Workplace Violence In Healthcare
Understanding the Problem
Workplace violence is a serious problem. Different organizations have defined workplace violence in various ways. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.” Enforcement activities typically focus on physical assaults or threats that result or can result in serious physical harm. Many people who study this issue, however, and the workplace prevention programs highlighted here include verbal violence—threats, verbal abuse, hostility, harassment, and the like—which can cause significant psychological trauma and stress, even if no physical injury takes place. Verbal assaults can also escalate to physical violence.
Definition of Workplace Violence (WPV) as Defined in Legislation:
“Workplace violence” means any act of violence or threat of violence that occurs at a medical facility, except for a lawful act of self-defense or defense of another person. The term includes, without limitation:
- The use or threatened use of physical force against an employee or other provider of care, regardless of whether the employee or other provider of care is physically or psychologically injured; and
- An incident involving the use or threatened use of a firearm or other dangerous weapon, regardless of whether an employee or other provider of care is physically or psychologically injured.
Early in the 2019 Legislative session, the Nevada Hospital Association heard rumblings of legislation regarding workplace violence which may be modeled after California Bill 1299. An advocate for workplace safety, the NHA recognized that meeting the requirements of 1299 or any similar program would be a time-consuming process involving significant challenges that needed to be overcome.
As the session moved along and AB348 was introduced, it was clear there could be many issues in creating a sustainable program with the proposed legislation. As introduced, the bill would have required in NRS:
- Significant capital improvements to facilities
- Staffing ratios
- Annual training for employees and independent contractors
- Formation of safety committees
- Modification to staffing committee law
- Expanded whistleblower law
- Expanded documentation of violence
The NHA had exhaustive conversations week after week with the proponents of the bill with few concessions.
As the session neared its close, all fiscal notes were removed from the bill eliminating most of the leverage to stop it. In May, the Senate Committee on Commerce and Labor moved the bill without recommendation less the sections that needed to be resolved, indicating that the bill would be held on the Senate floor, thus, allowing time for a compromise. Senator Spearman, chairwoman of the committee, stressed that there must be consensus on the bill before it would be moved off the Senate floor but made it clear that a bill would be moved forward.
Once this legislation was amended, it removed most of the NHA’s concerns. Regulations more clearly defining the NRS were adopted by the Board of Health in January 2022 and can be found here.
Please note that national legislation has been introduced on workplace violence prevention with many of the same detrimental items included.
The Nevada Hospital Association (NHA) hosted a series of two (2) six (6) week workshops for members only on workplace violence (WPV) prevention. The focus of this interactive workshop was the development of effective and sustainable WPV programs. Attendees were provided with practical information and tools that allows them to develop or enhance an existing WPV program at their facility.
At the end of the workshop, attendees were able to:
- Describe key components of a sustainable WPV
- Identify data needed to define the scope of WPV at their facility and to evaluate a WPV
- Define how to develop a comprehensive WPV program plan that is supported by leadership
- Identify resources needed to manage, implement, and sustain a WPV
- Identify common barriers to implementing a WPV program and how to address
- Start development of a WPV program plan and gap analysis of current WPV efforts at individual facilities.
Tools & Resources
- NHA Legislative Summary Checklist
- WPV Regulations R044-20 (Filed December 22, 2021)
- WPV Regulations Webinar: Violence at Nevada Medical Facilities Regulations - YouTube This recorded webinar from the Nevada Occupational Safety and Health Administration (OSHA) provides a high-level overview of the State of Nevada workplace violence regulations and requirements. Presented by Michael Rodrigues, with Nevada OSHA.
- Division of Industrial Relations WPV in Medical Facilities Resources