Although it may still be a political longshot, a groundswell of support is growing for a proposed healthcare violence prevention law.
H.R.1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act, was reintroduced by U.S. Rep. Joe Courtney, D-CT, earlier this year. As of May 28, the bill has 154 co-sponsors.
The bill would require OSHA to promulgate a standard requiring healthcare employers to protect healthcare workers from workplace violence.
The American College of Occupational and Environmental Medicine (ACOEM) recently came out in support of the legislation. ACOEM is a national medical society representing more than 4,000 occupational medicine physicians and other healthcare professionals.
“Within ACOEM, there is a large special interest section dedicated to Medical Center Occupational Health, focusing on the particular exposure and injury hazards faced by nurses, doctors, and other healthcare personnel,” the organization stated in a letter to Courtney.
“Physicians and other healthcare professionals across the U.S. are increasingly alarmed at the high rates of serious injury due to workplace violence within the healthcare professions.”
Workers in healthcare and social services have the highest rate of serious injury due to workplace violence, with a rate of 13.7 per 10,000 workers. That compares to 2.9 violent injuries per 10,000 workers in all professions, the group noted.
“An enforceable OSHA standard is needed to prevent foreseeable, serious, and life-altering violence against workers in hospitals, medical clinics, nursing homes, and social service settings,” the ACOEM emphasized.
Testimony was given at a recent hearing on the bill held by the House Subcommittee on Workforce Protections.
Jane A. Lipscomb, PhD, RN, professor of nursing and medicine at the University of Maryland, said “systemic acts of violence occur every day in these workplaces that are predictable and therefore preventable.”
Drawing from her experiences in researching violence and observing it in clinical practice, Lipscomb outlined the scope and longstanding nature of the problem.
“Quite frankly, I have too much firsthand experience working with victims of workplace violence, or in the case of workers who were murdered by patients in their care, their bereaved families,” she said. “I am here to testify that workplace violence prevention plans — tailored to the specific risk, workplace, and employee population — work.”
Voluntary guidelines, which have been issued by OSHA since 1996, fail to “incentivize” employers.
“Healthcare workers who I have spoken with report that they do not have a workplace violence prevention plan or that they have a ‘paper plan’ that does little to nothing to protect them from the ongoing risk of violence,” she said.
Lipscomb cited a randomized, controlled intervention trial that showed that interventions based on OSHA guidelines decreased violent injuries by 60%.1
OSHA can address violence through its General Duty Clause, but this a cumbersome mechanism that needs to be replaced by a specific standard, experts say.
“Because of employer challenges and subsequent legal review, the few workers who have risked filing an OSHA complaint have to wait months to years before OSHA is able to mandate common-sense changes to a workplace via an OSHA citation,” Lipscomb said.
Incidents Drive Nurses Away From Profession
Patricia Moon-Updike, RN, a member of the Wisconsin Federation of Nurses and Health Professionals, described how a violent attack drove her from the nursing profession.
“I have wanted to be a nurse since I was nine years old,” she said at the hearing. “I was able to realize my dream when I graduated from nursing school in 2007. Then, on June 24, 2015, it all changed.”
Moon-Updike was kicked in the trachea while trying to help colleagues restrain a teenage patient on a behavioral unit.
“All I remember is sitting in a chair, not being able to breathe, holding on to my trachea for dear life,” she said. “I just knew if I let go, it would collapse and I would die right there in that hallway. I was praying to stay conscious and focusing on the blood pressure cuff and the oxygen saturation monitor to keep my mind active.”
She recovered from the physical injury but developed post-traumatic stress disorder, anxiety, insomnia, depression, and social phobia related to the incident.
“The nightmares started; I couldn’t sleep,” Moon-Updike said. “I figured this was normal and it would pass. As the days passed, I became more scared of people, of people being unpredictable, people in crowds being unpredictable, children being unpredictable.”
The assault was not a random event, but a predictable scenario that could have been prevented with better planning, she said.
“I loved being a nurse,” she said at the hearing. “I have a huge problem still calling myself a nurse. I do not know what to call myself now. There is a deep loss when you used to make a difference in the lives of people, in your true calling and with passion.”
In other testimony, Manesh Rath, JD, a partner in the law firm of Keller and Heckman LLP, in Washington, DC, said the proposed law would bypass the traditional input from employers and other stakeholders.
“Workplace violence is a complex area of workplace safety that falls outside the scope of traditional rules and predictable human behavior,” he said.
Efforts to regulate the issue of workplace violence in healthcare should be thoughtful and proceed carefully, Rath said.
“The process should be inclusive of employers, employees, the security industry, the insurance industry, and the scientific and medical professions,” he said.
Rep. Alma Adams, D-NC, chair of the subcommittee on workforce protections, said healthcare violence is predictable and preventable. Given the typical seven-year period it takes OSHA to issue a standard, Congress must act to protect healthcare workers, she said.
“Instead of forcing healthcare and social service workers to wait years or decades for effective OSHA protections, this legislation would require OSHA to issue an interim final standard one year after enactment, and a final standard within 42 months of enactment,” Adams said.
- Arnetz JE, Hamblin L, Russell J, et al. Preventing patient-to-worker violence in hospitals: Outcome of a randomized controlled intervention. J Occup Environ Med 2017;59(1):8-27.