State law now requires California healthcare facilities to have comprehensive plans to protect clinicians from workplace violence.
The mandate, which went into effect April 1 and applies to all acute-care hospitals and skilled-nursing facilities in California, is part of a law that passed in 2014. The state's Division of Occupational Safety and Health worked over the last few years to establish the regulations with input from nurses.
The California Nurses Association strongly pushed for the mandate. Nurses typically bear the brunt of violence from patients and family members, with about 20% of nurses and nursing students across the U.S. reporting they have been physically assaulted on the job.
Many other states have adopted laws to address healthcare workplace violence, but California is the first to require hospitals to have a robust plan in place.
Under the law, providers must assess and identify areas in which employees are vulnerable to violence. Education and training must also be given to everyone that works at a facility including physicians.
The training must include how an employee can recognize potentially violent situations, strategies to avoid physical harm, how to report violent incidents to the employer, and any resources available to employees for coping with violence like critical incident stress debriefing or employee assistance programs.
The other portion of the law's mandates, which have been in effect since April 2017, requires healthcare facilities to implement and maintain a log in which every incident of workplace violence is recorded. Violence in the healthcare setting is currently tracked poorly, and one survey showed that just 19% of incidents are reported.
Bonnie Castillo, executive director of National Nurses United, commended the mandate for its focus on preventing workplace violence during a news conference Tuesday. "We as nurses take this seriously, and we will engage in an aggressive enforcement campaign to make sure hospitals comply" with the regulations, she said.
The California Division of Occupational Safety and Health will enforce the mandate, and providers can be fined if they are in violation. Typically, the division hears of violators through complaints. It doesn't randomly visit healthcare facilities.
The California Hospital Association largely supports the law, but it does have concerns about some aspects, said Gail Blanchard-Saiger, vice president of labor and employment at the association.
For instance, the regulations require hospitals to assess patients and visitors for potentially violent behavior. Blanchard-Saiger said there was very little guidance from the California Division of Occupational Safety and Health about how a hospital should appropriately do this. Additionally, providers are required to train everyone that works at the facility, but that can be hard to enforce because California hospitals don't directly employ doctors.
"Hospitals are committed to providing a safe work environment and complying with regulations, but there are challenges," she said. "There are a lot of different moving parts and ambiguity."
The California Hospital Association continues to discuss with the California Division of Occupational Safety and Health ways to clarify or provide further information about some of the mandates.
A Democrat-sponsored bill introduced in the U.S. House of Representatives last month is modeled after California's law.
