Opinion: The Return of the Hospital Visitors Merits Conversation About Workplace Violence

Debi Fischer, MSW, BSN, BA, LCSW, RN

In addition to worrying about the staffing needs in oncology units, RNs are facing workplace violence concerns at increasing rates. Workplace violence events can mean violence between staff membors or with visitors. As COVID-19 restrictions are relaxing and more hopsitals are welcoming visitors, safety considerations have become more relevant.

As of January 1, 2022, an official statement from the Joint Commission, the hospital accreditation agency, now includes a broader definition for workplace violence, which is defined as follows: “An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.”¹ Unfortunately, in the past decade, the incidence of violence-related health care worker injuries has steadily increased and, as of 2018, health care and social service workers are 5 times more likely to experience a workplace violence event compared with other American workers. Even though workplace volence is often underreported, these events are not occurring unnoticed. In fact, the Joint Commission has recently instituted Workplace Violence Prevention Standards as of January 2022¹ with the goal of identifiying threats, educating staff, and using social media to improve data collection.

The incidence rate of violent events toward RNs, specifically, is “approximately 3 times greater than the rate of violent events for all occupations (3.8 cases per 10,000 workers).”² Building this case, a look at the Bureau of Labor Statistics shows that in general, health care workers experienced an increase of 63% in violence directed toward them between 2011 and 2018.² These statistics can be misleading because not all events are reported. The result is that these events can “can impair effective patient care and lead to psychological distress, job dissatisfaction, absenteeism, high turnover, and higher costs.”³

Looking at data from 2018 also shows that health care and social service personnel, which would include RNs and social workers in oncology units were 5 times more at risk than other workers to be exposed to these types of incidents.¹ The bottom line is that this accounts for almost 73% of “all nonfatal workplace injuries and illnesses requiring days away from work.”¹

The reasons for the uptick in violence by visitors vary. Some have to do with a family member receiving a troubling diagnosis and the visitors’ reaction to it, others may be related to trying to navigate the health care system in general—which can be frustrating. Nursing shortages can also play a role in this; with fewer nurses to offer families a social support system, and with fewer nurses to adequately attend to individual patients, families may become overwhelmed quicker. According to the US Bureau of Labor Statistiucs, mental health disorders, political and social issues, and gender and race discrimination can also play a role.² Interviews with security personnel at hospitals, known as safety directors, revealed that the COVID-19 pandemic has exacerbated this reality. In fact, the National Nurses United Union, which is the largest union for RNs in the United States, report that almost half of 2000 RNs have experienced an “increase in workplace violence—more than double the percentage from a year earlier.”³

A new legislation will come before Congress which will be called the Safety from Violence for Healthcare Act.² The aim of this act is to establish consequences for those who want to hurt health care workers. In addition, an amendment put forth by Representative Kathrine Clark (D-Mass) will earmark $5 million for Health and Human Services to provide grants aimed to improve safety and security guidelines in health care.⁴

The new Joint Commission standards of care regarding workplace violence are now being implemented. In order to remain accredited, hospitals must comply with creating systems to promote policies and procedures to decrease workplace violence. This may include improved reporting systems, data collection and analysis, postincident strategies, training and education.

In oncology settings, where unfortunately nurses and social workers are dealing with the aftermath of a terminal diagnosis such as metastatic cancer, recognition of workplace violence and solutions impacts us every day when we swipe in at the clock for our shift. I hope these new efforts will improve the level of safety for all healthcare professionals.

References

1. Workplace violence prevention standards. Requirement, rational, reference. The Joint Commission. June 18, 2021. Accessed November 16, 2022. https://bit.ly/3V0FRtt
2. Boyle P. Threats against health care workers are rising. here’s how hospitals are protecting their staffs. AAMC. August 18, 2022. Accessed November 16, 2022. https://bit.ly/3TMXU5s
3. National nurse survey reveals significant increases in unsafe staffing, workplace violence, and moral distress. News release. National Nurses United. April 14, 2022. Accessed November 16, 2022. https://bit.ly/3tBzyRu
4. House appropriators aapprove FY23 health funding increases in Labor-HHS Bill. AAMC. July 1, 2022. Accessed November 16, 2022. https://bit.ly/3Okb7Sb