Workplace Violence Policies

Has a patient ever verbally or physically threatened you or one of your coworkers? If not, you're lucky. If so, you know that workplace violence represents a serious occupational risk. Acts such as physical assault or the threat of physical assault are considered workplace violence. In a medical setting, violence can erupt after an encounter with an angry patient or even another employee.

Homicide is the second leading cause of all job-related deaths and the leading cause of such deaths for women, according to the Bureau of Labor Statistics (1994).

From an OSHA compliance perspective, preventing workplace violence is a must. In fact, if there is a recognized violence hazard in the workplace and employers do not take feasible steps to prevent or abate it, employers can be cited by OSHA.

To minimize the chance of workplace violence occurring in your facility, consider taking the following action:

Provide safety education for employees. Local police departments can give training on how to recognize, avoid, or diffuse potentially violent situations. See "Tips To De-escalate a Potentially Violent Situation" below.

• Establish procedures for alerting supervisors to any concerns about safety or security.
• Install a system to alert security personnel, such as a "panic" button or an intercom system activated by a floor button.
• Encourage employees to report all violent incidents in writing to their supervisor, even if there were no injuries.
• Instruct employees not to enter any location where they feel unsafe.

If a violent incident occurs:

• Document all incidents and threats of workplace violence and promptly report violent incidents to the local police department.
• Provide prompt medical evaluation and treatment after each incident, regardless of severity.
• Inform victims of workplace violence of their legal right to prosecute perpetrators.
• Discuss the circumstances of incidents of assault with staff members. Provide opportunities for employees to share information about ways to avoid such problems in the future.
• Investigate all violent incidents and threats, monitor trends in violent incidents by type or circumstance, and institute corrective actions.

Workers who have been assaulted or have seen coworkers attacked have reported experiencing short- and long-term psychological trauma, fear of returning to work, and changes in relationships with coworkers and family. Stress debriefing sessions and post-trauma counseling services can help workers recover from a violent incident. Include these services as part of your violence prevention program.

Some Tips To De-escalate A Potentially Violent Situation

Do

• Position yourself so that you have immediate access to an exit.
• Project calmness. Move and speak slowly, quietly, and confidently.
• Be an empathetic listener. Encourage the person to talk, and listen patiently. Indicate that you can see he or she is upse
• Focus your attention on the person to let him or her know you are interested in what he or she is saying.
• Position yourself at a right angle rather then directly in front of the person. Don't invade the individual's personal space. A good distance is three to six feet away.
• Ask for small, specific favors such as asking the person to move to a quieter area (preferably where there are no objects that can be used as weapons).
• Establish ground rules if unreasonable behavior persists. Calmly describe the consequences of any violent behavior.
• Use delaying tactics to give the person time to calm down. For example, offer a drink of water.
• Repeat back what you feel he or she is requesting of you.
• Be aware of anything in the room that can be used as a weapon.

Don't

• Don't use communication styles that produce hostility (hands on hips, arms crossed, pointing fingers), apathy, brush-off, coldness, condescension, robotism, going strictly by the rules, or giving the runaround.
• Don't reject all of his or her demands at the start.
• Don't make sudden movements that can be interpreted as threatening.
• Don't challenge, threaten, or dare the individual; don't belittle the person or make him or her feel foolish. Don't criticize or act impatiently toward the agitated individual.
• Don't attempt to bargain with a threatening person.
• Don't try to impart a lot of technical or complicated information when emotions are running high.
• Don't take sides or agree with distortions.
• Don't make false statements or promises you can't keep.

The American Nurses Association offers an excellent brochure containing facts about what can be done to minimize the chance of medical workplace violence. To receive a copy of this brochure, call 1-800-274-4ANA and ask for item WP-5.

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