Environmental Designs
The following are environmental designs employers can use to help diffuse violence in the healthcare setting:
- Develop emergency signaling, alarms, and monitoring systems.
- Install security devices such as metal detectors to prevent armed persons from entering the hospital.
- Install other security devices such as cameras and good lighting in hallways.
- Provide security escorts to the parking lots at night.
- Design waiting areas to accommodate and assist visitors and patients who may have a delay in service.
- Design the triage area and other public areas to minimize the risk of assault.
- Provide staff restrooms and emergency exits.
- Install enclosed nurses’ stations.
- Install deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas.
- Arrange furniture and other objects to minimize their use as weapons.
Healthcare and social service workers face significant risks of job-related violence and it is OSHA’s mission to help employers address these serious hazards. This publication updates OSHA’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers. OSHA’s violence prevention guidelines are based on industry best practices and feedback from stakeholders and provide recommendations for developing policies and procedures to eliminate or reduce workplace violence in a range of healthcare and social service settings.
These guidelines reflect the variations that exist in different settings and incorporate the latest and most effective ways to reduce the risk of violence in the workplace. Workplace setting determines not only the types of hazards that exist but also the measures that will be available and appropriate to reduce or eliminate workplace violence hazards.
For the purpose of these guidelines, we have identified five different settings:
- Hospital settings represent large institutional medical facilities;
- Residential Treatment settings include institutional facilities such as nursing homes, and other long-term care facilities;
- Non-residential Treatment/Service settings include small neighborhood clinics and mental health centers;
- Community Care settings include community-based residential facilities and group homes; and
- Field work settings include home healthcare workers or social workers who make home visits.
Indeed, these guidelines are intended to cover a broad spectrum of workers, including those in: psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment centers, pharmacies, community-care centers, and long-term care facilities. Healthcare and social service workers covered by these guidelines include registered nurses, nurses’ aides, therapists, technicians, home healthcare workers, Occupational Safety and Health Administration 2 social workers, emergency medical care personnel, physicians, pharmacists, physicians’ assistants, nurse practitioners, and other support staff who come in contact with clients with known histories of violence.
Employers should use these guidelines to develop appropriate workplace violence prevention programs, engaging workers to ensure their perspective is recognized and their needs are incorporated into the program.
Violence in the Workplace: The Impact of Workplace Violence on Healthcare and Social Service Workers
Healthcare and social service workers face a significant risk of job-related violence. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”1 According to the Bureau of Labor Statistics (BLS), 27 out of the 100 fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts. While media attention tends to focus on reports of workplace homicides, the vast majority of workplace violence incidents result in non-fatal, yet serious injuries. Statistics based on the Bureau of Labor Statistics (BLS) and National Crime Victimization Survey (NCVS)2 data both reveal that workplace violence is a threat to those in the healthcare and social service settings.
BLS data show that the majority of injuries from assaults at work that required days away from work occurred in the healthcare and social services settings. Between 2011 and 2013, workplace assaults ranged from 23,540 and 25,630 annually, with 70 to 74% occurring in healthcare and social service settings. For healthcare workers, assaults comprise 10-11% of workplace injuries involving days away from work, as compared to 3% of injuries of all private-sector employees.
In 2013, a large number of the assaults involving days away from work occurred at healthcare and social assistance facilities (ranging from 13 to 36 per 10,000 workers). By comparison, the days away from work due to violence for the private sector as a whole in 2013 were only approximately 3 per 10,000 full-time workers. The workplace violence rates highlighted in BLS data are corroborated by the NCVS, which estimates that between 1993 and 2009 healthcare workers had a 20% (6.5 per 1,000) overall higher rate of workplace violence than all other workers (5.1 per 1,000).3 In addition, workplace violence in the medical occupations represented 10.2% of all workplace violence incidents. It should also be noted that research has found that workplace violence is underreported—suggesting that the actual rates may be much higher.
