It’s a dangerous world for nurses.
They are facing violent attacks in alarming numbers, prompting safety advocates to demand strict new rules and better training in hospitals and other health care facilities. “No one deserves to go to work and have violence implemented on them,” said Brandy Welch, a nurse in Long Beach.
The latest U.S. Labor Department data shows that nurses are attacked at over 3 ½ times the average national rate of occupational violence. Assaults against nursing assistants have been occurring at more than 16 times the national average.
For those providing psychiatric care, the statistics are even more staggering. Psychiatric technicians and psychiatric aides suffer from violence in the field at over 130 times the national average. By contrast, physicians, surgeons and psychiatrists all face violence rates lower than the national average.
Reducing workplace violence in the health care industry would do more than just protect nurses. Advocates say patients would benefit, too. “For nurses, the only way that they can practice to their full capacity and help their patients make a full recovery is if the environment in which they’re doing that is safe,” said Bonnie Castillo, director of health and safety for the California Nurses Association, an Oakland-based union representing registered nurses.
Jan Emerson-Shea, a spokesperson for the California Hospital Association, an industry trade group based in Sacramento, said that some of the safety risks for health care workers happen because hospitals are microcosms of their surrounding communities, complete with parallel risks.
“Hospitals are a place where life and death literally plays out every single day, so you have the range of human emotions,” she said.
A year ago, a 14-year-old patient, hospitalized for aggressive behavior, threw a large chair at nurse Brandy Welch. She decided not to duck and imperil those standing behind her, but instead tried to catch the chair, which left her right arm injured—an injury she still struggles with today. Even though Welch had been a nurse for 17 years, she had “only received minimal training on how to diffuse these types of situations,” she said.
“If we all had the same training and the same approach,” Welsh said, “I believe that it could have been handled better.”
Castillo said violence rates are on the rise in California due to a number of factors, including insufficient access to psychiatric inpatient services. Since 1995, available beds in psychiatric institutions in California have dropped by 25 percent. The health care industry struggles to provide care for these patients.
Castillo said nurses often bear the brunt of patients’ and families’ frustration when they encounter inefficiencies, expenses, and gaps in care. She said that without robust plans in the workplace, “when something happens, it’s chaotic instead of everybody knowing their role.”
Health care workers have long dealt with the risks of violence in the field but in 2010, the deaths of two health care workers—one who was bludgeoned to death by a psychiatric patient faking a seizure, and one who was robbed and strangled by an allegedly mentally ill patient—prompted the California Nurses Association to promote legislation to reduce the problem.
Sacramento lawmakers passed the union-backed bill, SB 1299, in September, 2014. It requires health care facilities to develop violence prevention plans. The legislation dictates that all employees receive training, and that health care workers not be retaliated against for reporting violent incidents.
The bill required the California Occupational Safety and Health Standards Board to publish annual reports on hospital workplace violence on its website. The board also was directed to adopt workplace violence prevention plans, formally adopted on October 20 by unanimous vote.
The regulations emphasize prevention of violence, in contrast to some proposed tactics which emphasized harsh penalties for patients and family members who inflict violence. The regulations define the threat of violence as part of workplace risk, and require employers to create comprehensive workplace violence prevention plans, which include trainings for all employees. The implementation will begin in January, 2017.
Emerson-Shea says that although hospitals agree with the aims of the legislation, people need to be careful about “prescribing a one-size-fits-all solution.”
“What would work in a hospital that’s in an inner city area and has particular issues with gangs, for example, it’s probably going to be a different solution than in a North Coast hospital with 50 beds,” she said.
Emerson-Shea also says that the state’s workplace safety board has likely underestimated the costs for such a comprehensive training, “because you’ve got to train every single employee on every single shift on every single unit.” She noted that the new mandate, like many others, comes without funding to cover the cost.
The regulations for California are now the most comprehensive in the country. The California Nurses Association’s national organization, National Nurses United, is petitioning the federal Occupational Safety and Health Administration (OSHA) to adopt similar standards nationally.
The petition was submitted to OSHA in July. It calls for OSHA to adopt many of the provisions included in SB 1299. The nurses union said it is waiting to find out whether the proposed federal regulations will be considered, and what sort of industry or political opposition might rise against the California approach.