workplace violence prevention 0421 - 1199c training · risk: the problem} workplace violence is a...

Workplace Violence Prevention in Healthcare

District 1199C Training Fund HWWH SH-29634-SH6

This material was produced under grant SH-29634-SH6 from the Occupational Safety and Health Administration, US Department of Labor. It does not necessarily reflect the views or policies of the US Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.


Preventing Workplace Violence in Healthcare: Learning Objectives


} What is Workplace Violence?} Who is Affected? Who Gets Hurt?} Risk Factors} Prevention and De-escalation} Recognize Warning Signs} What Employers Can Do} What Others are Doing} OSHA and Employee Rights

What is Workplace Violence?} A range of hostile behavior in the workplace:} Verbal Abuse} Intimidation, harassment, or threatening behavior } spoken, written, or physical

} Working around people who try to insult or intimidate you} Being exposed to hostile behaviors that get in the way of

your ability to do your job


Verbal Abuse, Harassment,

Bullying

Intimidation, Threats

Physical Contact, Assault

Severe Injury Death

BAD à à à WORST

What is Workplace Violence?

Psychological Intimidation/Harassment

Making statements that are:

• False (slander)• Malicious (mean) • Insulting • Name Calling• Rude, Disrespectful

• Bullying• Lying to hurt

someone’s reputation

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What is Workplace Violence?

Physical Intimidation/ Harassment

• Physically holding someone back

• Blocking movement• Impeding

• (Getting in their way, on purpose)

• Trapping, Cornering• Following

} Stalking} Inappropriate

contact/advances} Repeated unwelcome

touchingPPT-046-01 7


What is Workplace Violence?}Assault – Intentionally causing physical injury, pain or distressØ Hitting, slapping, punching, pushing,

shoving, poking or kickingØ May include use of weapons, furniture.

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Risk: The Problem} Workplace violence is a serious concern for 15 million

healthcare workers in the US} 2013 – over 153,000 workers reported assault in

healthcare facilities} 25,000 of these cases were severe enough to result in missed

days of work (up 12% from 2011)} Psychiatric aides have

the highest rates of missed days of workdue to workplaceviolence injuries

} Workplace Violence Underreported: These numbers may actually be higher


http://democrats.edworkforce.house.gov/publication/additional-efforts-needed-help-protect-healthcare-workers-workplace-violence

Risk: Who is affected?} About 2 million American workers are victims of

violence every year*} Can affect anyone} Some people are more at risk} Working alone or in small groups} Working late at night or in the early

morning} Working in high-crime areas} Lots of contact with the public} Working with long waits, over-crowding

• https://www.osha.gov/Publications/osha3148.pdf-

• Page 2


Who is at greater risk?

} Social Services Workers} Behavioral Health Workers} Frontline Healthcare Workers} Nurses and Aides} Medical Professionals


Who is at greater risk?} Those who care for patients can be at

risk during:Ø Communicating with FamilyØ Evaluating PatientsØ Emotional or PsychiatricØ Physical

Ø Meal timesØ Visiting HoursØ Patient TransportØ Patient CareØ Wound careØ Bathing


Risk: Where Violence Happens

PPT-046-01 11

Ø Waiting Rooms, Emergency RoomsØ Labor and Delivery RoomsØ Around Family MembersØ Patient HomesØ Alzheimer's UnitsØ Drug Treatment or Group HomesØ Whenever working around alcohol or

illegal drugs


Risk: Where Violence Happens

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Ø Poorly lit areas (stairs, parking lots)Ø No buddy or check-in systemØ No security or alarm systemØ Poor CommunicationØ Isolated workplaceØ Workplace exposed to crowded public

areas


Risk: Who Causes Violence?Anyone -} Patients} Patient’s family or friends} People you have worked with} Acquaintances} Random strangers

VIOLENCE CAN HAPPEN TO ANYONEregardless of age, race, ethnicity, religion, geography, ability, job title, appearance, sexual orientation, and gender identity.


Risk: What Makes People Violent?} Sometimes people who experience TRAUMA

(whether emotional or physical) act out in an uncontrolled ways when:} They feel “triggered” by situations that remind them of

hard times, or } They get traumatized by feeling:} Sick, vulnerable} Afraid, terrified} Alone, helpless} Grief } Anger, rage} Despair, hopelessness} Physical pain


Risk: What Makes People Violent?

} Intense Emotion, Frustration} Trauma } Mental or emotional illness

} Some people act with violence in order to control or dominate a situation

} Desperation: Having no other ‘tools’ to use


Escalating Behavior• Physical Attack• Sexual Abuse• Domestic Violence• Murder

Violence

Threats

• Shouting, yelling• Slamming doors, drawers• Throwing things• Damaging property

Disruptiveness

• Impatience• Change in tone of voice and body language• Inappropriate remarks or offensive language

Frustration


• Verbal or written• Threatening or obscene phone calls• Not respecting ‘boundaries’ • Being followed, stalked

De-escalation } De-escalation means To Calm Things Down


De-Escalation Tips

DO DO NOTØ Show a calm, caring

attitudeØ Try to acknowledge

what the person is saying and feeling

Ø Assess each situation for safety

Ø Stay Alert!

} Do not match the attitude of someone who is angry or frustrated

} Do not isolate yourself} Do not let yourself get

penned in} Do not lose a clear

pathway to ESCAPE


Interpreting BehaviorPeople express themselves in many different ways.

} Get training on cultural differences} Uncomfortable with someone’s behavior?} Ask them to behave differently:“You are talking really fast.I am having a hard time understanding you. Could you please slow down?”

}Difference is not danger


Prevention: Personal Boundaries

} Respect Personal Space} Keep about 1½ to 3 feet of space between you and other

people} Do not touch the person OR their belongings –

Especially if someone is upset or angry


Recognize Upset or Frustrated Behavior} Change in the person’s tone of voice } Change in the person’s body language} Impatient behavior} Changes in how YOU FEEL when talking to them

NOTE: Just because someone is displaying these actions does not necessarily mean they will become violent.


Compassionate Listening} When someone is frustrated -

Put yourself in their shoes} Think about what they are going through} A husband just found out his wife has cancer} A family cannot pay their medical bills} A sick patient feels they are not being given decent care

from the nurses/doctors

} Think about how you might feel in the same situation (frustrated, scared, angry, etc.)

} Consider how you would want to be treated in the same situation

} Think BEFORE you respond


De-escalation Techniques } When someone is frustrated:} LISTEN with respect} Speak with a soft voice} Re-state what the person said so they know you heard them} Try to help them, if you can} If you cannot help them, give them other options to find what they

need

} Apologize, if necessary} Tell people what to expect and be honest

Set limits on their behavior} “It’s not necessary to shout, I hear your concerns.”


Helpful Suggestions} Pay attention to your voice tone and

volume – your “energy”} Mirroring: Behave with the behavior you

want them to show you

} Use ‘open’ body language} Don’t cross arms, legs} Stay relaxed} Take a deep breath &

calm yourself down

} Try not to take their emotions or problems personally


Recognize Disruptive Behavior} Rude language} Yelling, shouting} Pointing and jabbing fingers;

pounding fists } May come closer to you than

you are comfortable with

NOTE: Just because someone is displaying these actions does not necessarily mean they will become violent.

However, this behavior is inappropriate and disruptive -It is not OK.


De-escalation Techniques} When someone is disruptive:} Keep yourself calm} Take a deep breath…..

} Choose your words carefully} Give clear instructions } Set respectful, firm boundaries

} If you can’t lower your voice,you will have to come back at another time when you can speak more calmly.} Please control yourself and sit down. Otherwise,

I will have to call security


De-escalation Techniques} Set boundaries by giving clear instructions} For example: } Please do not use profanity or curse} Please speak more quietly} If you continue to interrupt me I will not be able to help you} Please sit down

} Make sure YOU have a direct escape route to safety in case things get out of control

} Signal for help if you feel uncomfortable or threatened


Recognize Threatening Behavior} Actual written or verbal threats} Person invades your personal space

in a way that makes you feel threatened or intimidated

} Person does not respect the boundaries you or someone else has set


Recognize Threatening Behavior} Person follows, stalks, phones or

emails you in inappropriate ways} You feel scared because of:} What they said} How they behaved

} You are afraid for your physical safety} Being threatened with any kind of harm,

revenge, a weapon or violence} YOU might feel angry in response


Recognize When Someone Might Become Violent

} Loss of emotional control} Body language} Throwing things} Invasion of personal space} Inappropriate touch} Shoving, pushing} Weapons} History of violent behavior


Activityhttps://youtu.be/aHllPBt868E

1. Can you identify any hazards in the parking garage?2. Do you think Marks’s colleagues should have tried to talk to

him about how he’s been acting?3. Who is the “victim” here, Mark or his colleagues? 4. Should the supervisor have done anything before talking to

Mark in her office?5. Do you think the supervisor handled the conversation in a

good way? If so, why or why not?6. What could she have done differently?7. Can you identify any hazards in the supervisor’s office?8. What kind of programs or procedures could have been in

place to prevent the situation from reaching this point?District 1199C Training Fund HWWH SH-

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Safety and De-escalation Techniques

}YOUR SAFETY COMES FIRSTIf you think someone will become violent:} GET AWAY AND GET OUT!} CLEAR ESCAPE ROUTE} SAFE SHELTER

} Call for Help – Security – Police - 911} DO NOT confront the person} DO NOT try to stop the person yourself


Reporting and Documentation

}Report all incidences of inappropriate touch, workplace violence or intimidation} Keep a record of everything you report} Prevent the same thing from happening to

someone else


Which situation is safer for the nurse?} When in a room with a patient, place yourself so that you

can easily escape when possible


EXIT

EXIT

NURSE

NURSE

VISITOR

VISITOR

Note: If at any time patient or visitor behavior begins to escalate, make sure you have a clear exit plan.

Clothing Safety} Keep it Simple: Do not let your clothing

or accessories get used against you


ZERO TOLERANCE} ZERO TOLERANCE

for inappropriate touch} ZERO TOLERANCE

for threats or violence of any kind


Staying SafeYOUR safety is your top priority:

} Document & report any behavior that is:} Inappropriate} Threatening or Intimidating} Violent

} Keep copies of anything (everything) you report


Staying SafeLearn from ‘Close Calls’ } Hazardous incidents that almost happened} Came close} Just missed you} Dangerous but you escaped harm

} Take Close Calls seriously} Management should investigate and analyze Close Calls} What you learn will help keep other workers safe


Staying Safe – Review } Recognize Early Signs of ESCALATING BEHAVIOR} Frustration, Upset, Disruption or Violence

} Try to de-escalate before it gets out of control} Calm things down

} Set clear boundaries with clear and realistic consequences

} Get HELP if you feel threatened or intimidated} Know your EXIT ROUTE} Report and document what happened

YOUR SAFETY COMES FIRST


What can your employer do?

}Make it clear to ALL employees, visitors and patients that the facility has a Zero Tolerance Policy for workplace violence


What can your employer do?} Create Incident Reporting System} Threats, intimidation or harassment} Inappropriate touch} Violence} Close calls

} Create Incident Investigation Team } Explore Lessons Learned


What can your employer do?Provide:} Signs} HOW to get help} ‘Area Under Surveillance’

} Free medical care as needed} Workers Compensation

} Free, confidential counseling services for victims and witnesses of workplace violence

} Let employees know that no one will be punished in any way for reporting workplace harassment, intimidation or violence


What can your employer do?

} Write Violence Prevention Policy} Write effective Violence Prevention

Procedures, including Zero Tolerance Policy

} Provide Violence Prevention Training for all employees} Set up a Violence Prevention Committee


Violence Prevention Committee} Include workers with

direct patient contact} Include supervisors} Include Union

members & reps} Meet regularly} Review policies and

procedures to make sure they work well

} Investigate Incidents & Close Calls} Where, Why, How,

Who?} How could incident

have been prevented?} Walk-through the facility

to identify RISK} “Risk Assessment”

} Document challenges and successes


Violence Prevention Committee} Committee Makes Recommendations

based on incident investigations and facility walk-throughs:} Alarms and Signal Systems} Security devices (cameras)} Additional security staff} Better or more lighting


Violence Prevention Committee}Recommendations} Enclosed reception areas} Emergency Response Plans} Safe Shelter} “Shelter in Place”

} Clear Exit Pathways} No one works alone} Buddy System

} Security escorts if needed} Restricted Area Access} So public cannot reach workers without an escort} ID badges


Violence Prevention Programs Work} 4 out of 5 studies on violence programs suggest that

violence prevention programs can reduce the rate or severity of assaults

} California – the rate of assaults dropped in emergency rooms after the state adopted a law requiring hospitals to develop violence prevention programs


http://democrats.edworkforce.house.gov/publication/additional-efforts-needed-help-protect-healthcare-workers-workplace-violence

Active Shooter Situation} What should you do if someone comes into your

workplace/school with a gun and begins actively shooting?


Run. Hide. Fight. Surviving an Active Shooter Eventhttps://vimeo.com/73940709


Follow Up Questions} Did anything surprise you in this video about what you

should/should not do?} What do you think might have prevented this situation?} Have your thoughts/feelings changed about what you

should do in an active shooter situation?


What others are doing –New Jersey Law} NJ Law (Chapter 326, State of NJ 2011)} Requires hospitals, psychiatric hospitals & nursing homes to

establish violence prevention programs} Each facility must establish a violence prevention program} Violence prevention committee} Detailed, written violence prevention plan

} Yearly violence risk assessment/ plant inspection

$5,000 fine per violation that results in injury, $2,500 fine per violation that does not result in injury

*ten other states have laws to protect healthcare workers form workplace violence


What others are doing –Philadelphia Teaching Hospitals} Clear reporting and response systems} Training} Online Violence Prevention training through computerized

training system } Individual department trainings} Small group presentations} Identify and address potential hazards} Review safe hiding places} Self defense techniques

} Active shooter drills} Emergency evacuation and response drills


Federal EEOC Law} Equal Employment

Opportunity Commission (EEOC) – Title VII

} Worker are protected from harassment based on a legally protected class

} Acts done must be "severe or pervasive enough to create a work environment that a reasonable personwould consider intimidating, hostile, or abusive."

Protected classes: } Age - over 40} Disability, including

pregnancy} genetic information} national origin} race/color} Religion} Gender or Sex


Federal OSHA Law} OSHA General Duty Clause:} Public Law 91-596 Section 5 (a) (1)} Each employer must furnish to each of his/her employees

employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his/her employee's.”

FREE FROM RECOGNIZED HAZARDS WHICH COULD CAUSE

PHYSICAL HARM


Preventing Workplace Violence in Healthcare: Learning Review


} What is Workplace Violence?} Who is Affected? Who Gets Hurt?} Risk Factors} Prevention and De-escalation} Recognize Warning Signs} What Employers Can Do} What Others are Doing} OSHA and Employee Rights

References} Guidelines for Preventing Workplace Violence for Health

Care and Social Service Workers (OSHA-3148), (2015)} https://www.osha.gov/Publications/osha3148.pdf

} CDC/NIOSH Workplace Violence} http://www.cdc.gov/niosh/topics/violence/} Free on-line course about workplace violence prevention for

Nurses:http://www.cdc.gov/niosh/topics/violence/


Helpful Links for More Information} CDC Workplace Violence Prevention Course for Nurses} http://www.cdc.gov/niosh/topics/violence/training_nurses.html

} New Jersey Violence Prevention in Health Care Facilities Law} ftp://www.njleg.state.nj.us/20062007/PL07/236_.PDF

} OSHA resources} https://www.osha.gov/SLTC/workplaceviolence/evaluation.html

} Workplace Violence in Healthcare: Strategies for Advocacy by AnnMarie Papa, DNP, RN, CEN, NE-BC, FARN, and Jeanne Vanella, DNP, MS, RN, CEN, CPEN} OJIN: Online Journal of Issues in Nursing, Volume 18, No.1, Manuscript 5; Jan. 31, 2013


Employee Rights Under OSHA


} Rights of Every Employee

OSHA Rights and Whistleblower Protections

OSHA laws give workers the right to: } Participate in safety and health activities } Report work related injuries or illnesses } Report safety violations


Employer cannot take action against you for using your OSHA rights.

Retaliation is Against the Law


} Firing or laying off

} Blacklisting

} Demoting

} Denying overtime or promotion

} Denial of benefits

} Disciplining

} Failure to hire or rehire

} Intimidation

} Making threats

} Reassignment affecting prospects for promotion

} Reducing pay or hours

NO

No ‘Adverse Actions’ for Safety Activities

What if you get in trouble for complaining?Whistleblower Time Line

} OSHA LAWUnder Section 11(c) of the OSH Act, employees are protected from retaliation when they:} file a safety complaint} participate in a safety

inspection.

} TO BE PROTECTEDIf employees experience retaliation, they must file a complaint with

OSHA within 30 days.

} If employees win a complaint case, they could be entitled to back pay and compensation for damages

} If employees lose a complaint case, they have

15 days to “appeal” the decision.

} Second chance to win your case


FIVE Ways to Communicate with OSHA

1. E-mail an Interactive ONLINE Form

2. Call OSHA3. In-Person Visit4. Fax a Complaint5. Mail a Letter


How to contact OSHA} www.OSHA.gov} US Department of Labor/OSHA

Wanamaker Building100 Penn Sq East, 12th FloorPhiladelphia, PA 19107

Telephone: (215) 597-4955} Fax: (215) 597-1956} Toll-free number: 1-800-321-OSHA (6742)OSHA WILL KEEP YOUR INFORMATION CONFIDENTIAL


For more informationHealthcare Occupational Safety CenterHealth Workers Working Healthy Training ProjectDistrict 1199C Training & Upgrading Fund100 South Broad Street, 10 FloorPhiladelphia, PA 19119www.1199ctraining.org

QUESTIONS?District 1199C Training Fund HWWH SH-

29634-SH6

With thanks to:

• Jefferson School of Population Health• Jefferson University Hospitals

• Department of Public Safety

• CDC Workplace Violence Prevention for Nurses• Health Workers Working Healthy

• Technical Advisory Committee

• Google Images


workplace violence prevention 0421 - 1199c training · risk: the problem} workplace violence is a...

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