Workplace violence in healthcare is not new…
What is new, however, is the frequency with which it occurs. You may have experienced workplace violence firsthand as an NP business owner, or as an employee in a prior job.
Violence does not always come from an outside third party, but may also come from within the office, like from an aggressive patient or a disgruntled employee.
Workplace violence is not limited to physical attack, but includes threats, intimidation, harassment, verbal abuse, stalking, and other behavior that makes you or your employees feel threatened and unsafe.
While workplace violence in healthcare is more common in larger settings like hospitals, ERs, or social service agencies, smaller medical practices are no stranger to it.
How Serious Is the Problem?
The numbers are concerning…
According to the U.S. Bureau of Labor Statistics, healthcare and social assistance experienced 57,610 workplace-violence cases during 2021 – 2022 that were serious enough to require days away from work, job restriction, or job transfer.
This number represents nearly 73% of all such workplace violence cases across private industry, whereby women experience workplace violence more than three times as often as men.
Violence in the workplace appears to be increasing; data show an increase of 30% between 2011 and 2021/2022.
A survey by National Nurses United (NNU) also shows an increase in workplace violence…
NNU surveyed 1,267 registered nurses and found that 84.8% had experienced at least one form of workplace violence during the previous year, and 36.4% said violence on their unit had increased.
According to the CDC, more than double the number of health workers reported harassment at work in 2022 than in 2018.
Implications for Smaller Practices
While a smaller practice may not face the same risks as an emergency department, psychiatric facility, or large hospital, it still has vulnerabilities.
- There may be only one or two employees at the front desk.
- Staff may work alone early in the morning or late in the afternoon or early evening.
- There may be only minimal physical separation between the receptionist and an angry patient.
- And unlike large organizations, small practices don’t have security officers they can call on…
Which makes prevention especially important…
OSHA has issued guidelines for preventing workplace violence…
The agency identified several factors that may increase healthcare workplace violence, including long waits, understaffing, working alone, unrestricted public access, poor facility design, inadequate training, and insufficient security.
While some things are difficult to change in a small practice, others are easier to implement.
Here are 7 Things to Help Reduce Violence in the Office.
- Create a workplace violence policy.
Make it clear that verbal threats, intimidation, harassment, and physical violence toward staff will not be tolerated. Outline what will happen if the policy is violated, such as termination from the practice, referral to law enforcement, etc. Include a copy of the policy with your intake package, and have patients sign it. - Walk through your office looking for vulnerabilities.
As you walk through your clinic, ask yourself…How can staff deal with an aggressive patient in the exam room? Can someone easily get behind the front desk? Are exterior doors securely locked and well controlled? Are the parking area and entrances well lit? If you find a vulnerability, see whether you can adjust the workflow or usage for safety. Often, even small layout changes and adjustments can make a big difference. - Give staff a way to call for help.
You might use a security camera in public areas, like a hallway or waiting area, to give staff early warning of danger. You could install a panic button at the front desk and in exam rooms, use a wireless alert system, use an internal messaging system, or rely on an established code word that alerts other employees to a problem. There needs to be a way to alert others to potential danger. - Train employees in de-escalation.
You and your staff must know how to recognize escalating problem behavior. Make it a priority for everyone to understand how to maintain distance, avoid unnecessarily escalating an argument, and know when the priority changes from calming someone down to getting away and calling for help, like 911. - Pay attention to predictable triggers.
Try to keep predictable triggers to a minimum whenever possible.
Unexplained long wait times, payment and billing disputes, medication requests, and unhappy family members can all lead to conflict that can easily get out of hand.
Have clear and easy-to-understand policies in place, and enforce them…
While they will not eliminate every problem, they can keep unnecessary confrontations to a minimum.
I’ve experienced firsthand how an unpaid bill and strong demands for medication refill can result in disagreements and quickly escalate into a threatening situation. - Document every incident, even if nobody is hurt.
Even though everyone is busy, it’s important to document every incident…
A threat overlooked today may become important when the patient shows the same behavior at the next visit.
Make sure that all staff report incidents and review them together as a team.
Determine what exactly happened. What were the warning signs?
What could have been done differently? What should be done differently next time? - Have an emergency plan in place before you need one.
If a situation escalates to an emergency, who will call 911?
Where should staff and other patients go? What should employees do: evacuate or shelter in place?
What happens if an aggressive patient refuses to leave?
It’s best to have these conversations in advance. Decisions like these are much easier to make when everyone is calm and not under pressure.
Safety Considerations are Part of Your NP Practice
Even though OSHA does not have a specific federal workplace-violence standard, employers remain subject to OSHA’s General Duty Clause.
If you have any employees, you must provide a workplace free from recognized hazards likely to cause death or serious physical harm… who wouldn’t want to do this?
OSHA recommends that healthcare organizations establish workplace-violence prevention programs appropriate to the organization’s size and complexity. Depending on your state, you may have additional requirements.
As a practice owner, you spend considerable time thinking about HIPAA, cybersecurity, OSHA, malpractice risk, and protecting patient information.
Keeping yourself, your employees, and your patients safe deserves a place on that list, too.
Let’s hope you will never experience a serious violent incident; however, if you do, you and your staff will be prepared and know what to do.
Have you experienced violence in the workplace? What happeded and how did you handle it? What changes. if any, did you make in your clinic as a result? Please share your experience so we all can learn from it…
By Johanna Hofmann, MBA, MAc., regular contributor to the NPBusiness blog.”