The Justice Department recently issued a report on Indicators of Workplace Violence 2019. Much of the information in the report was already known from previous workplace death and injury reports issued by the Bureau of Labor Statistics (BLS) in 2019. The BLS has updated that data with its annual Census of Fatal Occupational Injuries (CFOI) for 2020 issued last Fall. For those following the issue, previous Congressional hearings and reports, as well as OSHA’s rulemaking efforts, there is little new in the DOJ report. But because of the attention it’s received and the way the data is used (and misused) it might be a good time for a review of the issue.
First, the good news. Although he DOJ reports that a total of 17,865 workers were killed in a workplace homicide from 1992 to 2019, “only” 454 homicides took place in 2019, which was a 58% decrease from a peak of 1,080 homicides recorded in 1994.
Things looked even better in 2020, which is outside the scope of the DOJ report, but 2020 was an odd year in the workplace. The BLS reported that the number and rate of workplace deaths declined overall in 2020, but much of that was likely due to the sharp decline in overall economic activity that year due to COVID-19. (BLS did not count work-related COVID-19 deaths.) Workplace homicides also declined in 2020 to 392. BLS reports that homicides have fallen from the 2nd leading cause of workplace death in the mid-nineties to the 4th leading cause today, after transportation; slips, trips & falls and contact with items. Workplace homicides accounted for 8.5% of all fatal occupational injuries in 2019 and 8.2% in 2020, compared to 16% in 1994, the year with the largest number of workplace homicides recorded by CFOI.
Who is getting killed and by whom?
For those of you who dutifully read the Weekly Toll, it is not surprising that from 2015 to 2019, the most workplace homicides occur in the sales and related occupations (21%) and law enforcement (19%). Owners or managers — mainly in restaurants and hotels — accounted for 9% of workplace homicides.
Women are particularly at risk from workplace homicide. Women made up 8.1 percent of all workplace fatalities, but represented 16.3 percent of workplace homicides in 2020. While men comprised the majority (366) of workplace homicides, homicides accounted for nearly 2 and a half times the share of all workplace deaths for women than for men. In 2020, around 17 percent of all workplace deaths occurring to women were due to homicide, compared to 7 percent of all workplace deaths occurring to men.
Women made up 8.1 percent of all workplace fatalities, but represented 16.3 percent of workplace homicides in 2020.
- As in the rest of society, guns are a problem: Shootings made up 79% of workplace homicides. Stabbing, cutting, slashing and piercing accounted for 9%.
- Black workers accounted for 25% of workplace homicides and experienced 11% of all fatal occupational injuries. (12.4% of the American population is black.)
Who is getting injured and by whom?
Workplace Violence Injuries
While the long term trend for non-fatal injuries resulting from workplace violence is down, the recent trend is troubling. The rate of non-fatal injuries resulting from workplace violence in 2019 was 70% lower than in 1994, but 25% higher than 2015. (This was the same pattern as non-fatal violence in general.)
The occupations most impacted by workplace assaults are different for non-fatal injuries versus fatalities. From 2015 to 2019, corrections officers (149.1 injuries per 1000 workers), security guards (95) and law enforcement officers (82.9) had the highest rate of non-fatal workplace violence injuries. That data is not surprising considering the work they do.
And those occupations, of course, are presumably trained and equipped to expect and deal with workplace violence. But workers in many of the other most vulnerable occupations are not trained to fight off assaults: Coming up next in most affected occupations are gas station attendants (59.4), taxi cab drivers (45.4), mental health workers (45.3), nurses (26.3) and teachers (11.9). Retail workers made up only 9% of the private sector workforce, but experienced 17% of total nonfatal workplace violence injuries.
Government workers also suffer high rates of assault-related injuries. These are particularly serious as government employees in 24 states aren’t covered by OSHA, and therefore don’t even have the benefit of OSHA’s General Duty Clause to protect them. During 2015–19, government workers suffered three times the workplace violence injury rate of private sector workers. In the medical, mental health, and teaching occupations, government workers had higher rates of nonfatal workplace violence than workers in the private sector. Government workers in medical occupations comprised only 8% of all government workers, but experienced 18% of the nonfatal workplace violence injuries.
During 2015–19, government workers suffered three times the workplace violence injury rate of private sector workers. These are particularly serious as government employees in 24 states aren’t covered by OSHA, and don’t even have the benefit of OSHA’s General Duty Clause to protect them.
A 2021 House Education and Labor Committee report detailed the impact of workplace violence on certain sectors of public employees:
In 2017, state government health care and social service workers were almost 9 times more likely to be injured by an assault than private sector health care workers (128.9 vs. 14.7 per 10,000 workers). Each year, nearly 7 percent of psychiatric aides employed in state and local government mental health facilities experienced violence-related injuries causing them to lose time from work. State psychiatric aides suffered an extraordinarily high rate of assault-related injuries in 2019—1,460.1 per 10,000 workers. State mental health and substance abuse social workers averaged 155 per 10,000 workers over the past five years; psychiatric technicians are at 429.6 per 10,000 workers; nursing, psychiatric and home health aides at 412.8 per 10,000 workers; health care support occupations at 506.6 per 10,000 workers; and nursing assistants at 132.1 per 10,000 workers.
Workplace Violence Severity
The figures above describe total injuries, but the BLS also measures severity — those workers who had injuries that required them to miss at least one day of work.
In 2019, the rate of serious workplace violence-related injuries involving days away from work was 1.7 cases per 10,000 Full Time Employees (FTEs). The highest rates of severe workplace violence injuries that year were suffered by protective services — 24.4 cases per 10,000 Full Time Employees (FTEs). Law enforcement workers had an incidence rate of nonfatal workplace violence requiring days away from work (42.5 cases per 10,000 FTEs) — down from 57.3 cases per 10,000 FTEs in 2015.
They were followed by healthcare support workers (21.4); education, training, and library (11.8); community and social service (10.4s); healthcare practitioners and technical (10.9); and personal care and service (3.4). Among all cases of workplace violence resulting in days away from work in 2019 (41,560), about 1 in 4 cases occurred among nursing, psychiatric, and home-health-aide workers (10,080).
- Women also fare worse than men in non-fatal assaults. According to the BLS, in 2019 women accounted for 63.5 percent of these nonfatal workplace assaults that involved at least one day away from work.
- Contusions and abrasions were the most common injuries from nonfatal workplace violence treated in the emergency room, followed by strains and sprains. Traumatic brain injuries accounted for about 12 of all workplace injuries from workplace violence.
- And back to guns again. When the perpetrator was unarmed, the worker generally didn’t die. In 78% of nonfatal workplace violence, the perpetrator was unarmed.
Physical injuries are bad. But the DOJ report also noted that from 2015-2019, 39% of workers suffering workplace violence injuries also reported moderate to severe emotional distress. That number is likely understated. As I noted earlier this year in a review of Code White: Sounding the Alarm on Violence Against Healthcare Workers, which reported on workplace violence in healthcare institutions in Canada:
Post-traumatic stress disorder (PTSD) is a familiar problem, especially for those with military combat experience. But healthcare workers experience similar combat-like situations. The Manitoba Nurses Association reported that 40 percent of their members experience PTSD symptoms related to violence at work. And those psychological injuries are compounded by failure of management to provide appropriate support or interventions despite the fact that “timely and appropriate support and intervention have been shown to decrease the likelihood of ongoing psychological trauma (p. 33).” One nurse who was physically and sexually assaulted was provided no counseling or referral to a sexual assault center. Such neglect is the rule, not the exception.
Reporting to the Police
The DOJ report also noted that fewer than half of all workplace violence incidents are reported to the police. Overall, during 2015–19, the percentage of nonfatal workplace violence reported to police was 41% (and 39% from 2015-2019). 46% of nonfatal workplace violence against workers in retail sales occupations was reported to police in 2019. In medical occupations, only 37% of cases were reported to the police.
The reasons for low reporting, according to the report:
During 2015–19, the most important reason for not reporting nonfatal workplace violence to police was that the incident was reported to another official, including guards, apartment managers, and school officials (39%)). Victims who did report nonfatal workplace violence to police because they did not think the incident was important accounted for 15% of victims.
My personal experience from years of working with healthcare workers on this issue is that management strongly discouraged workers from reporting incidents to the police and often retaliated against workers for reporting.
Misinterpreting the Causes of Workplace Violence
One thing that hasn’t changed over the years is the tendency of some to misinterpret the data in a way that tends to blame workers for the bulk of workplace assaults. For example, after reading this article from WorkplaceSafety.com, one might think that the main workplace violence concern is assaults from unbalanced co-workers and workplace bullying. Although the article notes that workplace violence “refers to any act in which a worker is abused, threated, intimidated, or assaulted at their place of employment,” most of the article deals with that small portion of workplace violence that involves “a co-worker, or any other person, who shows some or many of the warning signs” that are listed in the article.
What should we fear most? Unstable co-workers, or healthcare patients or families, retail customers and other criminals?
This phenomenon is nothing new. In fact, over 18 years ago, I wrote a post entitled Workplace Violence: Fashionable vs. Unfashionable, where I explained the difference:
Unfashionable workplace violence happened when mental health or social service workers got beaten up or killed working in understaffed institutions or making house calls in neighborhoods that the police wouldn’t go into with guns drawn. Late night retail clerks who were victims of robberies — often poor brown-skinned types — were also on the unfashionable side of the ledger. It was largely these incidents that led workplace violence to become the second leading cause of death in the workplace in the mid 1990’s.
The more fashionable kind of workplace violence focused the demented, mentally unstable worker (aren’t they all?) — often postal workers — who would come into work armed to the teeth and blow away their bosses and a few co-workers for good measure. These were fashionable because, unlike the unfashionable crowed, they got lots of press and provided fodder for armies of consultants who would scare employers into paying large sums for how to screen job applicants (or current employees) who might turn violent. And for good measure, they’d also counsel employers on how to fire people in a way that would minimize the chance that they might come back in and blow you away.
Instead of generating profit-making consultants, unfashionable workplace violence focused on boring issues like staffing levels in institutions, lockdrop safes and windows in retail establishments that left a clear view to the street, and locked doors and security guards for social service agencies. Instead of making money, these preventive measures cost money.
The problem with the fashionable workplace violence, is that it was largely a myth.
So what is the real story? What should we fear most? Unstable co-workers, or healthcare patients or families, retail customers and other criminals?
First, looking at all workplace violence injuries — even violence that doesn’t result in serious injury — only 11% of assaults are by supervisors, employees or co-workers.
But if you look at BLS statistics that that take into account severity of assaults (“severity” measured by at least one day away from work), the difference is more stark. Co-workers or work associates were the cause of only 1,230 out of 41,560 assaults resulting in serious injuries in 2019. That’s 3%. Patients, on the other hand, accounted for 18,090 or 44%. (The report does not include how many workplace violence-related fatalities were caused by co-workers.)
The problem with this misinterpretation is that not only does it lead policy makers to ignore the real causes of workplace violence, but listing “warning signs” encourages employers to use shaky criteria to profile their employees instead of implementing measures that can address the real causes of workplace violence. And as I noted in my 2004 article, many of the factors that might identify a potentially violent worker are common characteristics, many of which, for example, may be characteristics of a good union steward.
Indeed, the WorkplaceSafety.com article deviates from the general issue of workplace violence into identifying potential violent employees and workplace bullying. Both are important subjects on their own, but a small factor in the overall picture of workplace violence.
What is to be done?
Workplace violence is predictable and preventable. OSHA’s Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, for example, identifies risk factors for a variety of healthcare and social service environments, making it possible for employers to anticipate where they may be problems. The publication also identifies a number of measures that can be taken to reduce the likelihood of workplace assaults. OSHA also publishes Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments.
OSHA began work on a workplace violence standard for healthcare and social service workers in 2016, shortly before the end of the Obama administration. Unfortunately, the Trump administration did not move forward on that rule, and Biden’s OSHA is prioritizing COVID-19 and heat standards ahead of workplace violence. OSHA’s understaffing and small budget makes the problem worse. It is likely to be many years before the OSHA standard is issued.
OSHA continues to cite some workplace violence cases under the legally burdensome General Duty Clause which requires employers to provide a safe and healthful workplace and is used where there is no relevant OSHA standard. CalOSHA has an effective workplace violence standard and nine other states — Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Oregon, and Washington—have some form of laws or regulations covering workplace violence in health care.
The House of Representatives passed bipartisan legislation that would require OSHA to issue a workplace violence standard. HR 1195 would require OSHA to propose a final standard within two years of enactment, and to issue a final standard within 42 months of the date of enactment. H.R. 1195 would “ensure that health care and social service workplaces adopt violence prevention plans to prevent or mitigate violent incidents in the workplace using proven prevention techniques tailored to the risks in a given workplace.” The Senate, unfortunately, has not moved on this legislation, so barring a change of heart from Republican member of the Senate, it is unlikely to reach the President’s desk.
As with most workplace safety and health issues, the best solution for workers is strong contract language requiring employers to establish and implement a workplace violence program similar to the programs described in OSHA’s guidance.