Zero tolerance may not be best solution to workplace violence

Expert suggests employees better served with training

The idea of workplace violence is unsettling to employers, employees, and occupational health professionals. Often, the first reaction by anyone in those groups would be to maintain zero tolerance for violent behavior at work.

But according to W. Barry Nixon, SPHR, executive director of the National Institute for Prevention of Workplace Violence, enforcing a zero tolerance policy might not be the best option for employers or workers.

"I am not an advocate of zero tolerance policies, because they tend to be reactionary in nature," he says. "A zero tolerance policy says, 'If this happens, here's what we do,' but I prefer a zero incidence plan of progressive prevention.

"Zero incidence plans incorporate zero tolerance, but not as the sole solution to every problem," Nixon adds.

What's often missing in reaction-oriented zero tolerance policies, he explains, is the component of prevention.

Violence can erupt at any work site

According to NIOSH, every year between 1993 through 1999, an average of 1.7 million people were victims of violent crime while working or on duty in the United States. An estimated 1.3 million (75%) of these incidents were simple assaults, while an additional 19% were aggravated assaults. Of the occupations examined, police officers, corrections officers, and taxi drivers were victimized at the highest rates. (Data available at www.cdc.gov/niosh/injury/traumaviolence.html.)

The American Nursing Association (ANA), citing its own research, reports that nearly a half-million nurses per year reported that they were victims of violent crimes in the workplace.

But NIOSH suggests that almost any work site can be the scene of violence by or toward employees. Some risk factors include:

  • contact with the public;
  • exchange of money;
  • delivery of passengers, goods, or services;
  • a mobile workplace such as a taxicab or police cruiser;
  • contact with unstable or volatile people in health care, social service, or criminal justice settings;
  • working alone or in small numbers;
  • working late at night or during early morning hours;
  • working in high-crime areas;
  • guarding valuable property or possessions;
  • working in community-based settings.

Nixon points out that while some work sites, such as emergency departments within hospitals, are easier than others to segregate potentially violent people and secure other areas, other work sites are accessible to anyone who walks in.

"That's why the focus should not be so much on what to do when violence happens at the workplace, but how to prevent incidents from occurring and remove risks," he says.

The most important step, and the first one, that occupational health and safety managers should take toward prevention of violence at the workplace is to make sure there is a well-written violence prevention policy in place, and that it's not only in place, but also that it's implemented and enforced, Nixon explains.

Risk assessment should be part of developing a policy, he continues, so that health and safety managers can know where the site's areas of potential risk are. Risk assessment involves both physical examination of the site, plus input from employees about what they are concerned about. (See The NIX Model for Managing Workplace Violence.)

Assessment of the organization, installation of security measures to the physical site, and development of relationships with law enforcement, mental health, and other individuals and services that could assist the organization during a crisis are other components of the NIX system for managing workplace violence.

The final step is to fill employees in on the planning process and what they can expect from the program, supervisors, occupational health nurse, and management.

"The occupational health nurse can play an important role in making sure managers are aware of what are commonly known as warning signs, and in communicating information to managers and employees," says Nixon.

"People need to be educated, to know what to do if they recognize the signs. For supervisors, that also includes instruction on how to intervene properly and to know what their action plan should be if they recognize signs of problems. For employees, that action plan would probably be to report to their supervisor, occupational health nurse, or human resources office."

This brings up why zero tolerance policies are problematic and why many employers are moving away from them. "People hear that certain behaviors are not acceptable and there is zero tolerance — that that employee will be terminated, for example."

But what often happens, Nixon says, is that the behavior that is unacceptable is not deemed cause for termination. A zero tolerance policy can mandate termination for any verbal threat of physical harm, for example, but if a verbal threat proves to be essentially groundless and the employee is simply reprimanded, other employees might feel the company is selectively enforcing its own policy.

The occupational health nurse should participate in the prevention preparation that hopefully might prevent an incident of violence. While there is far less control to be had over violence that comes into the workplace from outside, other than physical security barriers, tending to the employees within the company provides a chance to address problems before violence erupts.

"There should be effective background checks during the hiring process, to screen for potentially violent people," says Nixon. But past history doesn't always reveal who might or might not become violent when three variables come together.

"For an incident to be more likely, first you have to have an individual who has a propensity toward violence — a violence-prone person who thinks violence is a way to solve problems," he explains.

"Second, there is a triggering event. It can be something that happens outside the workplace or at work that causes a person an extreme amount of stress — an ill loved one, a divorce, or being fired or penalized at work.

"And the third variable is how the company responds to an individual who they recognize is at risk. That is the one factor the organization has control over," Nixon adds.

While an employer can't control a person's propensity toward violence (particularly if it has not manifested itself), nor often have any influence on the triggering event, he says occupational health, risk management, and co-workers recognizing the signs of trouble and responding appropriately could be the difference between resolving the problem and a tragedy.

The most common signs, according to widely available Federal Bureau of Investigation advisories, include changes in mood, personal hardships, mental health issues (e.g., depression, anxiety), negative behavior (e.g., untrustworthy, lying, bad attitude), verbal threats, and past history of violence.

While human resources and safety managers can easily access information on the warning signs of workplace violence, a study by AAOHN in 2003 indicates that the majority of workers surveyed don't know how to recognize warning signs.

"AAOHN's study found that nearly 20% of the entire work force claimed they have experienced an episode of workplace violence firsthand, yet the majority still do not know what to look for when it comes to determining potential offender characteristics," according to AOHN president Susan A. Randolph, MSN, RN, COHN-S, FAAOHN. "These findings alone define a significant need for companies to commit to and implement workplace violence education and prevention programs. Without employee education, a company will be far less able to diffuse a potential violent situation before it arises."

"If you have an employee who is acting increasingly hostile, or they exhibit a number of signs indicating to you that something is wrong, that's when appropriate action is key," he continues. A supervisor, occupational health nurse, or human resources contact should take care not to apply his or her own feelings about the source of the stress as a means of measuring risk; Nixon says what might seem inconsequential to one person could be a major source of stress to another.

When prevention fails

If, despite best efforts, an episode of workplace violence occurs, the management aspect of the employer's plan is tested. Before this happens, the nurse should be familiar with the company's employee assistance program (EAP) and resources in the community that can be called on quickly to assist.

"Make sure your EAP is tied into a community network and that there's someone identified in advance who can do critical incidence debriefing and can help people manage so that they are not traumatized," Nixon suggests.

Steps taken at this time, as well as preventative steps that the company undertook, can protect the employer from liability if employees sue. If an employee complains of another employee's violent behavior, the employer must conduct an investigation and take preventative steps to remedy the situation and document the entire process. If there are threats made by a domestic partner to hurt an employee at work, employers should take action to protect the employee and others by increasing security as necessary.

Whether an employer is liable for an incident of domestic violence that occurs in the workplace will depend on the facts of the case, but when a violent incident occurs between co-workers or workers and customers, companies may be liable for if a supervisor knew about assaults, potential assaults, or harassment and failed to take appropriate action.

Nixon advises that the best way to train employees to respond to a perceived or real threat of violence at work is to have a plan for prevention and management fully developed, and then do a good job of educating and training the employees.

"In my model [the NIX model], training and education are the final step, and that's based on the premise that you've done all the other things necessary to create the plan that you need, and now you're ready to fully train your supervisors and employees on it," he explains. "A lot of organizations go from Step 1, assessment, to Step 2, training."

Training employees to recognize and deal with violence is different from other safety training, because the human factors make it more unpredictable than other occupational accidents.

"Workplace violence is not a random safety violation carried out by a process or machine, but by a walking, thinking person," he says. "Your response has to be thought out and can vary depending on the location and situation.

"If you have someone coming in with a gun, for example, it might seem that evacuating the building is the logical step. But it might be the worst thing you could do, because if evacuating everyone to the parking lot is the procedure during other emergencies, then the person with the gun might know that everyone is now concentrated in one place, in the parking lot."

Because health care workers typically have multiple contacts each day, often with people walking in off the street who might be dealing with tremendous stress, Nixon developed a list of seven things employees at health care facilities should know about violence in the workplace:

• Adapt and completely accept the paradigm that violence is not a part of the job. At the same time, accept the fact that the chance of you being exposed to workplace violence is very real. Refuse to accept that becoming a victim is inevitable because most incidents of workplace violence are preventable if your organization and employees take the necessary steps to prevent it.

• Read your organization's workplace violence prevention policy and understand the definition of workplace violence and its components.

• Make a commitment to know, understand, and recognize the potential warning signs or at-risk behaviors that individuals frequently demonstrate prior to an incident of workplace violence.

• Make a commitment to get training in workplace violence prevention.

• Take responsibility for your own safety and security at work. Report any and all concerns to the designated company representative, such as an occupational health and safety professional or human resource or security manager. Don't let peer pressure, a code of silence, belief that management will not take action, or anything else prevent you from taking steps to protect yourself. If you recognize that a colleague is exhibiting at-risk behavior, report it.

• As an employee, report any concerns about unsafe work conditions, breaches of your security policies, or environmental or organizational conditions that may contribute to workplace violence to your human resources representative, security, or occupational health professional.

• If your organization has a process for identifying high-risk patients and flagging charts or records of patients with a history of violence, make sure you understand them and take precautionary steps to protect yourself. Never dismiss them as unnecessary or not applicable (based on your experience with the person). If your organization does not have a process, work with human resources, security, or occupational health and safety professionals to develop one.

For more information, contact:

  • W. Barry Nixon, SPHR, Executive Director, National Institute for Prevention of Workplace Violence. Web site: www.workplaceviolence911.com. E-mail: wbnixon@aol.com.
  • American Association of Occupational Health Nurses, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Phone: (770) 455-7757. The AAOHN workplace violence survey report is available on-line at www.aaohn.org.
  • American Nurses Association, ANA's Workplace Violence: Can You Close the Door? available by calling (800) 274-4ANA.
  • Occupational Safety and Health Administration Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, OSHA 3148-1996. Available on-line at www.osha.gov/Publications/osha3148.pdf.