Security in hospitals is a sliding scale of professionalism; in many hospitals Security still reports to Food or Building Services, as it’s seen as a cost “burden” and one that can be buried in an already fragile budget.

All clinical staff, nursing, respiratory therapists, physicians, etc., as well as positions not commonly associated with being at risk for violence, e.g., patient financial services, now see violence, both physical and verbal, on a routine basis.

The media reports these events when they occur because they think they are newsworthy; ask a hospital employee that works in the Emergency Department, Behavioral Health, Clinic, etc., if a patient or visitor has threatened them due to (unacceptable) wait times, refusal to issue them pain medication (drug seekers), issue with their bill, etc. Most employees in these roles, over time, just consider being threatened “part of the job.”

It isn’t. Or, it shouldn’t be. 

Hospitals stress the importance of infection prevention by wearing masks, gloves, etc., all factors in keeping hospital staff safe. There are abundant policies and regulations that require this topic to be enforced in hospitals with the fundamental understanding that “universal precautions,” the philosophy that since you can’t “see” germs, you should always protect yourself, is understood.

This same philosophy should be practiced and reinforced in the prevention of workplace violence. “Universal precautions” can also be applied to preventing workplace violence by assuming that all patients may become violent, as, in infection control, all patients are assumed to have germs.

Violent patients aren’t always rocking back and forth in their seat, presenting as a bomb ready to go off. I stood by an elderly male patient on a stretcher in the Emergency Department one evening, who, in the course of conversation waiting for a room assignment mentioned that he was dying of pancreatic cancer. Offering a consoling response was the only answer I could offer; he politely accepted it and then stated, quite calmly: “With only a few weeks to live, I’ve often thought about preparing a list of those who have hurt me in my life and taking my shotgun at home and killing them. What can they do to me? By the time I’d be sentenced, I’d be dead.”

This patient wasn’t threatening staff either physically or verbally; he was quite the gentleman while he was waiting to be admitted to a patient room; yet, nobody knew what was going through his mind, nor cared, since his demeanor was calm and cooperative. 

If all patients were considered at risk to become violent; that an innocent statement, word, inconvenience, etc. might be their “trigger” to commit a violent act, staff would be better able to prevent workplace violence from occurring.

Fundamental training in preparing a room where the door is at your back in case you have to make a quick exit; being aware of blood pressure monitors, steel trays and carts, etc. that could be grabbed and used as a weapon, would all play a role in diminishing their use as a weapon.

Administrative staff in hospitals meet with staff, visitors and patients all the time to discuss a complaint, billing error, employee evaluation, etc. Meeting with them in a conference room with the door at their back and nothing on the table but a file folder is a fundamental safety requirement. All too often administrative staff meet with these individuals in their office with a coffee pot plugged in (with a glass pot, scalding liquid, etc.), scissors, letter openers, paperweights, etc. on their desk and within easy reach of an agitated, violent person. We had a Building Services Director stabbed in the eye by an employee who grabbed a pencil off the director’s desk; what was the topic they were meeting about? Intimidating and threatening behavior this employee was committing against co-workers.

In the State of New Jersey, there is a workplace violence prevention law that requires hospitals to have a workplace violence committee to review policies and procedures, incidents, post-incident review and after action, etc., with the additional requirement that 50% of the committee membership be those with direct patient care responsibilities, as to avoid a committee of strictly administrative personnel. No other industry in the State of New Jersey has a law specifically written for them; only healthcare.

According to OSHA, healthcare workers had a 20% (6.5 per 1,000) overall higher rate of workplace violence than all other workers (5.1 per 1,000) between 1993 and 2009.

Hospitals and healthcare organizations need to bring this topic to the forefront of their strategic planning and budgeting process, as to assure staff they are cognizant of the risks associated with their job(s). Workers compensations costs, overtime, damage to the brand, legal costs, etc., all can be reduced by an effective workplace violence prevention plan that trains employees how to prevent workplace violence, manage it when it occurs, and analyze on a continuing basis ways to improve worker safety by recognizing all patients, visitors, and employees are potential actors.

This article discusses issues of general interest and does not give any specific legal or business advice pertaining to any specific circumstances.  Before acting upon any of its information, you should obtain appropriate advice from a lawyer or other qualified professional.

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