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California’s health care employers prepare for workplace violence rule

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The murder of Napa State Hospital psychiatric technician Donna Gross at the hands of a patient in October 2010 highlighted the danger health care workers routinely face in their jobs and has culminated in California adopting the first workplace violence prevention standard for health care workers in the United States.

In October, the California Division of Occupational Safety and Health Administration Standards Board unanimously adopted the standard, which aims to reduce violent incidents and protect workers and will take effect April 1.

Under the Cal/OSHA standard, workplace violence is defined as “any act of violence or threat of violence that occurs at the work site.”

The standard will require that health care employers create a violence prevention plan, keep a comprehensive record of violent incidents and provide workplace violence training. It applies to hospitals, home-based hospice, emergency medical services, emergency medical transport, drug treatment programs, and outpatient medical services to the incarcerated in correctional and detention settings.

“The health care industry is ... three times more likely to face incidents of workplace violence than other private sector industries,” said Nick Smith, practice leader, security risk consulting at Willis Towers Watson P.L.C. in New York.

The regulation will drive further education and awareness that will “better protect health care workers, consumers, patients and anyone who touches the system,” he added.

David Quezada, Los Angeles-based vice president of loss control for workers compensation insurer Employers Holdings Inc., said the standard was a “call for more comprehensive protection for health care workers.”

Ms. Gross was strangled and robbed by a mentally ill patient while she was in a courtyard returning from a dinner break, according to a union newsletter. For Katherine Hughes, a registered nurse, member of the Service Employees International Union Local 121RN and labor specialist, the effort to protect health care workers began after attending Ms. Gross’ memorial rally and talking to other employees about the violence they are exposed to at work.

The organization started doing research around workplace violence and health care, including interviewing union members and participating in workplace violence prevention classes with experts from around the country.

“We came to the conclusion that we thought we had done as much as possible legislatively to address workplace violence in health care, so we decided to petition the Cal/OSHA standards board directly in February 2014,” Ms. Hughes said.

SEIU began attending Cal/OSHA meetings early 2014, where their members would share their personal experiences of workplace violence.

“Unfortunately, we have some really telling stories of how serious the injuries can be,” she said. “A nurse was stabbed 12 or 13 times and she survived her injuries but ... she certainly wasn’t the same person that she was before. The people we have talked to suffer a lot of post-traumatic stress on top of the physical injuries. We’ve had a lot cervical spine injuries, concussions that can cause ongoing health issues. I think no one really realized how serious and how prevalent violence in health care is.” 

The estimated injury rate for private-sector hospital workers hurt in workplace violence scenarios was 14.7 per 10,000 workers in 2013, according to a March report from the U.S. Government Accountability Office.

The workplace violence injury rate was estimated at 35.3 injuries per 10,000 nursing and residential care workers that same year. That’s compared with a workplace violence injury rate of 2.8 per 10,000 workers for all private-sector jobs, the GAO said.

California health care employers are still at the beginning stages of implementing the standard in their workplaces, but Ms. Hughes said employee involvement is prevalent throughout the regulation.

“The front-line employees have to be part of the hazard assessment, they have to be a part of developing the plan because who better than the people working there who know what they need?” she said.