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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Uncomfortably Numb: Healthcare Violence Protection Reg Could Take Seven Years

By Gary Evans, Medical Writer

Healthcare worker advocates won a long-sought victory when OSHA recently announced it would develop a violence prevention standard to protect those who care for others. With OSHA taking action before the current regulatory moratorium went into effect, there is reason to hope that the political will can be mustered to protect healthcare workers from an epidemic of violence.

Then came a cold truth that flattened the champagne and blew out the candles. On average, it takes seven years from the time an OSHA standard is proposed to when it is officially enacted, a labor official said. That is apparently the historical cycle, covering some periods when anti-regulatory administrations are not in power. In the current political climate, all bets are off.

In any case -- as urgent as the problem of healthcare violence is -- the OSHA process to enact regulation takes years of hearings, stakeholder meetings, and various and sundry bureaucratic and political requirements.

“I think the GAO assessed that generally it takes on average about seven years,” Jordan Barab, deputy assistant secretary of labor at OSHA, recently told healthcare advocates and union officials who petitioned for the rule. “But again, it is a process. It will require constant vigilance on your part to move the process forward, and if the crowd here is any indication, I’m sure constant vigilance will not be a problem. I think the evidence is clear in terms of the significant risk that workplace violence poses, in terms of the cost that workplace violence imposes upon employers, and particularly workers — not just in terms of money, but in terms of their physical and mental health.”

According to a 2014 American Nurses Association survey, 21% of registered nurses and nursing students reported being physically assaulted -- and over 50% verbally abused -- in a 12-month period.1 A back-of-the-envelope projection based on the nation’s nursing workforce suggests that hundreds of thousands if not more than 1 million nurses would suffer assaults over a seven-year period.

Of course, there are other variables and hopeful remedies, including the possibility of more state laws like the violence prevention measures recently adopted in California. There is also an argument for individual healthcare facilities and chains to adopt strong anti-violence programs, protecting workers from patients and visitors in order to remain competitive in the nursing market. Likewise, OSHA could step up efforts to protect health care workers through its General Duty Clause, though the lack of effectiveness of this tactic was one of the key reasons a specific regulation was pursued.

While expressing disappointment at the projected timeline for OSHA regulation, James Phillips, MD, of the American College of Emergency Physicians, said at a Jan. 10 OSHA hearing that there are some positive signs of progress and the medical community should not be discouraged.

“We can’t just rely on our government representatives and our organizations in Washington to make those decisions for us,” Phillips said. “As not only victims and healthcare providers, but as the research experts and those of us who are affiliated with them, it’s our job to develop consensus, expert guidelines to help guide hospitals and other facilities going forward.”


1. American Nurses Association. 2014. American Nurses Association Health Risk Appraisal (HRA): Preliminary Findings October 2013–October 2014.

For more on this story see the March 2017 issue of Hospital Employee Health.

Gary Evans has written about infectious diseases, occupational health, medical ethics and a variety of other healthcare issues for more than 25 years. His writing has been honored with five awards for interpretative and analytical reporting by the National Press Club in Washington, DC.