With violence in emergency departments on the rise, the American College of Emergency Physicians (ACEP) recently contributed to the development of new workplace violence requirements by The Joint Commission that went into effect for hospitals on January 1, 2022.
Increasing Violence in the ED
Surveys by ACEP and the Emergency Nurses Association (ENA) reveal that almost half of emergency physicians report being physically assaulted at work and nearly 70 percent of emergency nurses report being hit and kicked while on the job. During the COVID-19 pandemic, the problem has gotten worse. According to a study from workplace violence researcher Jane Lipscomb, published in the journal Workplace Health & Safety, nurses providing care for COVID-19 patients are more than twice as likely to be physically attacked or verbally abused at work than those who care for other patients.
“Given how politicized the whole issue of vaccines and masking has become, I would think that we’re actually going to see an increase in violence, rather than any kind of decrease,” Lipscomb said in a HealthDay Now interview.
The consequences of that violence goes beyond the immediate injuries, though.
“Nurses who have been assaulted might spend less time with patients, call out sick more often, are more distracted, and have less job satisfaction. Nurses might also develop anxiety and PTSD,” writes Katherine Kam for WebMD.
With staffing shortages ranked as the number one concern among hospital CEOs, and workplace violence among the reasons staff, particularly nurses, leave their positions, violence in the emergency department not only threatens the physical well-being of staff and patients, it jeopardizes the ability to offer 24-hour care to patients who need it.
“The number of physical beds in hospitals is only as good as the staff you can put bedside,” says Dave Dillion, vice president of public relations of the Missouri Hospital Association.
New Workplace Violence Requirements
According to The Joint Commission, the new workplace violence requirements offer a framework to guide hospitals and critical access hospitals in:
- defining workplace violence as “an act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.”
- developing strong workplace violence prevention systems
- fine-tuning policies and procedures
- creating easy and accessible reporting systems
- analyzing, tracking and trending data
- crafting post-incident strategies
Establishing leadership oversight for the program also is part of The Joint Commission standards, since “leadership is responsible for creating and maintaining a culture of safety throughout the hospital.” The Joint Commission recommends designating one individual who can be accountable for an organization’s workplace violence prevention program and can lead a multi-disciplinary team in the development of policies and procedures to prevent and respond to workplace violence along with the establishment of an incident reporting process. The team also would be responsible for follow up and support to victims and witnesses affected by workplace violence, including trauma and psychological counseling, if necessary, and reporting of workplace violence incidents to the governing body.
As well, hospitals are required to provide staff training and education to decrease workplace violence, focusing on things like what constitutes workplace violence, de-escalation, nonphysical intervention skills, physical intervention techniques, response to emergency incidents, and reporting process for workplace violence incidents.
An Advocacy Priority
According to ACEP, “addressing violence in the emergency department has long been a top advocacy priority” for the organization, especially since nearly 7 in 10 emergency physicians say emergency department violence is increasing, and about 80 percent say violence in the emergency department harms patient care.
In 2109, ACEP and ENA launched a “No Silence on ED Violence” campaign to bring attention to the problem of violence in emergency departments and to equip and empower members “to effect needed safety improvements at their hospitals, while engaging state and federal policymakers, stakeholder organizations and the public at large to generate action to address this crisis.”
The two groups also support the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195), which passed in the House of Representatives in April 2021 and currently sits with the Senate Committee on Health, Education, Labor, and Pensions. The bipartisan legislation would work through the Occupational Safety and Health Administration (OSHA) to issue standards for employers related to workplace violence prevention plans to protect health care and social service workers from assaults.
ACEP also has participated in an Action Team sponsored by the National Quality Forum, to help identify and propose ways to overcome key barriers to appropriately responding to, reporting and preventing future violent incidents in health care settings, and ACEP expects to be part of a panel in 2022 to help guide the development of a new OSHA standard related to workplace violence.
“The frequency of violent attacks on nurses, physicians and patients in our nation’s emergency departments is unconscionable and unacceptable. For medical professionals, being assaulted in the emergency department must no longer be tolerated as ‘part of the job,’” says ACEP.
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