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Violence against health care workers has been on the rise in recent years, and the COVID-19 pandemic has made the risks even worse for doctors, nurses and support staff.
Lawmakers at the federal level and in more than a dozen states have introduced legislation to mandate that health care employers implement violence prevention programs, and experts say resources and training are crucial to help mitigate the problem.
Violence against health care providers is the third-leading cause of serious workplace injuries in the health care industry, generating at least $540 million a year in workers compensation costs, according to Liberty Mutual Holding Co. Inc.’s 2020 Workplace Safety Index.
“COVID-19 certainly has both exacerbated existing sources of violence and opened up new areas of confrontation between health care providers, patient families and the general public,” said Jeff Duncan, Boston-based senior vice president and chief underwriting officer of the health care practice at Liberty Mutual.
Violent incidents against health care workers have been rising and extending beyond the emergency room and hospital to non-acute settings, such as physician offices, said Pamela Popp, Denver-based executive vice president and chief risk officer of GB Healthcare, a division of Gallagher Bassett Services Inc.
“We’re seeing an increase (in violence) across all of the health care settings, and although it’s a little challenging to make a correlation right now, it does appear that the pandemic has made it worse,” she said.
People are fearful and “have a feeling of a lack of control” due to the coronavirus, and as a result are more likely to enter health care facilities in an agitated state, Ms. Popp said. This can cause what should be a calm conversation to escalate quickly to shoving or other types of violence, she said.
Mr. Duncan said the industry lacks “broad, consistently followed” violence prevention standards. “The best way to reduce the probability and severity (of violence) against health care workers is thoughtful planning and mitigation techniques, facility design and robust reporting,” he said.
In February, federal lawmakers introduced H.B. 1195, which would require health care employers across the country to create a comprehensive program and processes to prevent violence against health care workers. Thirteen states have also introduced legislation that would create minimum standards for health care workplace violence prevention plans and training.
While guidelines for preventing violence in health care settings have “been around in different iterations for a long time,” the Occupational Health and Safety Administration does not have a specific standard related to violent incidents in health care facilities, said Lisa Stand, senior policy advisor for policy and government affairs at the Silver Spring, Maryland-based American Nurses Association.
“OSHA has demonstrated that even though there is no standard, they will use the general duty clause” to cite health care employers that fail to take steps to protect workers, said James Sullivan, Washington-based co-chair of the OSHA and workplace safety practice at Cozen O’Connor P.C. and former chairman of the Occupational Safety and Health Review Commission. “There is a real issue with assaults on nurses. … It’s a recognized problem, and that’s why you see the laundry list of unions and other employee organizations pushing for (H.B. 1195).”
Most large hospital systems have a violence prevention program, but it’s not always effectively communicated to supervisors, and training can be overlooked, said Renata Elias, Dallas-based senior vice president in the consulting solutions practice of Marsh Advisory, a unit of Marsh LLC. “It’s great to have a plan or program in place, but it’s no good if you don’t train and exercise,” she said.
And while basics like surveillance cameras, security guards and panic buttons are prevalent, only some health care employers provide training in de-escalation tactics and violence intervention and have a code system for violent incidents similar to those used for clinical emergencies, Mr. Duncan said.
Hospitals should conduct training at a minimum every year, including active shooter drills, and senior leadership should do tabletop exercises and review their violence prevention plans annually, Ms. Elias said.
If an incident does occur, the employer should use it as an opportunity to reevaluate its violence prevention program, she said. “If you had a workplace violence situation, you want to, after the incident, make sure you bring all those key players together and talk about what went well, what could we improve in the response,” she said.
Ms. Popp said simple, “almost maintenance-type” fixes should not be overlooked, such as ensuring all exterior doors are secured at all times, lights that burn out are replaced immediately, security cameras are working, and safeguards are put in place if staff feels unsafe in certain areas of the premises.
If neglected, “those are the things that allow violence to escalate sometimes without being identified” and should be addressed before adding more preventive measures, such as metal detectors, physical barriers and other security upgrades, she said.
Health care facilities can have robust violence prevention plans, but if employees fear being reprimanded for calling security or are afraid they might be overreacting, the measures are less likely to be effective, experts say.