, 70% intimidated) WHY should you be concerned? You can get injured Abuse is on the rise Affects the victim, their families and all who hear or bear witness to the abuse Also our job is to be safe and maintain the safety of ALL other healthcare workers and our patients. You deserve and have the right to be safe There is a lack of Violence Prevention Programs in the workplace Denial of problem Lack of communication Lack of collaboration Lack of respect Lack of clear written policy/procedures Lack of documentation and follow-up Lack of awareness of cultural/diversity issues Lack of security Lack of Zero Tolerance signs Inability to maintain safety devises Lack of education Lack of accountability Lack of an organization-wide commitment to safety 2
So what can you do about it? What contributes to increased Negativity and Stress in the workplace Understaffing that leads to job overload. Frustrations arising from poorly defined job descriptions and responsibilities. Poorly defined policy and procedure surrounding workplace violence Downsizing or reorganization. Labor disputes and poor labor-management relations. Issues with accountability and follow through. Poor management styles (for example, arbitrary or unexplained orders; over-monitoring; corrections or reprimands in front of other employees, inconsistent discipline). Inadequate security or a poorly trained/motivated security force. A lack of employee counseling/education. A high injury rate or high number of grievances. Get involved Support your peers Protect yourself and your patients Report all incidents Why bother to report? Under reporting has been a chronic problem. Report all threats, verbal and physical assaults, stalking and harassment in order to be consistent and to bring public attention to the problem. Violent acts should be a part of the Public Record no matter where they occur. Reporting can serve as a deterrent if prosecution becomes a routine consequence of violent behavior. Interprofessional Approach A strong, comprehensive violence prevention program requires a interdisciplinary team approach with clear goals and objectives suitable for the size and complexity of the workplace Interprofessional Approach The Team Administrator/Manager HR Physician/PA/NP Security Risk Management Social Service Admitting staff Nursing Police Nursing/Medical Assistants/Mental Health Workers Ancillary Staff Interprofessional Approach Flagging system to alert staff of any potential abuse or safety risk. Clear concise policies and procedures. Clear visable zero tolerance signs. Security. Lighted and secure areas (lighted stairwells/parking area; locked secured doors). Safety devices (bells, phones) Prevention Educational Programs Notify your supervisor/administrator immediately for any and all threats. Staff /victim should be immediately removed from the situation and evaluated by MD. Incident reports must be completed for any and all threats (need data collection for ongoing evaluation). 3
Interdisciplinary Approach Injured Staff Reporting PROCEDURE: Any staff member who identifies any person/patient as Abusive (verbally or physically) will notify the Charge Nurse, Supervisor and Security immediately. Security must be visible and present during the identified abusive person/patient stay. No nurse or staff member should approach the abusive person/patient without security. The physician or designee will immediately evaluate the abusive patient. Follow violence prevention policy. Maintain safety measures at all times. Attend Violence Prevention Educational Programs. File an incident report File Criminal Charges! DO NOT GIVE HOME ADDRESS Call the Supervisor. Notify security/police and request their presence. All injured staff should file an Employee Injury Incident Report. Injured staff should be seen in ED, employee health or by own PCP. Injured staff should take pictures of any injuries. Save all copies of reports for your personal records and keep a diary. Incident Report Documentation: Just the Facts When Completing both Incident Reports: 1. Include time, date and who was notified. 2. Report an objective description of the event including an assessment of the person who assaulted you. Respond in a cautious manner to any question that may imply blame what could you have done to prevent this? Nursing Note Documentation: Include an objective description of the event. Give specific and accurate statements. Quote comments made by the patient. Exclude any personal opinions, vague statements or any reference to any incident reports. Filing Criminal Charges Susan Vickory, RN, C modified by: Sheila Wilson, RN, MPH Sheryl Williams, RN, BSN Filing Criminal Charges Notify the police. File a police report (The police may come to the facility to take a report of the incident). Have ready the name and address of the abusive person/patient. Have ready how you have identified the person/patient as to who he/she say they are. Detectives may come into the facility and at that time you will need to identify the assailant by photo. Charges may be filed directly at the District Court by the detective. Notification of a date for a hearing will be sent to you by mail. 4
Clerk Magistrate District Attorney Will determine which cases go before the judge for arraignment. Bring with you: Pictures of your injuries, medical reports and the police report. Assistant District Attorney (Prosecutor) will handle the case. You don t need to hire a lawyer. A Victim Witness Advocate will meet with you and your witnesses to explain the court procedures. An ADA will keep you informed as to the dates of court appearances. Trial Bring witnesses or co-workers who can confirm your story. The ADA will prepare you, the victim, and your witnesses for testimony. You have the right to speak in court in front of the judge. Trial Prepare a impact statement about what happened and what you would like to see happen. Include how this has affected you physically, mentally and financially. The defendant has the right to choose between a trial by jury or trial by the judge. Closing Comments At this time, in this state, it is a misdemeanor to assault a nurse or any other healthcare professional. However, with the new Assault Law penalties have increased for the abuser. All Healthcare Workers and EMT s are included while on duty. If a weapon is used, it is a felony. If you are 60 years or older, it is considered elder abuse. If you wish to file a law suit in Civil Court for damages, pain and suffering, you will need to hire a personal lawyer or one who specializes in personal injury. Closing Comments Continued The organization has a obligation to provide a safe environment for staff and patients. We have a moral and ethical obligation to support and care about the wellbeing of one another and our patients. 5
Important! Remember! Become Involved! It takes a village to raise a child Please write to any and all federal and state legislatures to Stop the violence. It takes a BIGGER village to Stop Violence For any questions Please contact us at: www.stophealthcareviolence.org 6