The U.S. House of Representatives on Friday passed a bill that will create a minimum standard for health employers' plans to combat violence against their workers.
In a 254-166 vote, lawmakers approved basing the standard on voluntary guidelines created by the Occupational Safety and Health Administration in 2015. Under the bill, employers would need to create training programs, investigation procedures and track violent incidents against workers, with more specific regulations coming through OSHA rulemaking over the next three years.
Previously, employers weren't required to provide a certain level of protection for healthcare and service workers, even though they reportedly experience violence at five times the rate of any other industry sector, according to a 2018 report by the Bureau of Labor and Statistics.
"We're not trained in workplace violence," Dr. Ryan Stanton said, who is an emergency physician in Kentucky and member of the ACEP Board of Directors.
Stanton said a patient assaulted him and a nurse working in the emergency department at an inner city hospital. The nurse ultimately lost her job due to injuries sustained in the attack. He remembers being discouraged from pressing charges for fear it may hurt the hospital, a trend he has noticed across the country due to the lack of infrastructure in place to track complaints and protect against future violence.
Rep. Joe Courtney (D-Conn.), the bill's co-sponsor, urged colleagues to pass the proposal because of that scarce data.
Employers need to engage with their staff to determine what protections they need, according to Lisa Stand, a senior policy advisor for the American Nurses Association.
"Many nurses have been stigmatized in their communities during the pandemic and suffered violence as a result," Stand said.
The National Nurses Union has separately tried to fill the data gaps by surveying nurses on workplace violence during the COVID-19 pandemic. Two-thirds of 669 surveyed nurses have reported being verbally threatened, 40% have been scratched and 37.4% were slapped, punched or kicked. Nearly half said their employer ignored a report of the violent incident. Just over a third recalled an employer investigating the violence after it was reported.
While the sample size is small and reliant on voluntary participants, Jane Thomason, lead industrial hygienist at National Nurses United, believes reporting these incidents will allow employers to address the specific needs of their staffs.
Thomason said the bill's mandate isn't a "one-size-fits-all" prescription for workplace violence, but an assessment of the facilities to identify risks to employees and mitigate those factors.
"If [workers] are not safe to care for patients, patients will not be as safe, or receive as high quality of care, as employers want them to be," Thomason said.
But providers are wary that the bill could create an undue or repetitive burden, especially on rural and safety-net facilities. AHA's Executive Vice President Tom Nickels noted that the Congressional Budget office projected the bill would cost private companies $2.7 billion over the first two years and $1.3 billion each subsequent year due to training, investigation and other changes. Nickels wrote to Rep. Courtney that hospitals have already implemented "specifically tailored policies and programs to address workplace violence."
The bill doesn't require employers with prevention plans to adopt new ones unless they fail to meet OSHA standards. Industry experts claim the changes will ultimately be more cost-effective than current procedures as workers injuries are deterred.
"We really do have concerns that the bill in its directive to OSHA would probably end up as a one size fits all in terms of dealing with a sensitive issue," Chip Khan said, president and CEO of the Federation of American Hospitals. "Clearly safety and protecting employees and patients is job number one, as well as protecting our patients… Unless they alter the legislation it will be too prescriptive."
