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chapter 12 | Promoting a Healthy Workplace 177 CikguOnline
The overall private sector injury incidence rate is 2; ■ Health-care personnel working in high-crime
the overall incidence rate for health service workers areas
9.3. Broken down further, the incidence rate for ■ Health-care personnel working in buildings
social service workers is 15, and the rate for nurses with poor security
and personal care workers is 25 (bls.gov/news/ ■ Health-care personnel treating weapon-carrying
release/cfoi.nr0). patients and families
The aggressor can be a disgruntled employee or ■ Health-care personnel working with inexperi-
employer, an unhappy significant other, or a person enced staff
committing a random act of violence. Nurses have ■ Health-care personnel working in units needing
been identified as a group at risk for violence from seclusion or restraint activities
patients, family members, and other staff members. ■ Health-care personnel transporting patients
Violence may also have negative organizational ■ Patients waiting long times for service
outcomes. Box 12-2 identifies some of the causes. ■ Overcrowded, uncomfortable waiting areas
Examples of violence include: ■ Health-care personnel lacking training and poli-
cies for managing crises
■ Threats. Expressions of intent to cause harm,
including verbal threats, threatening body lan- Nurses must know their workplace. For example
guage, and written threats (www/nursingworld.org/dlwa.osh/wp5?):
■ Physical assaults. Slapping, beating, rape, homi-
■ How does violence from the surrounding
cide, and the use of weapons such as firearms,
community affect your workplace?
bombs, and knives
■ Do services like trauma or acute psychiatric care
■ Muggings. Assaults conducted by surprise with
increase the likelihood of violence?
intent to rob (cdc.gov/niosh/pdfs/2002-101.pdf)
■ Does the facility’s physical layout invite
The circumstances surrounding health-care work violence—for example, do doors open to the
contributes to workers’ susceptibility to homicide street? are waiting rooms cramped?
and assault (Edwards, 1999; nursingworld.org/ ■ How frequently do assaultive incidents, threats,
dlwa/osh/wp5; cdc.gov/niosh/pdfs/2002-101.pdf; and verbal abuse occur? where? who is involved?
www.osha.gov/) are incidents reported?
■ Are current emergency response systems
■ Prevalence of handguns and other weapons
effective?
among patients, families, and friends
■ Are post-assaultive treatment and support
■ Increased use of hospitals for criminal holds and
available to staff?
violent individuals
■ Are staffing patterns sufficient? is the staff
■ Increased number of acute and chronic mentally
experienced?
ill patients being released without follow-up care
■ Health-care personnel having routine contact Earlier in the chapter, the Florida nurse who was
with the public in unrestricted areas attacked and killed by a patient in April 2001 was
■ Health-care personnel working alone or in small mentioned. Although assaults that result in severe
numbers injury or death usually receive media coverage,
■ Health-care personnel working late or until very most assaults on nurses by patients or coworkers are
early morning hours not reported by the nurse.
Ms. Jones works on the evening shift in the emergency
box 12-2 department (ED) at a large urban hospital. The
ED frequently receives patients who are victims of
Negative Organizational Outcomes
Due to Workplace Violence gunshot wounds, stabbings, and other gang-related
incidents. Many of the patients entering the ED are
• Low worker morale
• Increased job stress high on alcohol or drugs. Ms. Jones has just inter-
• Increased worker turnover viewed a 21-year-old male patient who is awaiting
• Reduced trust of management treatment as a result of a fight after an evening of
• Reduced trust of coworkers heavy drinking. Because his injuries have been deter-
• Hostile working environment
mined not to be life-threatening, he had to wait to see