Avoiding Danger in the Workplace

LYNNE JETER

Bureau of Labor Statistics Shows Higher Incidents of Violence in Healthcare Settings

Every year, thousands of workers in the healthcare and social services industries are confronted with threats of violence and actual assaults.
 
According to the U.S. Bureau of Labor Statistics (BLS), under the Health Care and Social Assistance classification, 114 workplace fatalities occurred in 2007. Of those fatalities, 15 percent were attributed to homicide.
 
Also in 2007, 14 workplace fatalities occurred within the Healthcare Support Operations classification, which includes nursing, psychiatric, and home health aides. Of those fatalities, 36 percent were attributed to homicide.
 
Additionally, BLS reported 69 homicides in the health services sector from 1996 to 2000. Even though workplace homicides may attract more attention, the vast majority of workplace violence consists of non-fatal assaults. In 2000, 48 percent of all non-fatal injuries from occupational assaults and violent acts occurred in healthcare and social services, primarily occurring in hospitals, nursing and personal care facilities, and residential care services. Nurses, aides, orderlies and attendants suffered the most non-fatal assaults resulting in injury.
 
Injury rates also reveal that healthcare and social service workers are at high risk of violent assault at work. BLS rates measure the number of events per 10,000 full-time workers—in this case, assaults resulting in injury. In 2000, health service workers overall had an incidence rate of 9.3 for injuries resulting from assaults and violent acts. The rate for social service workers was 15; for nursing and personal care facility workers, it was 25—compared to an overall private sector injury rate of 2.
 
The National Association of Social Workers conducted a membership workforce survey in late 2007, asking respondents to identify safety issues in their work environments. Violence from adult clients, vehicle vandalism, vehicle accidents, physical assault from non-clients, and fear of the neighborhoods in which they work were cited as major safety concerns.
 
Elizabeth J. Clark, PhD, executive director of the National Association of Social Workers, testified before the U.S House Ways and Means Committee: "Another difficulty facing today's child welfare workers is the constant risk of violence. According to a 1998 national study of front-line caseworkers, more than 70 percent had been victims of violence or threats of violence in the line of duty. In a peer exit interview process conducted in one state, 90 percent of its child protective services employees reported that they had experienced verbal threats; 30 percent experienced physical attacks; and 13 percent were threatened with weapons. According to public agency caseworkers in Texas, their salaries do not reflect the risks to personal safety they face as part of their work. These caseworkers reported that, given the safety risks they are exposed to daily, they should be given hazardous duty pay, similar to workers in other high-risk professions."
 
Current OSHA guidelines recognize an industry at risk. According to Preventing Workplace Violence for Health Care & Social Service Workers, a prominent risk factor cited was solo work, often in remote locations with no backup or venue for assistance, such as communication devices or alarm systems. This risk holds particularly true in high-crime settings. For example, 51-year-old social worker Brenda Lee Yeager was assaulted and killed by the parents of a 3-year-old child during a scheduled visit in Cabell County, West Virginia. A report said "her death came slowly and after several attempts by the child's parents to strangle her individually."
 
Within the guidelines, to minimize risk, OSHA recommends installing and regularly maintaining alarm systems and other security devices, panic buttons, hand-held alarms or noise devices, cellular phones and private channel radios where risk is apparent or may be anticipated. OSHA also suggests arranging for a reliable response system when an alarm is triggered, and using the following administrative and work practice controls:
 
  • Use the "buddy system," especially when personal safety may be threatened. Encourage home health providers, social service workers and others to avoid threatening situations.
  • Develop policies and procedures covering home health providers, such as contracts on how visits will be conducted, the presence of others in the home during the visits, and the refusal to provide services in a clearly hazardous situation.
  • Establish a daily work plan for field staff to keep a designated contact person informed about their whereabouts throughout the workday. Have the contact person follow up if an employee doesn't report as expected.
 
John Sutton, CEO of New Orleans-based The Guardian, which trains healthcare providers on safety, security, and self-defense, noted that Carri Casteel, PhD, a professor at the University of North Carolina, has been conducting a 4-year study concerning Violence in Home Health for NIOSH, the right arm for OSHA that makes recommendations to pass new laws. (Results should be published by year-end.)
 
"It looks like the study is going to back up what BLS and OSHA have been saying about violence in the medical industry," said Sutton. "New reports show that violence on a national level was at about 4 incidents per 1,000 workers in 2009. On the other hand, the medical industry averages about 15 violent acts for every 1,000 workers. This is great part due to the 'culture' in the medical industry. There has to be a zero tolerance for any type of abuse because it's not part of the job."