It is well known that OSHA requires every employer to maintain a safe workplace. The law also requires hospital Emergency Rooms (ERs) to treat every patient, even those who may be dangerous. How does a hospital  employer balance those two obligations? It is not always easy.

In the last three years, there has been an increase in violence by patients against healthcare workers. No one can say for sure why this is occurring. In some instances, it may be because public hospital ERs are getting more crowded as unemployed patients who lack private insurance go to the ER to receive basic care. The crowded conditions cause long waits,  patients become frustrated, and violence may ensue. There are also volatile patients with mental health or drug or alcohol problems who present for treatment. Stressors that family members feel when a loved one is in a life-threatening situation can also contribute to volatile situations. The most challenging areas are the emergency rooms and public access areas of a hospital, but a violent patient (or family member) can "explode" anywhere.

Some states have used legislation to address the issue. In New Jersey, for instance, the state passed the “Violence Prevention in Health Care Facilities Act,” requiring select healthcare entities to establish violence prevention programs. New York has made assault on an Registered Nurse or Licensed Practical Nurse a second degree assault, which is a class C felony. The state also passed a public employer workplace violence prevention law that  requires public employers to establish violence prevention programs.

Even if your state does not have similar laws applicable to your institution, these statutes are harbingers of things to come. Moreover, they provide some useful guidleines for an employer that is looking to establish or improve its own program.

What should hospital employers be thinking about?

Emergency Response Systems – What is your emergency response system and is it adequate? Some years ago a violent patient shot his wife in the ER of a New Orleans hospital. The hospital realized that its emergency system, which automatically instructed staff to go TO the scene of an emergency, was not adequate. In that case, it would have staff rushing into a dangerous situation. The system was revamped with new codes, including one that instructed staff to go into a "lockdown" mode, under desks and behind doors, in the event that a shooter or violent person was loose in a facility.

Training – Training of all staff, but particularly those on the “front line” is, of course critical. Nurses are often on the receiving end of violence, which may include acts of violence from coworkers as well as patients. Employees should be trained in how to respond to each type of situation, whether it is violence by a patient, visitor or coworker. It is recommended that an emergency response protocol be established and that all staff members be trained to carry out and follow the protocol.  

Post Incident Response and Counseling – The immediate response should be prompt and appropriate medical care, which should be easy for a hospital. There should also be procedures in place to secure the facility, safeguard any evidence, inform the authorities, and prepare a written report. It is prudent for an entity to provide for post-crisis counseling, not only for those who may have been direct victims, but for those who may have witnessed an incident of violence.

Recordkeeping –  Keeping accurate records of incidents and making sure that incidents are timely reported through the proper channels may be a challenge for many institutions, but this is an important part of  an effective violence prevention program. Records of incidents and actions taken not only assist in responding to investigations or inquiries, and in the defense of legal actions, but also they are useful for determining patterns of behavior and assessing any weak spots in your security system.

Photo credit: Doug Webb