Workplace violence prevention in health care settings

Workplace violence is not really a new topic, it
has been around a long time. I started looking
at it with a group of people from OSHA I think back in the 1990s. And health care, even back
then, was pointed out to be one of the major
areas in which injuries both non-fatal and fatal were happening in the workplace, but it took this
amount of time — 2012 — for it to mature and
become important. It’s not that it was important before but a lot of times you had the tendency of
saying it was a criminal issue there is nothing you can do with it and it is
part of the job. So, we’ve changed our dynamic
to say that there is something that employers can do, should do and in
OSHA’s cases as of 2011, is saying that if you
are in certain industries you could be held accountable for injuries that happen to your
employees. We already know that many of the workplace
violence incidents that have happened, do
happen in outstate Minnesota. Outstate Minnesota is not the mecca of peace
and tranquility that we thought it was. They run
into such things as gang problems, they run into problems with meth problems … And some of the problems, maybe not in the
magnitude, of a metropolitan area, but they are
running into problems. Without the resources and knowledge base and
education that is available to the metropolitan
area, it does put them in an isolated situation. The second myth that we want to eliminate
today is that “It can’t be prevented.” We already know that there is best practices,
OSHA is not going to cite you on somethat that
is just random … is looking for the things that are recognizable. It is looking for things that are best practices
and that other companies or industries such as in health care have already developed
to try to prevent workplace violence from
happening. Years ago, I used to interview some of the
security guys in places and I said “What would
you do if this situation happens?” And they said, “Run.” I mean they are making $8
an hour. They are not going to throw their body on the
land mine. You know, so you got to take seriously that most
people are not going to come in as Superman
or Superwoman to save the day. You got to start thinking of a concept of what we
are going to do as a team or as an entity to
protect yourself. So how prevalent is workplace violence? It is
the fourth-leading cause of fatal occupational
injuries in the U.S. and the leading cause of death for women. And, usually it is because of spousal or
domestic violence. According to the Bureau of
Labor Statistics of Fatal Occupational injuries there were 506
workplace homicides in 2010. Now, this is important because when OSHA
starts looking at what industries they want to
address workplace violence … healthcare is going to be at the top of the line. Healthcare, social services, also late night
retail, taxi, bus drivers and teachers, but
realistically for Fed OSHA, they don’t cover Federal or public employees in
most cases. The state plans do. Minnesota does cover State
plans, but for the most part, healthcare is going
to be one of the top areas that they are going to look at to see if you are
providing adequate care for your employees. We talk about violence, it is defined by location.
You define what culture your workplace is
acceptable as far as violence. Not so much for emergency response, but what
do you accept as OK. If you are allowing
bullying, if you are allowing disrepespectful behavior, if you are allowing harrassment, and you may not be allowing it, but you might
not have any mechanisms for reporting, then it opens up an opportunity for people to
cross that line. So, you have to have foundational pieces in
place and you have to have a clear definition of
what workplace violence is. It includes all of these things, but it also
includes being followed, sworn or shouted at.
Not by OSHA’s definition, but we have to understand that workplace
violence does affect not only the physical, but
emotional and psychological. And you’re going to get early burnout. You’re
going to get people who don’t want to work in
that situation. We have places where people are choked,
beaten, stabbed … and they have to go right back in and work with
that same client and there is no provisions
made for their mental or emotional health. When we talk about things that you can put
physically or engineer techniques, we do have a Workplace Safety Grant Program
that covers safety, security for the protection of
your employees, so if things such as quick mechanism for
communication, things such as locks, things
such as trainings could come under that Safety Grant Program. It is not a hard
program, because I use to be the Safety Grant manager
two years ago, so you don’t need a grant
manager to write for this grant, but it’s something that you should look on to our
website to see if it’s something that you could
use. There is four different types of violence that
OSHA looks at: Violence by strangers, which is
more of a criminal type of violence, violence by customer or client, violence by coworkers, and violence by personal
relationships. All of these are things that could happen in the
workplace and employees should have a policy,
procedure or program that will address all these things, but OSHA is not going to site
violence by coworkers or violence by personal relationship at this time. They are only looking at the client or customer
relationship or those that happen by a stranger
as recognizable hazards. On the website there will be a more complete
breakdown of what each management
commitment, employee involvement, hazard assessment and hazard prevention and
control. But these are the tenants of any workplace
violence and some of you recognize them because they are the same tenants for safe
patient handling, but these are the tenants that they are going to
look at and say is the management aware, or
concerned about the hazard? Are they paying attention to the reports? Are the
employees involved? Have they been surveyed? Do they know how to report? Is there a reporting
system? Have you done a hazard assessment
of your workplace? Have you even done anything to prevent and
control this? It’s not good enough to say we trained
someone on how to use a technique and they
are 110 pounds. And they are working with people that are 200 and 300 pounds, and then
he or she is by themselves. You have to use something that is feasibly trying
to make a difference, so after a year or two if you
are still getting racking up injuries and you’re still racking up complaints it’s time to think about doing something
differently. Training and instructing your
employees … They should know what their communication is
… They should know what their emergency
response is … They should know how to handle
a patient that is out of control. It’s hard to try and control someone if you have
no training whatsoever on the proper method of controlling that person
without injuring yourself or the person. Reporting procedures, recordkeeping and then
doing an evaluation at least once a year to find
out is it effective? Is it making a change? And, has there been any difference from last
year to this year?

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