Workplace Violence in U.S. Health Care Settings - Term Paper Example

Workplace Violence in U.S. Healthcare Settings Introduction Workplace violence is becoming increasingly rampant in the United s. Recently, studies report that violence in the workplace has grown considerably and that it has became a severe large-scale problem in healthcare settings.1 A number of public opinion surveys substantiate the rising anxiety of the general public concerning public safety and workplace violence.2 Violence has been and persists to be a common issue in television, radio, and movies. Problems of violence and victimization are entrenched in the United States and have been considered a main concern in healthcare settings.3 Violence in the workplace is a multifaceted problem that is closely interwoven in the United States by several psychological, economic, social, situational, and medical crises.4 Violence can take place in any place or setting, and practically anyone within the healthcare environment can be a victim or offender- employers, employees, clients, family members, given the appropriate factors and conditions. The Bureau of Labor Statistics (BLS) and Census of Fatal Occupational Injuries (CFOI) disclosed that ‘healthcare providers are at 16 times greater risk for violence than other workers.’5 This fact demonstrates the idea that the frequency of violence in the workplace is rising and is underreported. Once confined to psychiatric and emergency units, attacks take place in a broad range of settings, with a growth in the occurrences of assaults in healthcare settings.6 According to an investigation of incidents made public in 1991 of hospitals in Canada and the United States, the largest number of nonfatal attacks took place in patient or health care settings.7 Likewise, the National Institute of Occupational Safety and Health (NIOSH) disclosed that 64% of nonfatal attacks happened in service organizations.8 Nurses are the major care providers in healthcare settings and can be in danger when giving care to perpetrators, victims, and witnesses. Scholars logically estimate that nurses and other providers of care are attacked more often than any other employees in the United States.9 An international research reported that ‘75% of all psychiatric nursing staff had been attacked at least once in their profession.10’ Furthermore, Blair and New (1997) guesstimate that roughly ‘50% of healthcare workers will be assaulted at least once in their careers.11’ Usually, majority of service organizations and occupations are at great danger given the considerable extent of contact with various people. The general operation and composition of healthcare organizations, nonetheless, weakens several violence-prevention strategies.12 For instance, workplace’s access restriction is a widespread violence-prevention measure.13 In numerous healthcare organizations, there is an entry access for 24 hours to possible patients, and open movement of people. Other causes of the vulnerability of healthcare settings to assaults are: (a) low staffing and high-acuity patients, (b) increased discharge rates of acute and chronically mentally ill patients, (c) current cost-cutting focus and widespread downsizing within the healthcare industry, (d) substance abuse, and (e) the general stressful nature of illness and uncertainty.14 Lewis and Dehn (1999) suggest that a reduction in the availability of community resources for patients with chronic mental illness as an outcome of budget reductions has led to treatment in outpatient situations, aggravating the risk for violence. 15 This essay will discuss the history, statistics, causes and effects of violence in healthcare organizations in the United States, as well as the policies and measures taken to reduce the frequency of violence in the workplace. History and Statistics of Workplace Violence in the United States The definition of workplace violence originates from a number of post office attacks that took place in the 1980s.16 These incidents, regarded as violence in the workplace, are homicide or other criminal acts by a dissatisfied and angry employee against superiors or colleagues. This is a precise classification of crime.17 The alarm to the general public was quite aggravated after the post office shootings. Workplace violence has been introduced to the general public due to this incident.18 Although workplace violence perhaps started prior to the post office killings, public awareness of the predicament began on 1986, when a postman killed 14 people before committing suicide.19 This incident instigated a new media awareness stage, but a few post office killings took place all over the United States.20 Statistics show that violence is a widespread phenomenon in American workplaces. However, statistics concerning the occurrence of workplace violence are conservative at best21; numerous occurrences are underreported or not reported at all because particular episodes may not be considered as violent acts against employees or because of assumptions that episodes must be reported only if they are severe.22 According to the National Crime Victimization Survey, ‘40% of the respondents did not report a violent incident because they believed it to be a private or minor matter, while 27% reported the incident to a company official, but not the police.23’ A research carried out by the Northwestern National Life in 1993 reported that ‘58% of employees did not report harassment, 43% did not report threats, and 24% did not report attacks.24’ Hence, the severity of the issue goes beyond average statistics, which nevertheless are disturbing and frightening. The U.S. Department of Justice in 1994 disclosed that violence in the workplace comprised ‘15% of the 6.5 million’25 acts of violence experienced by adolescents in the United States; similarly alarming is that over 7,000 murders happen in the workplace annually.26 The National Institute for Occupational Safety and Health (NIOSH) stated that the phenomenon of homicide in the workplace is worsened for employees where there is a heightened level of contact with the public.27 The federal government has stated that it is the legal duty of the employer to provide a practically healthy and safe workplace for workers.28 According to the 1970 OSHA General Duty Clause, employers are irresponsible if they fall short in identifying and taking actions to remedy or prevent a possible threat of violence.29 As stated by Schneid, it is important that employers set up precautionary instructions for the benefit of the employees, but rules by the OSHA and the state have the possibility of incurring a costly legal responsibility for employers.30 The latest OSHA policies require the following important program components for preventing violence in the workplace: ‘(a) management commitment and employee involvement, (b) work analysis, (c) hazard prevention and control, (d) education and training, and (e) record keeping and program evaluation.31’ Employers of healthcare providers are not excused from legal responsibilities. A psychiatric hospital in Chicago was penalized after several violent assaults on personnel by patients, including fractures, head injuries, bites, and bruises from kicking and punching.32 OSHA at first fined the psychiatric unit $10,350, but trimmed it down to $5,000 when the psychiatric unit consented to an abatement program that was designed to deal with the threats of violence.33 Security and safety of patients, visitors, employees, and personal belongings have been attended to by accreditation groups, like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).34 According to the policies of JCAHO, hospitals should perform safety evaluations and give training and education for violence prevention for the staff.35 Causes and Effects of Workplace Violence in Healthcare Settings In the workplace, violence normally is connected to a threat to a person’s social, emotional, and/or economic security. Americans use up a significant portion of their time at work or occupied in tasks related to work. An individual’s colleagues or friends usually are from his/her workplace.36 The identity of a person, to a considerable extent, may be characterized by the task s/he performs. Hence, any peril to an individual’s work is a direct and instant peril to numerous aspects of that person’s life. Worsening this predicament is a limited job market.37 In the past, a worker merely looked for a similar job when confronted with being fired or laid off. However, in the current job market a quite small fraction of employees who become jobless can hope to find a similar job.38 As claimed by Kinney (1995), roughly 10% of laid-off or fired workers can hope to find a similar job.39 Hence, majority of these workers will experience trouble in finding similar job and will find jobs at lower wages, look for other types of employment, or remain jobless. As a result, terms such as restructuring, mergers, downsizing, reorganization, and right sizing build tension and anxiety in workplaces and make these environments susceptible to violent acts.40 Moreover, the unfriendly features of organizational structure and the respect to superior/s by workers empower authorities. Workers cannot, or believe they cannot, articulate their issues, disappointments, and resentment without being put through disciplinary measures or forced resignation.41 Mantell and Albrecht (1994) introduced the concept ‘toxic companies’42 to characterize work environments that are supervised through a method of fear and constraint. The consequential environment is advantageous to abuse and oppression at the judgment of those in managerial or supervisory position. Several managers are hesitant to fire a difficult worker, even when it is evident that the worker causes a threat to the welfare and security of coworkers.43 Jossi (1999) explains a condition in which managers were afraid of a worker and kept encouraging him/her, hence s/he became the problem of others.44 In circumstances where the offender is not a member of the staff, the contributing factor or cause may be apparent unfairness or apathetic attitude toward a significant other.45 Family members of chronically ill patients are worried and anxious all the time. Discussions with healthcare providers may not provide sufficient answers, and the detached approaches of some physicians may further worsen the dilemma.46 Family members may perceive these attitudes as intimidating and become more uneasy and irritated.47 These feelings may be heightened as people feel powerless concerning their inadequate capability to help in the care of a loved one. In response to these various feelings, individuals may either physically or verbally attack healthcare providers. Early warning signals of possible assault required immediate and direct response and thorough assessment of each scenario.48 The threat of workplace violence can be attributed to different factors. Some classifications of risk factors have been regarded as possible causes for heightened violence in the workplace, such as psychological, physical, employment, organizational, and environmental factors.49 Healthcare providers take care of a wide array of population with a whole host of issues and difficulties. Nurses and other healthcare providers are faced with economic limitations. In several geographical regions, because of mergers and acquisitions, forced resignation from one healthcare unit may prohibit employment with other associated units.50 Physical risk factors involve poor lighting, several access routes, low visibility, etc.51 Healthcare settings create various issues. First, a large number of people are in and out of healthcare facilities every day, and significant others and loved ones are given permission to stay with the patient all night.52 Hence, it is difficult to make sure those individuals who belong from people who do not. Second, the expanse of most healthcare facilities makes it hard for security staff to monitor the whole facility effectively.53 Finally, the physical characteristic of most hospitals and other healthcare units poses threats, such as poorly lighted hallways at night, vacant patient rooms, and the presence of numerous units and areas.54 Violence in the workplace takes place more frequently than employers and employees may recognize. Such violence in healthcare settings can have severe psychological and physical effects. The extents of violence in the workplace can include a broad range of severity. Kinds of assaults can involve sexual harassment, bullying, physical abuse, verbal abuse and even homicide. If workplace violence is physical, hospitalization, pain, disfigurement, injuries, and death may result. Victims of violence in the workplace are more prone to suffer post-traumatic stress disorder (PTSD). This disorder is a widespread psychological problem that normally affects victims of violent acts.55 Other enduring psychological effects are self-blame, irritability, self-doubt, fear, lack of motivation, and depression.56 If victims are not given psychological support and assistance when reporting assault in the workplace, it will discourage them and other victims and/or witnesses from reporting assault. Finally, the detrimental effect to the healthcare organization of violence is not practically as significant or serious as the physical or emotional damage done to the victims, yet it remains a subject of concern.57 Violence in the workplace can hurt the morale of the organization. Several employees may need prolonged break, or may even leave their jobs.58 Other difficulties that may come up include damage to the image of the organization and lower productivity. Preventing Workplace Violence in Healthcare Settings The first step in preventing the threat of violence in the workplace is to formulate written anti-violence guidelines that understandably emphasize a ‘zero tolerance’ for violent acts. 59 These guidelines, which attend to nonhospital staff providers, patients, visitor, and employee factors, should insert a declaration that “this is a violence-free workplace and no aggressive, violent behavior will be tolerated.60” From the point of view of employees, any type of harassment, bullying, violent threats, and possession of firearms on company grounds are reasons for immediate termination.61 Employers should create a reporting system and develop appropriate response when a report is been given. Fellow workers normally are the first to notice that something is amiss but usually are reluctant to intervene or do not see that their concerns are taken seriously.62 The reporting system must involve the development of specific forms to report incidents of assault, and the creation of confidential methods and hotline for angry and happy workers alike that promote the immediate reporting of hostility, threats, and other violent conduct.63 Employers must have understandable written rules concerning forbidden behaviors and how violations or punishments will be dealt with. These must be disseminated during the process of recruitment and selection or sent to each worker every year.64 Regular meetings must be held to notify workers of any amendments to the present guidelines and to offer workers a chance to talk about any issues and explain any areas of uncertainty. Supervisors and managers, for their part, should be prepared for possible behavioral and situational issues. Nevertheless, workers should be given the chance to deal with any issues with human resources management. A duplicate of the signed guidelines should be kept in each worker’s document.65 Conclusion Violent episodes and attacks on nurses and other healthcare providers are underreported and widespread. A number of falsehoods are carried on in healthcare settings, encouraging healthcare providers think that being assaulted is a normal part of their employment. Healthcare providers should not be supposed to tolerate culpability for violent acts, and they have a lawful privilege to complain employers. As demonstrated in the two circumstances, the employers in healthcare organizations can be possibly responsible for damages stemming from failure to provide sufficient and practical safety or preventive measures. Nurses and other healthcare providers need to have a greater knowledge of their lawful rights related to the problem of workplace violence. References Chappell, Duncan & Vittorio Di Martino. Violence at Work. International Labor Office, 2006. Hitchcock, Janice, Phyllis Schubert, & Sue Thomas. Community Health Nursing: Caring in Action. Delmar Cengage Learning, 2002). Levy, Barry S., D.H. Wegman, S.L. Baron, & R. Sokas (eds). Occupational and Environmental Health: Recognizing and Preventing Disease and Injury. Lippincott Williams & Wilkins, 2005. Mckoy, Yvonne & M.H. Smith, “Legal Considerations of Workplace Violence in Healthcare Environments,” Nursing Forum 36, no.1 (2001): 5+. Privitera, Michael. Workplace Violence in Mental and General Health Settings. UK: Jones & Bartlett Publishers, 2010. Smith-Pittman, Mable H. & Yvonne McKoy, “Workplace Violence in Healthcare Environments.” Nursing Forum 34, no. 3 (1999): 5+ Read More