Workplace Violence: Healthcare Workers, Patients, and Families

Violence in the workplace poses serious legal and ethical questions regarding the safety and security of workers. In the modern healthcare industry, the possibility of patients and families attacking healthcare workers is a very real threat that employees and providers must face. Not only does violence against healthcare workers pose a danger to the employees themselves, but the fear of attack raises important and significant legal liability questions. In addition, there are significant financial costs that come as result of workplace violence in nursing.

First, it becomes necessary to define what we refer to as workplace violence and to determine the scope of the issue. Strickler (2013) reports that “violent acts against healthcare workers” are common enough to the point where over half of the healthcare workers surveyed by Strickler claimed they did not “feel safe from workplace violence” and that they, as a collective, felt ill-prepared to “handle violent incidents”. (p. 58). Not only is workplace violence common enough to warrant these fears, but preparation and training for these incidents are lacking. The Occupational Safety and Health Administration defines workplace violence as “violent acts directed toward persons at work or on duty” ( 2013). Thus, there is a significant enough issue at hand to warrant serious legal concern.

There are several major legal implications of workplace violence. First, liability exists in any field where employees are at risk for serious injury as a result of their interaction with potentially violent patients and families. With some 25% of emergency room nurses experiencing violent attacks from 2009-2011 (Sohawon, 2011), it is clear that significant risk exists for employees; this risk is compounded with interaction with “behavioral health” patients, many of whom suffer from undue aggression (Online Journal of Issues in Nursing, 2013, p. 1). If healthcare providers fail to make proper use of “employer potential controls for these hazards”, the company may be at fault for lacking in proper safety measures for their staff (Hartley, 2012). The Occupational Safety and Health Administration (OSHA) is the federal agency responsible for these voluntary guidelines. 

 A company may be held legally liable if it can be shown that the management had been negligent in its duties to provide for the care and safety of its staff, especially in occupations where workplace violence is not unknown. However, OSHA guidelines are voluntary and not binding in federal court. Patient-employee violence is the subject of legislation in Washington and California and the states now require “comprehensive safety programs, including the prevention of ‘reasonably foreseeable’ assault on employees” (OSHA, 2013, p. 8).  Thus, while legally there is some state level requirements at ensuring safety of patients, there is no conclusive binding federal legislation on this matter. 

Ethically, healthcare providers must balance the safety and security of their staff with the well-being of their patients. Should patients prove troublesome, the need to administer medication and otherwise aid in their treatment is still necessary. Sohawon (2011) argues that “workers may not fully appreciate” the dangers they will be in, and that “they may feel that control measures adopted are inadequate” (p. 22). Moreover, not only is training often deemed to be insufficient, but it becomes difficult to justify putting a healthcare worker into a dangerous situation where they may be unsafe. While employers have a moral and ethical obligation to maintain a safe working environment, the ethical dilemma of the question requires the use of a value judgment to determine whether or not an employer has taken the proper safety steps. 

There are significant legal and ethical implications of workplace violence in the healthcare industry. Not only do employers have a strong legal and ethical obligation to protect their staff, they also must do their best to help sick and injured people who may place their staff at risk. Employers also face legal liability if their employees are injured on the job, and there exists only haphazard attempts at making sure staff training is fully up to speed to allow workers the capacity for a proper response. 

References

Hartley, D., Ridenour, M., Craine, J., & Costa, B. (2012). Workplace violence prevention for healthcare workers-an online course. Rehabilitation Nursing, 37(4), 202-206. 

Occupational Safety and Health Administration. (2013). OSHA. Retrieved from https://www.osha.gov/

Sohawon, K., & Whitaker, S. (2011). Healthcare workers in safe hands. Occupational Health, 63(9), 20-23. 

Strickler, J. (2013). When it hurts to care: Workplace violence in healthcare. Nursing 43(4), 58-62. 

Workplace Violence in Healthcare: Strategies for Advocacy. (2013). Online Journal of Issues in Nursing, 18(1), 1-1.