New research released by the Occupational Safety and Health Administration (OSHA) and the International Association for Healthcare Security & Safety (IAHSS) Foundation has confirmed what most working in healthcare security have suspected for years — that staff working in hospitals, and particularly emergency departments, can and do experience much higher rates of workplace violence than individuals working in other occupations.
OSHA’s Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers found that in 2013, the number of assaults involving days away from work were as many as 12 times greater in healthcare and social assistance facilities than in the private sector as a whole (13 to 36 per 10,000 workers in healthcare compared to three per 10,000 in the private sector). Additionally, between 1993 and 2009, healthcare workers had a 20% overall higher rate of workplace violence than all other workers, and workplace violence in medical occupations accounted for more than 10% of all workplace violence incidents. Despite these troubling figures, the OSHA report speculates that the actual rates may be much higher because workplace violence in general is underreported.
The rate of violent crime at U.S. hospitals also appears to be increasing. According to the IAHSS Foundation’s latest research, which was released at the IAHSS annual conference earlier this month, from 2012 to 2014, the rate of violent crime increased 40%, from 2.0 to 2.8 incidents per 100 beds. The vast majority of aggravated assaults (79%) and assaults (90%) were against employees and were committed by customers, clients, patients, students, inmates or any others for whom the organization provided services. OSHA found that inpatient and acute psychiatric services, geriatric long term care settings, high volume urban emergency departments and residential and day social services present the highest workplace violence risks for hospital staff. Working directly with people who have a history of violence, abuse drugs or alcohol, gang members, and relatives of patients or clients increases hospital employee risks, as does working in areas with high crime rates, facilities with poor environmental design and bad lighting, and hospitals that don't provide sufficient ways staff can communicate during an emergency. Patients, families and friends who possess guns, knives and other weapons also increase the risks for workplace violence.
The OSHA report also highlights organizational risk factors, including:
- Lack of facility policies and staff training for recognizing and managing escalating hostile and assaultive behaviors from patients, clients, visitors, or staff;
- Working when understaffed—especially during mealtimes and visiting hours;
- High worker turnover;
- Inadequate security and mental health personnel on site;
- Long waits for patients or clients and overcrowded, uncomfortable waiting rooms;
- Unrestricted movement of the public in clinics and hospitals; and
- Perception that violence is tolerated and victims will not be able to report the incident to police and/or press charges.