“I’ve had a 33-year career and would say I’ve been assaulted at least 50 times if not more. I’ve been kicked, been punched, been called every name in the book, been bit, slapped, had weapons pulled on me … and it’s something that’s becoming more and more common throughout the state. It’s not just in psychiatric units or emergency rooms but in all areas of health care settings — within doctor’s offices, hospitals — we are seeing it and hearing about it from nurses.” — Karen Coughlin, registered nurse for the Department of Mental Health at Taunton State Hospital and the vice president of the Massachusetts Nurses Association
Nurse Elise Wilson would agree to that characterization. She’s in critical condition at UMass Memorial Medical Center after Conor O’Regan, reportedly unhappy with the care he received three weeks earlier, went inside Harrington Hospital in Southbridge, MA and stabbed Wilson multiple times.
EMTs, mental health attendants, ER nurses and others tell the same story, and Cyrus Moulton in the Worcester Telegram gathers the statistic to back them up:
According to the Bureau of Labor Statistics as cited in the Occupational Safety and Health Administration report “Caring for Our Caregivers,” U.S. health care workers suffered 15,000 to 20,000 workplace violence-related injuries every year from 2011 to 2013 that required time away from work for treatment and recovery. Health care accounts for nearly as many injuries as all other industries combined, according to OSHA.
During that same time, assaults constituted 10-11 percent of serious workplace injuries in health care, compared with 3 percent of injuries among the private sector as a whole, the BLS reported.
The problem appears to be increasing.
Between 2005 and 2014, rates of workplace violence incidents have increased 110 percent in private industry hospitals, according to the National Nurses United, the country’s largest union and professional association for registered nurses.
And it’s happening in Massachusetts.
According to a November 2015 to January 2016 survey of more than 220 nurses by the MNA, 86 percent of nurses reported experiencing some kind of violence in the past two years. Seventy-four percent reported violence as a somewhat serious or very serious problem in their workplace in the past two years.
Things seem to be getting worse not because people are getting more evil, but because of deterioration social conditions.
I first became aware of workplace violence against healthcare and social service workers in the 1980’s when the nation was undergoing a wave of budget cuts, closing mental health institutions and de-institutionalizing many mentally ill persons. While the mental health system may have been long overdue for restructuring and modernizing, the frequent result of these policies were people being discharged to the streets or community homes when they needed a much higher level of care.
Today’s problems are different, but the end result — increasing the hazards that health care and social service workers face — is the same:
According to Christine Pontus, an occupational health and safety specialist with the MNA, several factors can be attributed to the rise in workplace violence against health care workers.
She said a lack of mental health services and the deterioration of the mental health care system mean more mental health patients are using emergency rooms for treatment. Furthermore, the opioid crisis has increased the number of impaired patients in hospitals. Meanwhile, understaffing and overcrowding of emergency departments and hospitals mean many nurses are always in “crisis mode” rather than “prevention mode” and don’t have the time they would like to develop a rapport with patients, Ms. Pontus said. Nurses have also said that some consider assaults to be part of the job. And at many hospitals, there is no comprehensive plan for handling workplace violence.
What is to be done?
Legislation has been introduced into the Massachusetts legislature that would require “health care employers to conduct an annual risk assessment for workplace violence and, based on this assessment, develop and implement a program and written plan to minimize danger. The act also allows health care workers to take up to seven days paid leave per year to address matters related to an assault and requires that health care employers notify the Department of Public Health and local district attorneys of assaults.”
But that bill (and others before it) is being opposed by the he Massachusetts Health and Hospital Association which says it would cause conflict and confusion because it would “conflict with proven protocols that are already in place.”
During the Obama administration, OSHA increased enforcement of workplace violence cases using the General Duty Clause, and also began working on a workplace violence standard. Those efforts sent a strong message to health care employer across the country that they have the legal responsibility to implement measures to protect their employees from workplace violence.
Ultimately, a workplace violence standard is needed. Under the best of circumstances, using the General Duty Clause to enforce safe working conditions is difficult, resource intensive and prone to legal failure (or inappropriate settlements) in the end. A workplace violence standard would be a win-win. Not only would it improve worker protection, but it would also provide more certainty to managers of health care institutions.
Of course, the fate of a workplace violence standard — or any future OSHA standard — is uncertain in this administration that doesn’t like any kind of regulatory protections for workers – even going so far as to require that two worker protections be removed for every one added.
In the end, of course, no single OSHA standard or increased enforcement can resolve all of the problems caused by an underfunded and deteriorating mental health system in Massachusetts or across the country, That will take time. But we know there are ways to protect Elise Wilson and other health care workers. There is no reason that she or any other health care employee should bear the cost of those problems with their health or their lives.
We know how to protect them, and we shouldn’t have to take away protections from one group of workers in order to provide needed protections to others.
Resource: Check out OSHA’s website on Workplace Violence.