___________________________________________________________ Violence in the Healthcare Workplace
Mandates for the development of zero-tolerance violence policies have been set for healthcare organizations [7]. This sends a clear message to employees that all types of workplace violence, including harassment, are not tolerated [66]. Such behaviors should be followed up with the appropriate disciplin- ary action [81]. The main premise of zero-tolerance policies is that workplace violence is reduced by promoting open com- munication of acceptable behaviors [81]. However, it is crucial for organizations to remember that a zero-tolerance policy itself does not prevent workplace violence [167]. After implementing zero-tolerance policies, mechanisms must be implemented to support the organizational message. First, a reporting, monitoring, and documentation system should be in place. Having a mechanism for reporting and documenting allows the type of aggressive violence and abusive behaviors to be identified and discipline enacted uniformly [82; 132; 198]. This should minimize under-reporting and send a clear message about where and how to report various types of violence. A monitoring system would also allow for collection of data and identification of risk factors to be utilized in training and the development of intervention strategies [66; 82]. Furthermore, evaluating the effectiveness of these prevention and interven- tion strategies is vital to not only help build the knowledge base but enhance transparency [198]. It is recommended that an interview be conducted with the victim and witness(es) as soon as possible after the event. The American Federation of State, County, and Municipal Employees recommends questions covering [83]: • Location, date, and time of the incident • Description of the perpetrator and relationship to victim (e.g., stranger, client/patient, colleague) • Type of aggressive behavior (e.g., physical assault, use of weapon, verbal threat) • Was the worker alone when the incident occurred? • Prior incidences (e.g., threats prior to the incident) • Other witnesses (e.g., security guard) • Factors or circumstances leading up to the incident • Any reports to the employer about previous incidents Ultimately, post-incident debriefing helps to increase staff awareness and future reporting of workplace violence events [167]. Another recommendation is for employee assistance programs to take a more active role in helping to prevent workplace violence. EAPs can address certain stressors, whether they originate in the individual, the home, or work, that may pre- cipitate workplace violence. Voelker found that when the U.S. Postal Service worked to improve their employee assistance programs’ counseling services, their incidence of workplace violence was reduced [81].
Security measures should also be a key priority. Certain sec- tors, such as hospitals, operate on a 24-hour-a-day basis, with a constant flow of patients/clients, family members, and staff. Many healthcare organizations have implemented more stringent and secure entry identification mechanisms; some facilities require staff to wear badges with photos or require the swipe of an electronic identification card to enter certain areas [84]. Security cameras may be installed in key areas, panic buttons installed for easy access, and patient waiting areas be clearly visible to staff and security guards [196]. OSHA has established the following recommendations for organizational policies for decreasing workplace violence and promoting the safety of employees [7; 107]: • Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats, and related actions. Ensure that managers, supervisors, coworkers, patients, and visitors know about this policy. • Ensure that no employee who reports or experiences workplace violence faces reprisals. • Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress. • Outline a comprehensive plan for maintaining
security in the workplace. This includes establishing a liaison with law enforcement
representatives and others who can help identify ways to prevent and mitigate workplace violence. • Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that the team or responsible individuals develop expertise on workplace violence prevention in health care and social services. • Affirm management commitment to a worker- supportive environment that places as much importance on employee safety and health as on serving the patient or client. • Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting affected employees and facilitating recovery. Post-incident interventions encompass immediate medical and psychological care, counseling services for staff who both directly experienced and witnessed the violence, and debriefing procedures to learn from the incident in order to revise inter- nal policies and procedures, as needed [195; 196]. Although healthcare facilities are busy, it is essential that debriefing not be postponed [195].
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