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WA law targets workplace violence
Mental health workers gain protection
It's hard to imagine a scenario of greater emotion, conflic, and potential risk than when a mental health worker visits the home of a mentally unstable person to evaluate them for involuntary psychiatric commitment. In 2005, such a visit by Marty Smith in Kitsap, WA, turned deadly. Two years later, his case spurred a Washington state law to protect community health workers from violent assaults.
Although the Marty Smith Law does not address employees in acute care facilities, it may become a catalyst for further protections against workplace violence, worker advocates say. The law allows workers to request assistance when they visit homes for crisis intervention or to evaluate someone for detention. It also provides for training and for access to information about a patient's "history of dangerousness or potential dangerousness."
"This is really one of the top workplace safety and health hazards that [health care and mental health] workers face," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU). "We're going to do everything we can to pass laws at the state level."
About 45% of nonfatal assaults resulting in lost work time occur in health care, notes Jane Lipscomb, PhD, MS, BSN, FAAN, RN, director of the University of Maryland School of Nursing Center for Occupational and Environmental Health and Justice. "This is a huge national issue with the best estimate of the number of workers who are victims of workplace violence estimated at 1.7 million incidents a year," she says.
About half (54%) of employers with 250-1,000 workers and 82% of employers with 1,000 or more workers in health care and social assistance reported an incident of workplace violence in the prior year, according to a 2005 survey by the U.S. Bureau of Labor Statistics.
A Washington state study found that the health services sector was second only to social services as the industry with the highest risk for workplace violence.1
Gang- or drug-related violence may spill into the emergency department. Or patients may be agitated, disoriented, or suffering from a psychotic episode. With the movement of patients from psychiatric hospitals to community settings, the hazards rise for community mental health workers and acute care facilities, says Lipscomb.
"The mentally ill aren't necessarily inherently more dangerous. It's when their treatment isn't appropriate that we have these incidents," she says.
Lipscomb and Kathleen M. McPhaul, PhD, MPH, RN, assistant professor in the Work and Health Research Center at the University of Maryland School of Nursing conducted focus groups of community mental health workers in Washington state as part of a field study. They found that high caseloads, solo visits, and lack of training contributed to the hazards.
The U.S. Occupational Safety and Health Administration included those risk factors among others in its 2004 Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers and noted that "health care and social service workers are at high risk of violent assault at work."
OSHA advises hospitals and other health care employers to analyze their workplace violence injury records, conduct a security analysis, and survey employees to get their input on preventing violent incidents. OSHA recommends establishing a violence prevention team that includes representatives from management, operations, employee assistance, security, occupational safety and health, legal, and human resources staff.
Training of all employees should occur at least annually, OSHA says. But training alone is not sufficient, notes McPhaul. Reducing workplace violence requires a comprehensive program. "This is not the type of hazard that can just be trained away," she says.
The guidelines provide specific suggestions of security measures, policies, and training components. (For a sample checklist, see article below.)
"Not only do we need universal precautions against blood exposures in health care, but we also need them against workplace violence," says Lipscomb. "Every hospital should have a program. Unfortunately, the majority of them don't."
Hospitals often call to obtain help with workplace violence training programs, she says. But she notes, "Training in and of itself is not going to reduce or eliminate the problem."
(Editor's note: The OSHA guidelines are available at www.osha.gov/Publications/OSHA3148/osha3148.html.)
1. Foley, M. Violence in Washington Workplaces, 1995-2000 (Technical Report No. 39-4-2002). Olympia, WA: Washington State Department of Labor and Industries; 2002.
Assessing your workplace for risk of violence
How can you reduce the risk of workplace violence at your hospital? The U.S. Occupational Safety and Health Administration recommends conducting a worksite analysis that includes a review of records, input from employees, and a thorough walk-through to identify potential hazards. The American Nurses Association in Washington, DC, developed several checklists to guide such an analysis, which are available in the OSHA guidelines (www.osha.gov/Publications/OSHA3148/osha3148.html). Here are two of those checklists:
Assessing safety of the environment:
Assessing day-to-day work practices: