Nurses and other healthcare workers joined Members of Congress yesterday at a news conference to discuss violence on the job in the healthcare industry. Ms. Helene Andrews, RN recalled being assaulted by a 25 year old psychiatric patient at Danbury Hospital. She was handing him mediation and a drink of water when, she explained:

“Without warning, the patient suddenly became viciously violent. He punched me with his full strength in my jaw, hurtling me backward onto the floor. The impact of my body crashing down shattered my left leg at the hip.’’

If that wasn’t bad enough, Andrews later learned that staff at the hospital were not consistently told which patients had violent histories. The News Times’ Dan Freedman notes that in Andrews’ case,

“her attacker’s mother had visited — something that could easily trigger a violent assault.”

The news conference was called by Senator Patty Murray (D-WA), Rep. Bobby Scott (D-VA), Rep. Frederica S. Wilson (D-FL), and Rep. Joe Courtney (D-CT) to announce a new report from the Government Accountability Office (GAO). They’d asked GAO to investigate the efforts by the Occupational Safety and Health Administration (OSHA) and state agencies to address workplace violence in health care facilities.

GAO used data from three different federal agency sources to estimate the number of non-fatal workplace violence incidents in 2011. The incidents included those perpetrated by patients (the most common incident) and patients’ family members. The most common types of assaults were hitting, kicking, and beating, such as these reported by hospitals staff from emergency departments:

• Worker hit in the head by a patient when drawing the patient’s blood and suffered a concussion and a permanent injury to the neck; and
• Worker knocked unconscious by a patient when starting intravenous therapy on the patient.

And this from a residential care facility:

• Patient became upset after being deemed unfit to return home and attacked the worker

How serious is the problem? Among other things, GAO reported for the year 2011:

• Data from HHS’s National Electronic Injury Surveillance System indicates for example, more than 64,000 hospital employees sought treatment in an emergency room for violence-related injuries.
• The Department of Justice’s National Crime Victimization Survey estimated that nearly 81,000 healthcare workers were assaulted on the job.
• The Bureau of Labor Statistics estimates the rate of lost-time violence-related injuries in 2011 was five times higher for individuals who are employed in hospitals and other in-patient facilities when compared to the rate for all private-sector workers.

These numbers certainly understate the problem. GAO held discussions sessions in five US cities with a total of 54 healthcare workers. They heard a variety of reasons that many healthcare workers don’t report violence-related incidents, such as “fear of being blamed for causing the attack.”

GAO also noted that nine states (California, Connecticut, Illinois, Maine, Maryland, New Jersey, New York, Oregon, and Washington) have laws that require health care employers to establish a program to protect workers from on-the-job violence. Here, for example, is the law passed in 2011 in Connecticut and here for the State of Illinois.

At the news conference announcing the GAO report, Senator Patty Murray said:

“Violence should never be part of any job description.”

Rep. Bobby Scott (D-VA) said:

“…OSHA should move forward and develop an enforceable violence prevention standard to help protect our nation’s healthcare workers.”

His congressional colleagues at the event shared that opinion, as did those with the Service Employees International Union, AFSCME, National Nurses United, the Steelworkers, and other organizations that represent healthcare workers.

OSHA officials told GAO that they are

“…not planning at this time to develop a workplace violence prevention standard because it has identified other workplace hazards that are higher priorities for regulatory action.”

The agency has used its “general duty clause” authority to issue 17 citations from 2010 through 2014 in the healthcare industry for violence-related hazards (e.g., here, here.)

OSHA has also sent “Hazard Alert Letters” (i.e., sort of a “you have a problem” but “we can’t cite you for it” notice) to 48 healthcare employers with recommendations to implement violence-prevention measures. [OSHA doesn’t seem to have these particular letters posted on its website.]  GAO criticized OSHA, however, for not routinely following up with the employers who received the hazard alert letters (HALs).

“OSHA has a centralized information system, but has not systematically used it for tracking the status of HALs. While OSHA’s information system is capable of tracking the status of HALs, OSHA officials are not sure if regional offices are consistently entering updated information. …Without a uniform process to follow up on these HALs, OSHA will not know whether the hazards that placed employees at risk for workplace violence at these facilities continue to exist.”

Healthcare workers are a special breed. They are compassionate and called into a career to care for the sick. Most are underpaid for their skills and the services they provide. The National Crime Victimization Survey suggests that each day in the US at least 200 of them are assaulted on the job. The healthcare industry has done a good job keeping this secret. It’s a disgrace that healthcare workers are the most assaulted workers in the country.

Thanks to the Members of Congress who are responsible for requesting the GAO report. It sheds light on a horrible problem.