How to address a report of a safety issue

Take report seriously; document follow up

Ensuring employee safety requires more than a set of policies and procedures. It requires immediate action and thorough investigation once an employee reports an unsafe situation, says Robert W. Markette Jr., an attorney with Gilliland & Markette in Indianapolis.

Take each report seriously, says Markette. Although the issue may seem minor, be aware that most cases of violence in home health were preceded by warning signs that the home health employee didn't report, or didn't view as serious, he explains.

Make sure that employees know that they don't have to stay in the home if they feel threatened, says Markette. "If the patient or a member of the patient's family yells at the employee or threatens them in any way, they should leave and let their manager talk to the family," he says.

There are gray areas in which some home health nurses use their own judgment, admits Markette. "Some patients with dementia will threaten others, curse, or yell — and the behavior is related to the disease," he says. "Older, more experienced nurses will often take the behavior in stride, but younger nurses or aides may not be prepared to handle the situation," he says.

Regardless of the situation, once an employee reports that he or she doesn't feel safe, a manager must investigate, says Markette. "If there is violence or a threat of violence, suspend service while you investigate," he suggests. "After the investigation, a manager and another person from the agency should visit the family," he says. The agency should always send two people to meet with the family, with one person having the authority to make decisions and the other person as a witness to the meeting. The purpose of the meeting is to identify the issue, outline the results of the investigation, and discuss the actions that will be taken to resolve the issue. The employee involved in the report should not be present, he says. "All of these points should be included in a letter that will be given to the family," he says. A family member or the patient must sign a form acknowledging receipt of the letter, he adds.

In some cases, the agency might ask a family to fix unsafe conditions in the home, make sure that family members or friends who threatened or made the employee feel unsafe are not at the home when the employee is there, or confine a dog during the employee's visit, says Markette. "If the family and patient agree to the conditions, resume service," he says.

There may be cases in which patients or family members don't want certain employees based upon race or gender, and that prompted the threatening language, says Markette. "An agency cannot assign employees based upon race or gender," he emphasizes. If the family or patient insists upon certain gender or race, then the agency will have to discharge the patient, based on the family's unwillingness to provide a safe environment, he adds.

Dementia patients can present challenges, but Markette suggests that the agency try to assign more experienced nurses to them if there is no real potential for violence. "If you do make a staffing change after an investigation, be sure to point out to the employee who filed the complaint that it is not a reflection on the employee's performance; it is related to being able to serve the patient," he suggests.

If the patient and family don't address the issues outlined in the letter, it is appropriate to send another letter informing them that due to their inaction, your agency must discharge the patient, says Markette. Although agency managers are reluctant to appear to abandon a patient, it is acceptable to discharge a patient when there is clear evidence and documentation that providing care places the home health employee in a potentially dangerous situation, he says.

Finally, after the report has been investigated and issues have been resolved, be sure to communicate with the employee who initiated the complaint, says Markette. "Explain the process and the results thoroughly, so that the employee knows the complaint was taken seriously."


For information on responding to safety concerns, contact:

• Robert W. Markette, Jr., Attorney, Gilliland & Markette, 3905 Vincennes Road, Suite 204, Indianapolis, IN 46268. Telephone: (317) 704-2400 or (800) 894-1243. Fax: (317) 704-2410. E-mail:

For a free copy of an article "Preventing Workplace Violence for Health Care and Social Service Workers," go to and select "publications and articles," then scroll down to select the article.