Abstract
Despite the vast research on workplace violence, reports of violence towards our health care workers continue unabated. The overall image that emerges from the literature suggests health care professionals are regularly exposed to workplace violence and need to conduct additional training in identifying high-risk individuals who have the propensity for violence and measures to deescalate the situation. Employers have a moral and legal obligation to ensure they provide a safe working environment and implement processes to prevent injury or harm to their employees. Risk management processes guide organisations to first understand risk, identify risk mitigation strategies and implement sound control measures to reduce the risk to as low as reasonably practicable. The purpose of this paper is to investigate risk management guidelines to develop risk strategies to reduce the probability of workplace violence towards our health care professionals. The study identified two strategies to assist in de-escalating and identifying high-risk personnel as a measure however further investigation is needed to reduce the high occurrences of violence towards health care professionals.
Introduction
Early on in my career as a Western Australian Police officer I was involved or subjected to violence in the workplace regularly as a general duties officer. On any given shift, there was the potential that I would be dealing with either an overly intoxicated, visually upset, drug-affected, suicidal or mentally ill person/s, all which could become extremely violent either towards me or individuals nearby. To assist in dealing with these types of situations, police officers received first-rate training and are given the necessary equipment and tools to deal with all kinds of situations. Majority of situations are resolved peacefully, either by using de-escalation techniques such as verbal judo, calming the individual down and as a last resort, use of force. Trained police officers are normally armed with various use of force options, handgun, pepper spray, baton, handcuffs, and radio to request additional resources to assist however nurses who are in regular contact with similar individuals don’t have the luxury afforded to sworn police officers. Nurses are also subjected to an overly intoxicated, visually upset, drug-affected, suicidal or mentally ill person/s, however, they are not afforded the same level of protection. It is incumbent of both the worker and employers to work together to eliminate risks in the workplace and every worker deserves to work in a risk-free environment, free from injury. A person conducting a business or undertaking must eliminate risks in the workplace, or if that is not reasonably practicable, minimize the risk as far as reasonably practicable. The principles of risk management involve a multiple-step process that requires management to determine the risk management context and develop risk criteria, identifying the risks to their employees, analysing and evaluating those risks and selecting appropriate risk treatment processes, communicate the process/s and conduct regular reviews. The purpose of this paper is to discuss applying risk management principles, framework and process to the risks associated with workplace violence to nurses and advise on the context, scope, and criteria for a risk management approach to reduce the likelihood of injury both physical and psychological to nurses.
Literature Review
Workplace violence includes incidents that cause physical and psychological harm to employees from abuse, threats, and assaults in circumstances related to their employment. Worldwide, violence in healthcare is estimated to comprise a quarter of all workplace violence incidents and is a major occupational hazard within the health care profession. (World Health Organisation, 2019).
Violence is present in all work environments but nurses are on the frontline of the health care system. They have the closest contact with patients and their relatives, and thus are at greatest risk of being abused. International studies have reported that the prevalence of workplace violence against nurses in the hospital setting varied from 10 to 50 percent, and even up to 87 percent (Kwok, Law, Li, Ng, Cheung, Fung, Kwok, Tong, Yen, Leung, 2006).
Whether its easy access to drugs or people who believe their care or needs takes precedence over everyone else’s in the room either due to the feeling of entitlement, mental illness or sheer frustrations on both ends of the spectrum, health care workers are either the subjected or the perpetrator of workplace violence (Rudge, 2012). In an article, Kaur and Kaur (2015) stated that “professions within the healthcare industry are becoming increasingly violent places in which to work with healthcare professionals being common targets for violent and aggressive behaviour”.
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Workplace violence has been studied extensively in mental health and, to a lesser extent, in emergency departments. A study conducted in a Florida emergency department, reported 100 percent of the nurses had being exposed to verbal threats and 82 percent reported being physically assaulted. Justifications for the excessive level of violence in emergency departments included, access to weapons, frustrations with waiting times and hospital policies and the normalisation of violence in the community (Lipscomb & Love, 1992).
According to a study conducted in assessing the effectiveness of clinical education to reduce workplace violence, female health care workers were 78.8 percent more likely to be involved in workplace violence and 58.7 percent of incidents involved a single nurse (Adams, Knowles, Irons, Roddy, & Ashworth, 2017). A recently released social media campaign to highlight the prevalence of occupational violence faced by frontline nurses in emergency departments in South Australian revealed there had been a total of 6,245 calls for security made in 2016-17, which equated to 1,480 more calls the same time last year (ANMF.org.au, 2017).
The effects of workplace violence include absenteeism due to morale issues, increased staff turnover, reduced efficiency and decreased satisfaction at work as well as the effect on spouses, children, and families in general. As such, managing violence in the health sector remains a priority, as seen in the many reports which identify the development of workplace violence prevention programs as organisational priority action strategies for decision-makers and managers to improve quality of work-life for health care professionals as well as quality of care and patient outcomes (Rudy, 2012).
Professional workplace behaviour is an important part of preventing violence and depends on a variety of abilities and understanding of the situation to ensure conflicts do not deteriorate into aggression. The approach to ensure ‘safety of self and others’ and have ‘respect for the individual and his/her unique needs’ is critical to avoid and counteract violence and aggression. An example would be intensive observation, in which the care workers simply focus on observations to reduce the risk of harm to others, rather than involving or interacting with the patient. Increased security including overt video surveillance cameras and monitoring of all entrances and exits and adequate lighting have been shown to contribute to the prevention of workplace violence (Ford, 2010).
A study by Johansen, Morken, & Alsaker (2015) identified the risk of violence increased when care workers were required to work alone. Experiences ranged from working completely alone to situations where co-workers were nearby in the building, but out of sight. The study also emphasised the importance of the ability to sound an alarm or call for assistance when they felt threatened. Although seldom used, an alarm or a distress alert gave them a sense of security however the efficiency of the alarm depended on the security response time.
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