The lukewarm response from management deters workers from reporting incidents, further obscuring the issue. Studies suggest that more than half of physical assaults on nurses and up to 80 percent of verbal abuse goes unreported. At the same time that nurses are blamed, hospitals do little to prepare them for what lies ahead. “We keep hearing the recurring theme that we aren’t getting any workplace-violence-prevention training in our nursing curriculum, we’re not learning it at our institutions,” says Daniel Hartley, an epidemiologist and the National Institute for Occupational Safety and Health (NIOSH) coordinator for workplace-violence-prevention research. “There’s nothing worse than a novice nurse going into health care and not realizing that he or she will encounter physical and verbal abuse on the very first day on the job.”
Violence-prevention programs reduce the risk of assault by training workers to recognize frequent cues, such as drug use and threatening body language, and educating them about strategies to help defuse situations. Accurate incident reporting is a crucial part of this type of intervention, as it helps hospitals identify specific hazards, such as poor lighting, understaffing, and inadequate safety training, and take steps to remedy them.
In a 2011 ENA study on workplace violence, hospitals with mandatory reporting policies experienced half the rate of physical violence as hospitals without reporting policies. The Veterans Health Administration has successfully reduced assaults in its hospitals by electronically flagging high-risk offenders, such as people who have been abusing drugs and alcohol and those with a history of attacks on caregivers, who are then treated with extra precautions.
The Occupational Safety and Health Administration (OSHA) issues guidelines for violence-prevention programs, but there is no federal statute requiring hospitals to adopt them. Several states have passed laws making it a felony to assault a health-care worker, but only a few have included provisions for violence-prevention training and incident reporting. Hospitals are generally left to monitor themselves.
Since the government doesn’t collect the statistics, it’s impossible to know exactly how many hospitals lack adequate safety protocols, but ENA surveys suggest that the number could be substantial. Some hospitals have comprehensive violence-prevention programs, but many nurses report that they receive minimal to no workplace-safety training and must learn on their feet when a situation turns violent.
Before his assault in 2008, Rinehart recalls one half-day training session about five years earlier on how to protect yourself in the event of an attack, “like how to get out of a choke hold,” but it lacked elements such as how to recognize and defuse aggression. “The prevention piece was completely missing,” he says.
NIOSH developed a free online training program that went live last year. Hartley reports that they’ve had more than 8,000 people complete the module so far, but individuals must seek out the training on their own time. NIOSH could not say whether any institutions have made the module part of their workplace-violence curriculum. They have done some hospital outreach, but it has mostly been “nursing associations bringing [the module] to management,” Hartley says. And buy-in is still an issue.
When Anderson was working on the New York State Violence Against Nurses law in the 1990s, the state senator sponsoring the bill “recommended that we just get legislation passed that made it a felony to assault a nurse and didn’t require all kinds of education and training programs,” she says. “He said it would be very costly and make it harder to get the legislation passed,” and predicted opposition from hospitals.
The New York law now requires institutional workplace-violence prevention, but only from public employers. The cost of violence prevention is small, however, when compared to the amount that hospitals lose in worker-compensation lawsuits every year and in time off due to injury—roughly a third of which is patient-inflicted, according to OSHA statistics.
“There needs to be a cultural change that it’s not okay to hit a nurse,” Wolf says. “Until then, any intervention that is attempted is unlikely to be accepted.”
Original article was published in Scientific American, December 31, 2014 |By Roni Jacobson http://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/