The largest nurses union in the U.S. called for more robust federal workplace safety rules this week as one of the strongest workplace violence prevention rules in the nation went into effect in California.
National Nurses United joined the California Nurses Association to call for the law to be used as a model for federal efforts aimed at preventing violence against health workers. The new California law requires healthcare employers to have workforce protection plans in place, including violence prevention training for all employees.
"In my years in the hospital, I shared the experience that too many nurses have been encouraged to see as just 'part of the job' of being kicked, hit, spat at and threatened," said Bonnie Castillo, executive director of National Nurses United. "These experiences are terrifying but they are not uncommon."
Castillo said the group is urging nurses to hold all California "healthcare employers accountable for following the law."
Workplace violence in healthcare is a pervasive problem. As FierceHealthcare has reported, 75% of workplace assaults between 2011 and 2013 occurred in healthcare settings and 80% of emergency medical workers will experience physical violence at some point in their careers.
In March, Rep. Ro Khanna, D-Calif., introduced a similar federal measure with support from 14 other members of Congress. The federal bill would require the Occupational Safety and Health Administration to develop a national standard for both health facility and unit-specific healthcare workplace violence prevention plans.
It is unclear how U.S. hospitals would respond to such mandates, but the requirements could come with some challenges. The American Hospital Association, which urged the Occupational Safety and Health Administration last year to support research and share best practices for preventing violence in the healthcare and social assistance sectors, declined to comment.
The California Hospital Association told Modern Healthcare they support the law but have concerns about certain requirements, such as a rule that would make hospitals assess patients and visitors for violent behavior without offering guidance of how to appropriately do that. A spokeswoman also raised concerns about enforcing training requirements when doctors are often not directly employed by hospitals.
There appears to be growing support on Capitol Hill and among employers for workplace violence prevention programs in light of headline-grabbing active shooter situations like the attack on YouTube employees this week, said Randy Spivey, CEO of the Center for Personal Protection and Safety in McLean, Virginia.
His company provides training to companies and individuals. Spivey told FierceHealthcare the cost for a typical health system to license content for such training is typically less than $50,000 a year.
Workplaces need to create a policy that identifies who takes responsibility for the program, such as a human resources manager or head of security, Spivey said. They must spell out acceptable behavior and what employees should do if they see a problem.
"There needs to be some sort of protocol of how you’re going to respond to the incidents as they occur," Spivey said.
Employees need to be required to undergo awareness training to recognize the warning signs that someone might be progressing toward violence. "Those people don’t just snap. There is always a progression," he added.
Employers should also address some of the common "weak links" in their planning, Spivey said. For instance, middle management supervisors need advanced training to ensure complaints are handled properly when they are reported by employees. Workplaces need to be willing to tackle some sensitive issues, but people are often reluctant to talk about a scenario like an active shooter situation or domestic violence.
All of this is tricky, but it is all the more important in a healthcare environment. "They have to have survivor/protector mindset because there are patients involved and not just employees," Spivey said.