So it's come down to this.
Healthcare workers are so vulnerable to violence that the Occupational Health and Safety Administration believes many cases go unreported because of "a persistent perception that assaults are part of the job."
Managers are expected to maintain a safe and secure workplace for patients and staff. But that task is becoming increasingly difficult as outpatient traffic builds and visiting hours are relaxed.
Aggressive patients, angry family members and the presence of drugs are facts of life in the medical marketplace, and each contributes to the high violence risk faced by workers.
"More assaults occur in the healthcare and social services industries than in any other," said Department of Labor Secretary Robert Reich. "Almost two-thirds of the nonfatal assaults occurred in nursing homes, hospitals and establishments providing residential care and other social services."
That doesn't mean, however, that fear of violence should come with the territory. Employers can reduce the risks with some common-sense approaches.
A good place to start is the nine pages of guidelines recently issued by the Department of Labor for preventing workplace violence for healthcare and social service workers. Among the things to consider:
Employers should establish violence prevention programs and track their progress in reducing assaults.
Assign responsibility to various aspects of the programs so that managers and staff understand their obligations.
Create a clear policy of zero tolerance for violence, verbal and nonverbal threats, and related actions.
Emphasize the need for prompt and accurate reporting of violent incidents.
Organize a team to assess the vulnerability to workplace violence and identify preventive actions.
Analyze incidents and identify jobs/locations with the greatest risks of violence.
Assess any plans for new construction or physical changes to reduce security hazards.
Use a closed-circuit video recording for high-risk areas on a 24-hour basis. The government says public safety is a greater concern than privacy in these situations.
Enclose nurses' stations and install service counters using bullet-resistant, shatterproof glass in reception areas, triage, admitting and client service rooms.
Ensure that counseling and patient-care rooms have two exits.
Arrange furniture to prevent staff from being trapped by hostile patients or visitors.
Provide adequate and qualified security coverage. Times of greatest risk occur during patient transfers, emergency responses, mealtimes and at night.
Research the behavioral history of new and transferred patients. Identify any past violent or aggressive behavior on charts, log books or verbal census reports.
Make sure that nurses and/or physicians are not alone when performing intimate physical examinations of patients.
Discourage patients from wearing jewelry to help prevent possible strangulation in confrontational situations.
Provide staff with identification badges, preferably without last names. Require that the badges be visible and worn during all working hours.
Develop special policies and procedures for home health workers.
Employees who may face security hazards should receive formal instructions of the specific danger associated with the job or work unit.
Mandatory training classes should be provided to employees annually.
Following training, managers should be able to recognize a potentially hazardous situation. To reduce or eliminate the hazards, managers should have the authority to make any necessary changes in the physical plant, care programs and staffing policy.
Detailed medical reports of work injuries and supervisors' reports should be kept on file. The reports also should describe the environment where the injury occurs, potential or actual cost and lost time.
Conduct a strong follow-up program for victims of violence. Medical and psychological treatment not only will help them cope with the injuries but also will prepare them to confront or prevent future incidents.
Common sense must dictate the tenor of a workplace safety program. Sometimes the best of intentions can trigger horrid results. Consider the security drill orchestrated earlier this year by the administration of Memorial Hospital of Martinsville (Va.) and Henry County (March 25, p. 19).
Workers were going through their paces in the early-morning hours of Jan. 25 when four gunmen stormed the emergency room. Four nurses were ordered at gunpoint to empty the drug bin. About five minutes later, the bandits removed their masks and explained the stunt was a preparedness drill.
The armed security staff, nursing supervisor and the physician on duty were notified in advance. But the frightened staff members and petrified patients who were victimized by the ruse didn't find the incident educational. Local police are investigating complaints made by the four nurses. At this point, no reports or charges have been filed.
Meanwhile, Memorial's management is trying to turn this lemon into lemonade. Director of Human Resources Susan Reynolds says the hospital has used information culled from the disastrous disaster drill to improve security. For example, she cites the formation of a security committee to stave off potential problems. Furthermore, the hospital has increased ER security and installed a swipe card security system in place of a punch code process.
Reynolds maintains the drill was "a very effective means of measuring where you stand" but admits "next time the drill will be handled differently."