Workplace Violence
Introduction
Workplace violence (WPV) can be defined as either verbal or physical abuse towards an individual or group of people at work or on duty (Lee et al., 2020). Workplace violence is a global safety management issue, especially in healthcare environments. In 2015, a surgeon working at Brigham and Women’s Hospital in Boston, Massachusetts, was shot and murdered by a deceased patient’s son (Phillips, 2016). The media coverage reported that while this should be considered an isolated incident in the United States, workplace violence is a significant concern in medical practice. Additionally, the media emphasized that even though most of these cases are verbal, other forms of abuse that medical practitioners are susceptible to include assault, domestic violence, sexual harassment, stalking, and battery.
This review addresses
the current knowledge on violence in the workplace in different healthcare
environments, its prevalence, potential risk factors, and prevention measures.
Similarly, the study also shows the challenges researchers have faced on coming
up with experimental concepts, and the resultant need for additional
evidence-based research.
Workplace violence in
the healthcare setting is a persistent, ubiquitous, and underreported issue
that has been largely ignored (Phillips, 2016). The Joint Commission has
reported that firms that were initially regarded as haven have now shown an
increased rate of violent crimes, including homicide, assault, and rape. In the
USA, the healthcare sector is the second industry that is most prone to
workplace violence after law enforcement (Harrell, 2011). Therefore, the
majority of studies on violence in healthcare work environments has been
directed to the identification of statistically significant strategies for
reducing risk factors. Many existing studies focus on profiling and identifying
potential victims and perpetrators of violence. The few pieces of research that
have addressed interventions for overcoming this problem have stated the
difficulty of a simple solution that fits all cases.
Literature Review
Prevalence of Workplace
Violence
The most common incident
in workplace violence in healthcare environments is whereby the perpetrator is
affiliated with the firm and acts violently when being served by the
institution. This form of WPV is known as type II assault. Byon et al. (2020)
carried out a meta-analyses study to identify susceptible sub-groups to type II
violence and provide evidence for its prevalence. The researchers accessed a
total of five significant databases and came up with 21 studies published
between 2005 and 2011. Pooled estimates of the prevalence were obtained after
the meta-analyses of the studies.
Similarly,
meta-regression was carried out to compare professional versus paraprofessional
prevalence. The results showed that the prevalence of violence for Home
healthcare workers (HHWs) was 0.223 per year for combined violence, 0.102 for
physical abuse, and 0.364 for non-physical abuse. Hence, many healthcare
workers suffered from non-physical maltreatment compared to physical violence.
Similarly, professionals were more vulnerable to WPV than paraprofessionals.
The findings of this study showed the need for interventions that prevent type
II assault for home healthcare workers.
Moreover, Nowrouzi-Kia,
Isidro, Chai, Usuba, and Chen (2019) performed a logical review to pinpoint the
predecessor aspects in workplace violence against nurses. Just like in Byon et
- (2020), the researchers conducted a literature search from databases such
as PsycINFO, Embase, CINAHL, and Ovid Medline). An individually tailored review
protocol was used for each of the four databases. The Cochrane
Collaboration ‘Risk of
bias’ and the Critical Appraisal Skills Programme (CASP) were used to assess
the quality of the study. The different types of workplace violence were
divided into two groups: type II (patients to workers) and type III (workers to
workers). The study indicated that the majority of WPV was type II assaults.
This research confirms the findings of Samuels, Hunt, and Tezra (2018), which
show that health workers experience a lot of physical violence from their
patients (type II) and non-physical abuse, such as being shouted at.
Consequently, even
though other forms of workplace violence deserve attention, the majority of the
focus should be on type II assaults. In 2014, a research survey on the rate of
crime in hospital settings indicated that 75% of violent crimes were aggravated
assaults against health employees by patients (Phillips, 2016). Additionally,
approximately 25% of the incidences of fatal violence occur in the workplace
environment. According to Phillips (2016), the data presented by the Bureau of
Labor Statistics demonstrate that healthcare employees are approximately four
times more probable to take time off because of violence compared to as a
result of other injuries.
However, interpretations
of existing data on WPV is difficult because of significant inconsistencies.
The National Institute for Occupational Safety and Health and the Bureau of
Labor Statistics are among several other federal organizations that collect
data on workplace violence. Moreover, the finding of academic researches on WPV
vary significantly. There are inconsistencies in defining violence categories
such as verbal assaults, battery, threats, and physical assaults (Pompeii et
- 2013; Taylor & Rew, 2011). On the other hand, different instruments are
used to measure workplace violence. Taylor and Rew (2011) reiterate this issue
by highlighting that no two research studies have used similar tools to assess
WPV in emergency departments. Nearly all studies were prone to recall bias and
selection bias since they implemented voluntary retrospective designs—these
inconsistencies in studies on workplace violence compromise reliability of
research.
Furthermore, the federal
Bureau of Labor Statistics may report grossly inadequate data. Wuellner and
Bonauto (2014) found out the number of injuries reported by the federal agency
was as high as three times the actual number. It makes it challenging for
researchers to quantify the issue of workplace violence. Besides, the federal
agency does not record incidences of verbal abuse. Therefore, the limitations
of statistics make it difficult to gauge the prevalence of healthcare workplace
violence. Without reliable statistical data from high-quality research, it will
be challenging to come up with effective methods of preventing workplace
violence.
Risk Factors of WPV
The most known characteristic
among committers of healthcare workplace violence is an unstable mental health
status as a result of mental illness, delirium, dementia, or substance
intoxication (Pompeii et al. 2013). The main aim of profiling is to pinpoint
people that are highly likely to commit violent acts and prevent the incidents
before they occur. Even though specific healthcare units such as emergency
departments, nursing homes, and psychiatric units are at higher risks,
predicting the possibility of WPV based on medical characteristics and
diagnosis is challenging and can cause patient discrimination. According to
studies, some of the primary risk factors of WPV include long wait times,
inadequate food quality, crowding, low socioeconomic status, gang activity,
presence of weapons, and is provided with “bad news” regarding prognosis and
diagnosis (Phillips, 2016). Other studies demonstrate that patients who have
experienced violence before are more likely to perpetrate workplace violence in
healthcare environments. However, this proposition is yet to be proved
(Hartley, Doman, Hendricks, & Jenkins, 2012). Consequently, the analysis of
demographic information about victims and perpetrators of violence has not
presented specific features that can help anticipate the threat of violence in
hospital settings. Nonetheless, there is a need for special attention to
patients under police custody as these patients are responsible for
approximately 29% of gun violence in emergency units, with about 11% happening
during escape attempts (Kelen, Catlett, Kubit & Hsieh, 2012).
Conversely, with regard
to environmental risk factors, the Occupational Safety and Health Administration
(OSHA) guidelines describe working in high urban emergency units as a potential
risk factor for the workplace environment. Nonetheless, a prospective study
also showed that the rates in both suburban and urban emergency departments are
similar (Kowalenko, Gates, Gillespi, Succop & Mentzel, 2013).
The majority of
workplace homicides in healthcare settings are committed by using guns. The American
healthcare sector recorded a total of 154 shootings that occurred within
hospital premises between the years 2000 and 2011. Out of this number, 41% were
on hospital campuses, 29% in emergency units, and 19% on inpatient floors.
Mercy killing (14%), suicide (21%), and revenge (27%) were the three most
ascribed motives (Harnum, 2014). 8% of the incidents involved perpetrators
snatching a firearm from a police officer while 28% involved an officer
shooting a perpetrator in the institution. However, incidents involving
shooting are sporadic forms of workplace violence as response training is
currently a universal measure in hospitals. Nevertheless, while this training
may be a useful measure, experts recommend the implementation of a
comprehensive “all threats” approach.
Prevention Measures
One possible approach
that was debatable by the public in an attempt to prevent workplace violence
was by installing metal detectors in hospital environments. These security
measures appear to be the obvious choice for keeping dangerous weapons out of
hospital facilities. According to Kansagra (2008), only about 15% of American
emergency departments had metal detectors by 2008. According to a survey
conducted in 2003, 3446 weapons were confiscated in 8 months after installation
of metal detectors, out of which 78% were metal detectors (Phillis, 2016).
However, with the uncommonness of violence by firearms, the critical question
is whether metal detectors reduce WPV. A 1999 survey showed no significant
change in the rate of WPV despite the confiscation of a large number of
weapons. There is a perception that metal detection improves the general
security of a facility.
Conversely, there are
many recommendations for reducing type II assaults. Only a few of these
recommendations have been supported by experimental research. Apart from metal
detectors, prevention of WPV requires a program that factors issues affecting
individual workers, healthcare facilities, and law enforcement organizations.
Some of the recommended approaches are self-defense training and training in
aggression de-escalation techniques. Hiring guards, installing cameras, and
erecting fences are some other measures that can be adopted.
On the other hand,
healthcare institutions need to adjust their policies to improve levels of
staffing to reduce wait times and overcrowding, avail adequate medical
facilities, and sufficient security. These measures will reduce some of the
risk factors related to type II workplace violence (Phillips, 2016). The
solution to this challenge is probably a combination of several measures.
Arnetz et al. (2014), in a controlled, randomized, large study proposed a
standardized intervention to decrease the prevalence of WPV.
Discussion
This study shows that
violence in the healthcare setting workplace is a critical safety management
issue in the United States. Numerous studies and surveys have been conducted on
the matter to identify potential risk factors and come up with effective
measures of preventing WPV. Many studies show that type II assault is the most prevalent
type of violence in the workplace (Byon et al., 2020; Nowrouzi-Kia et al.,
2019). However, other types of WPV, such as verbal violence, should not be
overlooked. Phillips (2016) shows that verbal abuse is a risk factor for a
battery. A criminal justice theory called the “broken windows” concept states
that apathy towards minor offenses creates a conducive environment for more
serious crimes. This principle is also applicable to workplace violence.
Tolerating battery and verbal abuse invites more severe forms of WPV. Hence,
countermeasures should be initiated after the signs of agitation, such as
threatening language, are identified. The zero-tolerance policy that entails
reporting all cases of violence to security officers and supervisors is the
most effective approach of dealing with workplace violence because it prevents
escalation of incidents.
Furthermore, although
laws that prevent WPV exist, the Joint Commission and policymakers should
evaluate the efficaciousness of the regulations to mitigate the issue of
WPV—for instance, making battery a felony offense in all states will help to
safeguard healthcare providers against this form of violence. Healthcare
facilities are not expected to have particular strategies that prevent abuse in
place. The Occupational Safety and Health and Health Administration has only
voluntary guidelines that reduce WPV in the healthcare environment. Similarly,
the Joint Commission’s policies about WPV are vague (Phillips, 2016). Hence,
many administrators are unfamiliar with how to implement such strategies.
On the other hand,
studies show that psychiatric facilities and emergency departments are highly susceptible
to different forms of violence (Pompeii et al. 2013). Increased violence rates
cause job dissatisfaction, burnout, and an increased number of missed days.
Since these facilities are critical in the healthcare sector, it is vital to
address the problem of workplace violence. Improving security in these
departments and increasing staffing levels will help to reduce the associated
risk factors.
Conclusion
Safety in workplace
settings is essential in all industries. The Healthcare industry is one of the
most significant sectors because it prevents deaths and guarantees human life
through the provision of patient care. Therefore, ensuring the safety of
providers should be a high priority for policymakers. In the United States, the
healthcare sector is the second-most industry that is prone to workplace
violence after law enforcement. This research has shown that some of the most
common forms of WPV are verbal assaults, battery, threats, and physical
assaults. The effects of these forms of violence are detrimental as they may
result in job dissatisfaction, burnout, and an increased number of missed days.
Consequently,
legislators could enact more strict punishments for assaults against healthcare
employees. Similarly, the organization should establish policies that encourage
reporting of potential threats of aggression from patients and other workers.
Adopting a zero-tolerance policy when it comes to workplace violence will
foster the reduction of rates of healthcare workplace violence. Furthermore, a
comprehensive approach that entails a mix of measures such as installing metal
detectors, increasing security in high threat areas, and fences will help to
keep hospitals and other facilities secure. Prevention of workplace violence
encompasses efforts from individuals, the organization, and the government.