Alliance NewsWorkplace ViolenceDiana Quinlan, CRNA, MAAccording to the National Institute on Occupational Safety and Health (NIOSH), 7,600 workers were killed on the job between 1980-1989. The leading cause of death in the workplace is homicide, followed by motor vehicle injury and finally machine related fatalities. Hospital workers are at highest risk of suffering a fatal injury. Important to physicians is the fact that more assaults occur in the health care and social services industry than any other occupation. Workplace violence is defined as physical assault, or threat of assault on the job. This violent behavior comes in several forms: homicide, taking of hostages, assault, rape, robbery, stalking and harassment (the leading form of violence on the job). There are one million U.S. victims of job-related crimes annually. Several factors put the health care provider in high-risk situations:
Federal, state and local government employees comprise only 18% of the work force yet account for 30% of victims of workplace violence. Men are victimized on the job more often by a stranger, while women are most often attacked by someone they know. The cost of this victimization is high when one considers the economic loss of wages, costs of medical bills, workmen's compensation claims, and the emotional costs of fear, anger, stress and depression. An estimated 3.5 days of work are lost annually per crime. The following three cases from reported claims involving anesthesia providers show the diversity of the problem:
The emotional risks for these and other victims of assault include short and long-term psychological trauma, fear of returning to work, and changes in the relationships with coworkers and family. Workplace violence may be any situation that:
In the hospital setting factors that may contribute to violent behavior include concern, fear and anxiety over layoffs, wage and benefit cuts, productivity demands, and longer work hours. The following are some classic warning signs that one may be predisposed to violent behavior:
Beyond the listed predisposing situations there are still others that may trigger a behavioral cascade in the violent perpetrator:
Anesthesia providers have reported several violent acts. One anesthetist was assaulted by their patient's intoxicated family member who then left the treatment room and was luckily apprehended as he tried to reenter with a handgun. The second situation was a provider who feared a fellow staff member will harm them if they report that person's violent behavior. These two situations, one where catastrophic physical harm was barely averted, and the second where the anesthesia provider continued to suffer emotionally from fear, intimidation and anxiety, demonstrates the diversity of our exposure to workplace violence. Victims of violence, real or threatened, can experience physical change. Seventy-five percent have twice the rate of stress related conditions like insomnia, headaches and depression. They may suffer from marital discord, substance abuse or suicidal ideology; and they are ten times more likely to want to change their jobs. Merely witnessing an episode of workplace violence can disrupt someone's life greatly. This "Secondary Victimization" can lead to a condition of hyper vigilance, suspicion and paranoia. My own experience with this as an anesthetist is a good example. I witnessed an "altercation" between two hospital employees just outside the recovery room. My intent was to ask them nicely to lower their voices for the sake of our patients. Upon entering a stairwell, I observed the perpetrator stab the victim in the chest. Luckily for me the perpetrator just pushed me aside to escape. Unfortunately for the victim, the knife wound was a fatal despite vain attempts to operate immediately. In spite of my giving the police a positive identification of the murderer, he was never brought to trial or convicted. Instead he returned to work and threatened and harassed me the remaining years of my tenure. Despite what you believe, it CAN happen in your workplace. Listen carefully and take all threats seriously. Create a safe physical environment by removing all objects from your workplace that can be a potential weapon. Remove furnishings that could block your exit in an emergency, and develop a "Key Word System" as a signal for danger. Be mindful of verbal and nonverbal indicators of impending danger:
Remember that most attackers are not strangers. Most violence from the public that is directed toward managers and staff 43% of the time involves current or former employees, and 36% of the time it is perpetrated by customers or clients. There are five major categories of violence classified primarily by identification of the intended victim. Think about how these occur and then what you can do to reduce your risk. Employer-directed violence involves homicide directed at coworkers or managers. It may occur months after job loss, moreover, it may traumatize the workplace for months or years to come. Domestic-related violence may be the homicide of a spouse or a "target of affection." The perpetrator comes to the workplace seeking alternative victims when legal restrictions protect the spouse. Property-directed violence includes employee-against-employer acts designed to damage company property. It may also involve sabotage such as planting a virus in the computer system, bomb threats, or stealing company secrets. Commercial-directed violence generally occurs during a robbery or attempted robbery. Women, the elderly and teenagers are most often vulnerable with jobs in fast food chains, banks, grocery stores, etc. Terrorism and hate crimes are random behavior and decisions not evident in other types of workplace violence. You might consider it an example of "being in the wrong place at the wrong time." We cannot easily change where we live and work, but we can use constructive steps for dealing with angry employees or clients. Follow these examples to learn how to reduce your risk.
Observe, listen, avoid defensiveness, and develop parameters to diffuse the situation. This simple approach can greatly improve your interpersonal relationships and may one day save your life. It would appear that the health care industry has done little to protect its own when compared to other commercial establishments. Responses to a questionnaire distributed to AANA State Presidents revealed that one-third knew of situations where CRNA's were at risk or have been victims of some form of workplace violence. A survey by the Emergency Nurses Association found that 31% of the security staff at hospitals had no training in handling violent behavior. Furthermore, only 10% had any form of self-defense training. The Occupational Safety and Health Act (OSHA) was created by the federal government in 1970 to "ensure safe and healthful working conditions." It is their policy to cite employers that fail to adequately protect their workers from acts of violence. Despite this public policy, OSHA is concerned that violence is under reported and that there is a persistent perception within the health care industry that assaults are part of the job. Although some attempts at protecting the hospital environment are made up front with pre-employment screening, too little is directed toward protecting the actual employee. OSHA requires mandatory notification of workplace injury within eight hours of the incident if three or more employees are hospitalized, or if the injury caused a fatality. An official log of injury and illness (OSHA 200), is used to document an injury requiring more than first aid, time lost from work, change of duty, and any loss of consciousness. As employees we should stand up for our rights, ascertaining whether adequate programs are in place, and then strive to make them work effectively. Employers who anticipate, appreciate, and sustain the needs of their employees in maintaining a safe working environment are one step ahead in preventing workplace violence. Management and employees must work together in a committed team approach. If you feel that your workplace is a potential site for violent acts, work aggressively to establish policy and institute changes that will afford better protection. Lastly, if you have not had any education regarding workplace violence in your institution encourage it and get moving in the right direction before you find that you are another example of "being in the wrong place at the wrong time."
June, 2000/ Jacksonville MedicineWhat's New
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