WHITE PAPER MEDICAL WORKPLACE VIOLENCE THREATS AND ISSUES [Growing Recognition and Impact] Prof. Eugene Schmuckler PhD MBA MEd CTS® Dr. David Edward Marcinko MBA CMP® On November 6th 2009, a 39 year old Army psychiatrist named Maj. Nidal M. Hasan MD [1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia] went on a savage 100 round shooting spree and rampage that killed 13 people and injured 32 others Yet, the impact of workplace violence became widely exposed, more than two decades before, in Edmond, Oklahoma. In August 1986, Patrick Henry Sherrill, an employee of the US Postal Service, angered by perceived injustices against him by his employers, shot and killed fourteen people, wounded six, and then killed himself. By 2012, the Bureau of Labor Statistics (BLS) reported that: 1. Nearly 2 million Americans report they’ve been victims of violence at work. 2. In 2010, 1 in 9 workplace fatalities were homicides. 3. Homicide is the most common cause of workplace fatalities in women. 4. Workplace violence is one of the gravest occupational hazards for healthcare workers. 5. Nearly one-third of nurses are subjected to physical or verbal assaults at least once a month. 6. Geriatric wards and waiting rooms are two of the most frequent sites for hospital violence (along with emergency departments and psychiatric wards). 7. A Detroit hospital began screening with handheld metal detectors — and collected 33 handguns, 1324 knives, and 97 mace type sprays during a 6- month period. 8. A veteran’s hospital in Oregon reduced violent attacks by 91.6% after implementing a database that identified patients with a history of violence. 9. An NYC hospital reduced reported violent crimes by 65% after implementing ID badges and color-coded passes that limited access to hospital floors. Introduction These shocking events have not only added, and reinforced, the term “going postal” to our lexicon, but contributed to our almost blasé attitude about them. Want more recent evidence? A Boston cardiac surgeon was mortally wounded by a gunman at Brigham and Women's Hospital in January 2015. Dr. Michael Davidson, of Wellesley, was shot twice at a cardiac center after a man demanded to see him. The 44-year-old Davidson died despite frantic efforts of co-workers to save him. The shooter, who turned the gun on himself and committed suicide in an examining room, had some kind of previous relationship with the doctor, and was identified as Stephen Pasceri, 55 of Millbury, MA. Dr. Davidson, a Yale graduate, had worked at the hospital since 2006 and was an assistant professor at Harvard Medical School. Yet, during Super Bowl XLIX week pre-game preparations, the local and national attention seemed only to be riveted on accusations that Coach Bill Belichick and the Boston Patriots football team deliberately deflated 11/12 of the footballs used in the division championship game. ASSESSMENT OF WORKPLACE VIOLENCE IN HEALTHCARE 1. What Is Workplace Violence? Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence. The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes: threatening behavior — such as shaking fists, destroying property, or throwing objects; verbal or written threats — any expression of intent to inflict harm; harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities; verbal abuse — swearing, insults, or condescending language; muggings — aggravated assaults, usually conducted by surprise and with intent to rob; or physical attacks — hitting, shoving, pushing, or kicking. Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger. The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.1 Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace. Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker. Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators. Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace). 2. Effects of Workplace Violence The healthcare sector continues to lead all other industry sectors in incidents of non-fatal workplace assaults. In 2000, 48% of all non-fatal injuries from violent acts against workers occurred in the healthcare sector.2 Nurses, nurses’ aides, and orderlies suffer the highest proportion of these injuries. Non-fatal assaults on healthcare workers include assaults, bruises, lacerations, broken bones, and concussions. These reported incidents include only injuries severe enough to result in lost time from work. Of significance is that the median time away from work as a result of an assault or other violent act is 5 days. Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite costly to the facility as well as to the victim. A study undertaken in Canada found that 46% of 8,780 staff nurses experienced one or more types of violence in the last five shifts worked. Physical assault was defined as being spit on, bitten, hit, or pushed.3 Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical assaults in intensive care, emergency departments, and general wards. A study in Florida reported that 100% of emergency department nurses experience verbal threats and 82% reported being physically assaulted. Similar results were found in a study undertaken in a Canadian hospital. Possible reasons for the high incidence of violence in emergency departments include presence of weapons, frustration with long waits for medical care, dissatisfaction with hospital policies, and the levels of violence in the community served by the emergency department.4 1 Cal/OSHA, 1995; UIIPRC, 2001. 2 Bureau of Labor Statistics, 2001. 3 Duncan, S., Estabrooks, C.A., & Reimer, M. “Violence Against Nurses.” Alta RN. 2 (2000): 13-14. 4 Lipscomb, J. & Love, C. “Violence Toward Healthcare Workers — An Emerging Occupational Hazard.” AAOHN Journal. 40:5 (1992): 219-228. Lipscomb, B.B. “Healthcare Workers,” in B. Levy & D. Wegman (editors) Occupational Health: Recognizing and Preventing Work-related Disease and Injury. (4th ed.) Philadelphia: Lippincott, Williams & Wilkins, 767-778. Similar findings have been reported in studies of mental health professionals, nursing home and long- term care employees, as well as providers of service in home and community health. Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all healthcare providers. Personnel working in large medical practices fall into this category as well. Although no area is totally immune from acts of violence it most frequently occurs in psychiatric wards, emergency rooms, waiting rooms, and geriatric settings. Many medical facilities mistakenly focus on systems, operations, infrastructure, and public relations when planning for crisis management and emergency response: they tend to overlook the people.1 Obviously, no medical facility can operate without employees who are healthy enough to return to work and to be productive. Individuals who have been exposed to a violent incident need to be assured of their safety. The costs associated with workplace violence crises are not limited to healthcare dollars, absenteeism rates, legal battles, or increased insurance rates. If mishandled,