Workplace Violence and Abuse Prevention
Prepared by members of the MNA Workplace Violence and Abuse Prevention Task Force
Statement of the Problem
Violence pervades many aspects of American society as well as the international community. Healthcare facilities known as “caring places”, and once considered immune, are now frequently the site of violence.
The National Institute of Occupational Safety and Health (NIOSH) at the
U. S. Department of Health and Human Services, Centers for Disease Control, defines workplace violence as violent acts, including physical assaults and threats of assaults, directed toward persons at work or on duty. (1) The U. S. Department of Justice defines a threat as a statement or expression of intention to hurt, destroy, punish, etc. as in retaliation or intimidation. (2) It is widely recognized that following these violent events, many nurses and other healthcare workers often leave their jobs in healthcare and never return.
The healthcare setting was once perceived as a refuge from the elements outside, as a place to treat the sick and injured. Now it has joined the many workplaces that experience more than 1,000,000 assaults annually. In fact, healthcare and social service workers have the highest incidence of injuries from workplace assaults. Emergency departments and psychiatric units have always witnessed violence. Current trends in patterns indicate that violence now pervades throughout the hospital.
Prevalence of Violenc in Healthcare Settings
The U.S. Department of Labor, Bureau of Labor Statistics (BLS) data reveal that healthcare and social service workers are at high risk of violent assault at work. In 2000, heathcare and social service workers overall had an incidence rate of 9.3 per 10,000 for injuries resulting from assaults and violent acts. This compares to an overall private sector injury rate from assaults and violent acts of 2 per 10, 000 full time workers.(3)
Between 1993 and 1999, violent victimization, in the workplace and against nurses reached 429,100 reported events. Workplace violence and victimization rates for nurses were 72% higher than for medical technicians and more than twice the rate of other medical field workers.(4)
According to the U.S. Department of Justice, Federal Bureau of Investigation, “of greater concern is the likely under-reporting of violence and a persistent perception within the healthcare industry that assaults are part of the job. Under-reporting may reflect a lack of institutional reporting policies, employee beliefs that reporting will not benefit them, or employee fears that employers may deem assaults the result of employee negligence or poor job performance.”(2)
Traumatic Effects of Violence on Patients
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, post traumatic stress disorder (309.81) is identified as a disorder that affects a person who has: “1. experienced, witnessed, or were confronted with an event or events that involve actual or threatened death or serious injury or a threat to the physical integrity of self or others and 2. the person’s response involved intense fear, helplessness, or horror”.(5)
These events are known to precipitate a multitude of persistent and debilitating responses. “The traumatic event is re-experienced in one or more of the following ways, recurring and intrusive distressing recollections (and dreams) of the event, intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event or physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event”. (5)
MNA Task Force members believe that patients suffer secondary traumatization in the same manner and from the same causes as nurses and other healthcare workers who experience or witness workplace violence or abuse.