When comparing the healthcare industry to other industries, one may observe that there is a significantly disproportionate amount of workplace violence in healthcare. On Friday, October 21, 2016, the California Occupational Safety and Health Administration (Cal/OSHA) unanimously pushed for a General Industry Safety Order regarding “Workplace Violence Prevention in Health Care.” This National Standard was passed by the Office of Administrative Law a few months after and became known in the California Code of Regulations as Title 8: Section 3342.
This Standard broadly defines “workplace violence” as a threat of violence or executed acts of violence that take place at the work site. The definition excludes lawful acts that are ruled as either self-defense or defense of others. Title 8 Section 3342 is an amendment of Senate Bill 1299, which only applies to hospitals. In correspondence to studies conducted in the report released by the U.S. Government Accountability Office (GAO), research indicates that depending on facility type, workplace violence in healthcare occurs approximately five to 12 times higher than rates of nonfatal workplace violence for employees in other industries. According to GAO’s report, “Health care occupations like psychiatric aides, psychiatric technicians, and nursing assistants experienced high rates of workplace violence compared to other health care occupations and workers overall.” The likelihood of these attacks grows each day with likely perpetrators being patients, patients’ family members, or visitors.
Title 8: Section 3342 – There are four types of workplace violence in healthcare and they are as follows:
- Type 1 Violence: This type of workplace violence is committed by individuals without legitimate business at work sites, including violent acts by those entering workplaces with premeditated motives. For example, a mentally-unstable individual may plan a school shooting by purchasing a gun, sending threats to the campus ahead of time, and showing up to commit the crime.
- Type 2 Violence: This type of workplace violence is aimed towards employees by patients, clients, inmates, visitors, customers, students, or others that accompany patients. For example, a patient may lash out on their nurse due to being off their medication.
- Type 3 Violence: This type of workplace violence is taken against employees by former or current employees, supervisors, or managers. For example, an enraged employee may return to their former workplace to seek revenge on a coworker that got them terminated.
- Type 4 Violence: This type of workplace violence is completed by individuals who are not employed by the workplace, but have or had personal relationships with employees. For example, a disgruntled ex-husband may show up at his spouse’s workplace to instigate violence.
Title 8 Section 3342 was passed by the Standards Board in order to further define and clarify that this requirement is not only applicable to hospitals, but rather the majority of facilities, that are “organized, maintained, and operated for the diagnosis, care, prevention, or treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which the persons are admitted for a 24-hour stay or longer.” This Standard which includes workplace violence in healthcare training will additionally encompass drug treatment programs, emergency medical services, medical transports, and outpatient medical services for incarcerated individuals in correctional and detention facilities. Instances where this Standard would not be required would be with specific state-run health facilities.
The new standard is applicable to all employers with employees in health care facilities, service categories, and operations, and requires employers to provide the safeguards that are required by Title 8: Section 3342. These safeguards mandate that employers furnish “personal protective equipment, training, and medical services, at no cost to the employee, at a reasonable time and place for the employee, and during the employee’s working hours.” This Order requires healthcare facility employers implement and maintain a healthcare workplace violence prevention plan comprised of various procedures. These procedures cover instances of “effective identification of risk factors, dissemination and compliance of protocol, and post-incident investigations.” It is highly encouraged that employers review their organization’s plan at least once a year in order to ensure that it is still effective and if not, then revisions should be made to ensure compliance with Title 8 Section 3342 when needed.
At a minimum, a healthcare organization’s review of their workplace violence in healthcare prevention & training plan should address:
- Employees and their representatives
- Employees work areas, services, and operations
- Existing security measures
- Job design
Employers are obligated to provide workplace violence training to employees so they are aware of the forms of workplace violence that they are at constant risk of encountering while on the job. Employers have a responsibility to collaborate with employees and representatives in creating training curricula and training materials, hosting training sessions, and revising the training program to stay up to date. Training should be conducted when the healthcare workplace violence prevention plan is initially introduced, when new employees are hired or assigned new duties, when new practices and equipment are introduced, and when new workplace violence hazards have been identified. Initial training must call attention to known workplace violence hazards as well as corrective measures put in place by employers. In addition to the mandatory training that should be provided to employees, healthcare employers will also need to maintain detailed records of all incidents, post-incident responses, and workplace violence injury investigations in the form of a violent incident log.
Each entry in the violent incident log should consist of the following details:
- Date, time, location, and department of the incident
- Vivid description of the incident
- Classification of who committed the violence, circumstances at the time of the incident, and when the incident occurred
- Type of incident
- Consequences of the incident
- Contact information for the individual submitting the log entry
The passage of Title 8: Section 3342 is an active reminder that even though compliance training is an imperative requirement of many organizations, the purpose it serves should not be taken lightly. Rules and regulations listed in this Standard were put in place to protect vulnerable employees, prevent physical injuries, avoid business disruptions and extra expenses (medical and legal), and preserve organizational morale and reputation. Educating employees about these issues will not only help the organization remain compliant, but also create a dialogue about sharing the mutually beneficial responsibility of maintaining a safe workplace. Preventing workplace violence in health care is a challenging feat; however, with the proper precautions taken, supervisors and employees will learn how to identify questionable language and behavior before they escalate into physical violence.