In the absence of long-sought federal legislation to prevent violence in healthcare, Oregon becomes the latest state to enact protections for healthcare workers against workplace violence.

Effective Jan. 1, the law requires healthcare employers to conduct comprehensive security and safety evaluations using state or nationally recognized workplace violence prevention methods. It also requires healthcare employers to establish, in coordination with the workplace safety committee, a process by which committee shall review healthcare employer’s assault prevention and protection program.

Compelling testimony from healthcare workers preceded the vote, including that of Jennifer Barr, RN. “We must strengthen the current statute that requires the collection and tracking of data,” she said. “Currently, it is not required that this data be reported or made available to workplace staff to view. This is completely unacceptable. Employees have a right to know their risk for experience violence by simply coming to work.”

The state law requires healthcare employers to direct a workplace safety committee to document violent incidents in an annual report and make that available to the public and employees. The employer must submit the report of incidents and injuries to the state director of the Department of Consumer and Business Services no later than Dec. 31 each year. It requires the employer to document healthcare assaults or other behavior at risk of violence in the patient record.

“In my personal experience, the workplace violence I have seen or experienced comes primarily from patients who are mentally altered,” Barr said. In one instance, Barr was attacked by a patient who had left his bed to go to the bathroom during a night shift.

“He was unsteady and a great fall risk, so I responded to his bed alarm and found him in the bathroom,” Barr testified. “In attempting to get him from the bathroom back to his bed, he became agitated and grabbed me around my neck. Due to the nature of the room setup, I was trapped in the bathroom and unable to make a quick escape. Fortunately, one of my male colleagues was right outside the room and responded to my cry for help immediately. Our one security guard on duty that evening was engaged in a situation in the emergency room at that time. I was thankful the situation did not escalate.”

‘I Was Lucky’

Katherine Luers, RN, also testified before the state legislature, telling Oregon lawmakers how her attempt to go the extra mile for a patient led to disaster.1

“In my work as a neurology nurse, I frequently deal with confused and disoriented patients. One day, I was caring for a confused gentleman with alcoholic dementia,” she said. “We had a good working relationship all day long, and as we were short-staffed, I agreed to stay an additional 4 hours beyond my 12-hour shift to help care for the patients.”

As the sun set, the patient became increasingly agitated and paranoid, a phenomenon familiar to many night shift nurses, she said. The patient said he believed his medication was poisonous and that hospital staff were planning to kill him.

“I continued to reorient and reassure him,” Luers said. “The patient got out of bed and his bed alarm went off. I ran into the room to keep him safe, as he was quite unsteady. Although my hospital provides training in de-escalation and preventing assaultive behavior for nurses, I was not on my guard, since I worked with this gentleman successfully all day. He was startled, and also believed I was trying to keep him in the hospital to kill him. He grabbed me by the windpipe. I was shocked by how difficult it was to break his hold or just back out of the room.”

She called for help, and another staffer called a Code Gray, rallying security staff to be at the scene within two minutes to defuse the situation.

“Because of the procedures in place, I was lucky that I was not physically injured, but the experience traumatized me,” Luers said. “I was surprised by how long-lasting the emotional effects were. I now feel vulnerable with patients in a way I did not before this incident. … nurses like myself are getting injured and abused every day. We know that the best way to limit violence is to enact comprehensive workplace violence prevention programs, where hospital administrators, managers, and security personnel are committed to solving the problem.”

The Oregon law makes it unlawful for healthcare employers to retaliate against employees who make good-faith reports of assaults that occurred on work premises. In addition, security must have sufficient staff to provide security at all times in the ED.

The law allows the hospital industry to phase in the requirements, setting a deadline of June 30, 2021, for completing the work site evaluations. State officials will compile reports summarizing employer compliance and report to the Legislative Assembly by March 22, 2022.

While California was the first state to enact violence protections, other states are trying to follow. A proposed federal law remains in regulatory limbo. Sixteen states proposed healthcare violence prevention laws in 2019, and Nevada and Washington state also have adopted laws to protect healthcare workers.

A federal bill (HR 139) that would require an OSHA standard to prevent violence in healthcare remains in limbo. The issue has been subject to a protracted struggle for years, with OSHA finally agreeing in 2017 to promulgate a standard — an immediate non-starter, as a moratorium was placed on enacting new federal regulations.

A 2018 report by the National Institute for Occupational and Safety (NIOSH) found that healthcare violence is increasing. Overall, 106 participating hospitals reported a 72% increase in workplace violence injuries. The rate went from 4.4 injuries per 1,000 full-time equivalent (FTE) workers in 2012 to a high of 7.2 per 1,000 FTE in 2015, NIOSH found.2

The study authors did not assess the reasons for violence, but cited patient factors such as the increasing prevalence of substance abuse, mental illness, dementia, and other conditions as likely contributing causes. In addition, workplace factors like understaffing, high turnover, and long patient wait times can exacerbate the situation.

REFERENCES

  1. Luers K. Testimony in support of SB 823, March 20, 2019. Available at: https://bit.ly/3arSPsX.
  2. Groenewold MR, Sarmiento RFR, Vanoli K, et al. Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015. Am J Ind Med 2018;61:157-166.