The United Kingdom's Department of Health announced last week that it was providing an additional £97 million ($198 million US) to its National Health Service for programs to protect healthcare workers from violence and abuse. The Health Secretary noted:
"Over 58,000 NHS staff were physically assaulted by patients and relatives in England in 2005-06. This is completely unacceptable. NHS staff working alone and in the community are particularly at risk.  NHS staff dedicate their lives to caring for the sick and in return they deserve respect. Anybody who abuses our staff must face tough action and the possibility of jail."
I don't know how many thousands of healthcare workers are assaulted on the job annually in the U.S., but I'm sure there's no comparable federal effort afoot in our country to provide this same kind of protection for our health-service workers.
The most recent data I could find on workplace violence incidents among healthcare workers appeared in a 2002 NIOSH document entitled, "Violence: Occupational Hazards in Hospitals."  It referred to Bureau of Labor Statistics (BLS) data (and on hospital workers only) and reported 2,637 nonfatal assaults in 1999. (A rate of 8.3 assaults per 10,000 workers, compared to a rate of 2 per 10,000 workers for all private-sector industries.)
These BLS rates are significantly less than those reported by public health researchers. A study by Peek-Asa, et al (1998) estimated a non-fatal annual assault rate of 465 per 100,000 hospital workers and a study by LaMar et al (1998) reported that nurses accounted for 7% of the total number of workers compensated (through the Minnesota Workers' Compensation system) for work related assaults [1,2].
A bit more recently, May and Grubbs (2002) surveyed nurses working at a large (770-bed) acute care medical center in Florida. 88 percent of the nurses survey reported being verbally assaulted in the previous year and 74 percent reported being physically assaulted, most often from perpetrators suffering from cognitive dysfunction or substance abuse. The researchers reported that the assaults were just as often instigated by a family member or visitor, as the immediate patient. [3] In a survey of 4,918 State-licensed RN's and LPN's in Minnesota, Gerberich and colleagues reported annual rates of 13.2 per 100 nurses for physical violence and 38.8 for non-physical violence [4].
The UK's investment of $198 million to better protect their healthcare workers focuses on a few specific solutions, such as providing 30,000 safety alarm devices for healthcare providers, especially those who work alone. The small device includes an alarm that the worker can sound when she or he is threatened or assaulted. It includes an electronic tracking device to help locate the at-risk or injured healthcare worker and summon help. Portions of the $198 million will fund additional security personnel, a special reporting system to track incidents and target prevention efforts, conflict resolution training for staff, and resources to prosecute those who assault healthcare workers.
UNISON, the largest trade-union in Britain, welcomed the announcement which was made by the Health Secretary at a speech to the Labour party conference.  The union also applauded legislation moving through the House of Commons which would make it a punishable offense for "a person causing a disturbance to refuse to leave NHS premises."
"Karen Jennings, UNISON head of health, said: 'Aggressive behaviour in any form is distressing for NHS staff, patients and visitors, and should not be tolerated. So-called nuisance behaviour is often highly offensive and can easily escalate to more serious offences such as assault. ...This legislation provides another weapon for hospitals to use to protect their nurses and other NHS staff.'"'
In the U.S., it is action on the State-level which may make a difference for the safety of healthcare workers. Nurses in Massachusetts, for example, are lobbying support in the State legislature for a law requiring hospitals to implement comprehensive workplace violence prevention programs, and provide counseling to worker-victims of violence. The bill was the brainchild of the Massachusetts Nursing Association's (MNA) Congress on Health and Safety Task Force on Workplace Violence.
In a June 2007 news release issued by the MNA, nurses described their first-hand experiences with assaults on-the-job.
"Ellen MacInnis, a nurse at St. Elizabeth's Medical Center, described her ordeal to the committee. She was attacked by an intoxicated patient who swung at her and in doing so dislodged her own IV. As a result, MacInnis was exposed to HIV and Hepatitis C. 'I still have anxiety. It's been a life-changing event. I just want to be safe while I'm doing my job.'"
Patricia Duggan, who at the time worked at Mt. Auburn Hospital, described her encounter with a patient who became belligerent, attacked her and threatened to wait for her until her shift was over. She contacted her nurse manager who specifically told her not to call the police. Duggan called the police anyway and when the officers escorted her to her car at the end of her shift, they found the assailant waiting in the parking lot. 'My managers were furious at me for calling the police,' Duggan said, 'and I was reprimanded.'"
In the Occupational Health News Roundup, I learned that Kentucky adopted a new law earlier this year to provide better protections, such as electronic safety alarms, for certain State employeed in the Department of Community-Based Services. The bill was named to honor Boni Frederick, a 67 year-old social worker who was murdered in October 2006 while taking a 10-month old baby for a scheduled visit with the infant boy's mother.
âThis bill will make working conditions safer for human services workers,â said Rep. Tom Burch (D- Louisville), a sponsor of the bill. âOur authorization of neutral visitation centers, extra staff and enhanced safety tools will mean significant changes in the way staff can help families. These workers see things and help people in situations most of us could never imagine, and they deserve this support.â (here)
The other kind of support that health- and family-service workers deserve is recognition by management officials of the severity of the problem. Craig Slatin ScD, MPH, an associate professor at UMass Lowell, notes that "managers don't understand the seriousness of these issues and how they relate to the safety of their workers."
Which brings me back to the UK's new initiative to protect the NHS staff from violence on-the-job. In the Health Secretary's announcement, he reported "over 58,000 NHS staff were physically assaulted by patients and relatives in England in 2005-06," suggesting they have at least some mechanism to track these incidents.
But in our nation's disjointed health care-, workers' comp- and workplace safety and health systems, we don't have national-level statistics on incidents of violence against health care or social workers (as mentioned above, the latest Bureau of Labor Statistics data on the topic is dated: 1999) ---which might be a key reason why managers and national-level lawmakers have failed to recognize the seriousness of the problem of violence against healthcare workers, and do something about it.Â
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[1] Peek-Asa C, et al. Incidence of nonfatal workplace assault injuries determined from employers' reports in California. J Occup Environ Med, 1997; 39: 44-50. (abstract)
[2]LaMar W, et al. Work-related physical assault. J Occup Environ Med, 1998; 40: 317-324. (abstract)
[3] May DD, Grubbs LM. The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center J Emerg Nurs, 2002; 28(1): 11-17.  (abstract)
[4] Gerberich SG et al. An epidemiological study of the magnitude and consequences of work-related violence: the Minnesota Nurses' Study. J Occup Environ Med, 2004; 61: 495-503. (abstract)
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A 2005 study of Michigan ER doctors showed that 75% were verbally threatened, 28% were physically assaulted and 3.5% were stalked in the previous year.
This study was quoted in a recent Wall St. Journal column, "Nurses' Reality: Enduring Slights, Injuries While Caring for Patients."
One might also wonder where OSHA is on workplace violence. OSHA issued guidelines on workplace violence in health care and social service institutions during the Clinton Administration, but has done very little enforcement; none during this administration.
Interestingly, a federal judge ruled last week against an Oklahoma law that prohibited employers from banning firearms from the workplace because it was in violation of OSHA's General Duty Clause:
Thanks Jordan. Glad to know that there is at least one judge who puts workers' rights to a safe workplace above some broad reading of the Second Amendment on bearing arms.
You can add Oregon to the growing list of states trying to take some action in this area.
During the last state legislative session, the lawmakers passed HB2022, which applies to hospitals, home health care services associated with a hospital, and ambulatory surgical centers. These selected health care employers are required to:
* Conduct periodic security and safety assessments to identify existing or potential hazards for assaults committed against employees;
* Develop and implement an assault prevention and protection program;
* Provide assault prevention and protection training on a regular basis for employees;
* Maintain a record of assaults committed against employees taht occur on the premises of the health care employer (or in the home of a patient receiving home health care services).
Furthermore, employees who have been previously assaulted by a patient may request that a second employee accompany him or her when treating the patient. If a second employee cannot be provided, the employee has the right to refuse to treat the patient. The employer cannot impose sanctions on an employee who used reasonable physical force in self-defense.
After the first year of the law's implementation (2008) the health care employers are required to submit their logs of assaults to the Department of Consumer and Business Services (which houses Oregon OSHA) for data analysis. DCBS is the required to submit a report to the 2009 legislature (be on the look-out for that... Since I'll probably be the one writing it, I'll let you know.)