___________________________________________________________ Violence in the Healthcare Workplace
Extensive literature reviews have highlighted reasons that workplace violence is under-reported [40; 99; 122; 151]: • Lack of clear definition of workplace violence • Fear of being blamed for the incident or of the incident somehow being attributed to the victim’s negligence • Belief that workplace violence is a normal occupational hazard
Domestic violence victims do have legal rights that affect the workplace. In some states, there are statutes that provide guaranteed leave from the workplace, albeit unpaid, so victims can seek medical, legal, and social services due to domestic violence [98]. However, in some states, the employer has the right to ask for certification of their need to take a leave [98]. Other victims may utilize the Family and Medical Leave Act (FMLA), a federal law that offers job-guaranteed leave. Although it was created specifically for domestic violence vic- tims, it may be used by victims who require time to heal from the consequences of violence, deal with child care issues, or to obtain legal services [98]. However, for those who cannot afford to lose income, the FMLA may not be a feasible option, because it protects leave, but not necessary pay [184]. The American Disabilities Act (ADA) may also be a resource, but it also has limitations. For example, the ADA only covers disabilities that make it difficult for an employee to perform the essentials of their job; it does not cover those who can continue working but at a diminished capacity or whose injuries or mental health conditions are less severe [184]. States may also have specific laws protecting victims from workplace discrimination. For example, in California, an employer is not allowed to terminate an employee who is a domestic violence victim for taking time off (as much as 12 weeks) to obtain medical, counseling, and/ or legal services, in accordance with the California Survivors of Domestic Violence Employment Leave Act [121]. REPORTING WORKPLACE VIOLENCE As noted, the magnitude of workplace violence in various human service sectors may be underestimated because inci- dences of workplace violence are typically under-reported. Research indicates that workplace violence incidences are typically reported less than half of the time [185]. Ergün and Karadakovan’s study with nurses who have experienced workplace violence indicated that the majority opted not to report the incident [28]. In the United States, approximately 50% of workplace violence incidences are not reported [99]. In some cases, reporting is done informally and verbally instead of via a formal procedure [100]. The most common process for those who did report the incidents was submission of a formal, written statement to the administration. Results of a study conducted by Rowett, who examined social workers’ views about reporting client violence, showed that only 5% of incidents of physical violence against social workers were reported to management [39]. Rowett speculates that lack of disclosure may be due to stereotypes of social workers who are assaulted by their clients, stating [39]: Both assaulted and non-assaulted social workers painted a common picture of the typical assaulted social worker as someone who sought out riskier situations, confronted the client, challenged unnecessarily, was more demanding and less flexible, and less able to detect potentially violent situations and handle them once they had arisen.
• Fear that the perpetrator might retaliate • Fear of jeopardizing one’s job or position • Dissonance between the service providers’ professional role and being a victim • Embarrassment • Belief that the incident is too minor to report • Belief that violence is part of the job • Belief that reporting the incident is futile • Excusing the perpetrator’s behavior
It has also been speculated that the ideology of various helping professions might influence reporting behaviors. For example, it has been suggested that the pervasive ideology in the field of social work has been client-driven, which is reinforced by the emphasis of consumerism in our society, and this might explain why social workers are reluctant to disclose and report incidents of client violence [41]. Perceived time constraints can also contribute to the under- reporting of incidences of workplace violence. If it is perceived that reporting is a laborious process and will take a significant amount of time in addition to a practitioner’s heavy workloads, reporting may be avoided [100]. In a study conducted by Macdonald and Sirotich, of 171 social workers in Ontario, Canada, a large majority (88%) reported that they had been verbally abused by a client during their careers [42]. Additionally, 66% reported being threatened with physical assault, and 28% experienced a physical assault by a client. The top three reasons social workers in this study gave for not reporting incidents of violence were: • The incident was not serious enough to warrant such an action. • Violence is just part of the job. • Nothing would come out of reporting it. Other studies have found similar motivations for failing to report, with other concerns including fear of retaliation and lack of support [178; 182; 186]. There is a culture of acceptance of violence in many workplaces [152]. For example, emergency department nurses who are victims of workplace violence are often discouraged by hospi- tal administrators from pursue legal action, or administrators may be reluctant to implement steps to mitigate risk factors for workplace violence (e.g., disruptive patients, long wait times). Similar conclusions were found in a 2015 study with
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