Homicide is now the second-leading cause of death on the job, and workers at nursing homes, hospitals and other residential or psychiatric programs are especially vulnerable.
That's among the conclusions of a new report from the Labor Department, which has released guidelines to help employers protect their workers (See related story, p. 20).
"Healthcare and social service workers often face aggressive patients, visit clients' homes in dangerous neighborhoods or encounter violent situations in hospital emergency rooms," Labor Secretary Robert Reich said. "Employers can reduce the risks to their workers with some common-sense strategies."
According to the Bureau of Labor Statistics, workplace violence affects three per 10,000 workers in the private sector. For nursing homes it's 38 per 10,000, and for residential care the rate is 47 per 10,000.
Between 1980 and 1990, on-the-job assaults took the lives of 27 pharmacists, 26 physicians, 18 registered nurses, 17 nurses aides and 18 healthcare workers in other categories, according to one study.
The Occupational Safety and Health Administration identified unique factors that put healthcare workers at risk:
Too many handguns in circulation among patients and their associates.
The use of hospitals by police and the justice system to hold criminals and disturbed, violent persons.
Chronically mentally ill persons released from hospitals without follow-up care, who don't take their medication and can refuse hospitalization.
Low staffing levels during meal times, visiting hours and when staff transports patients.
Long waits in emergency rooms, which anger patients.
The presence of drugs and money at pharmacies, clinics and hospitals.
Isolated work with patients during examinations or treatments.
Solo work outside the facility in high-crime locations.
OSHA also noted that violence on the job is probably underreported because of "a persistent perception within the healthcare industry that assaults are part of the job."
The new OSHA guidelines can be found on the Internet at http: www.osha.gov under "What's New."