Violence against healthcare workers is a growing problem that needs to be addressed, but collecting the data needed to inform solutions is a challenge.
Last month, the Ontario Council of Hospital Unions drew attention to consistently high levels of healthcare workplace violence, which includes verbal and physical abuse directed toward staff while working. It's estimated that half of healthcare workers in Canada experience some form of violence while on the job. Rates in the U.S. are equally high – a JAMA study estimated that 24,000 assaults took place between 2010 and 2013.
These numbers represent only a portion of the workplace violence healthcare workers’ experience. Despite the scope and severity of the problem, workplace violence is consistently underreported. A review in the New England Journal of Medicine estimated that only 30 percent of nurses and 26 percent of doctors report violent incidents.
Workplace violence comes in many forms: verbal threats, sexual harassment, physical assaults and – in rare cases – death. Patients, their families and medical professionals can all commit workplace violence against healthcare workers.
Some healthcare settings carry a higher risk than others. Emergency departments, psychiatric facilities and long-term care centers have some of the highest rates of workplace violence. In these spaces and many others, workplace violence has become “just part of the job,” which is one of the most common reasons why professionals do not report their experiences. Workers have also reported feeling a lack of support from the institutions they work for and some worry about potential negative repercussions of reporting.
Unfortunately, low-levels of reporting only make it more difficult for institutions to get a sense of when and why their staff experience violence. Since risk factors for violence vary between individual institutions, this data is critical. Without it, the result can be a vicious cycle where a lack of information impedes the development of solutions.
The good news is that there are ways to break the cycle. In 2016, California introduced new multi-pronged regulations to protect healthcare workers. Additionally, individual institutions like Michael Garron Hospital (formerly Toronto East General Hospital) in Ontario simultaneously reduced incidences of workplace violence and demonstrated a commitment to healthcare workers by implementing alarms for staff and de-escalation training, among other strategies. These risk-based solutions provide practical skills for healthcare workers who face a risk of violence and can work well with strategies to boost event reporting to build morale and encourage staff to report what they experience.
Here are some strategies to encourage reporting:
- Make reporting simple. Integrating workplace violence reporting into existing reporting protocols can create a low-barrier environment to make reporting violent incidents as routine and accessible as recording patient data.
- Let staff know their safety is the top priority. Shifting conversations about workplace violence and integrating tools like training and specific protocols can help staff feel supported and encourage reporting. This can improve rates of professional conduct reporting, too.
- Increase report transparency. Engage healthcare workers by sharing information about the risk of violence in their workplace and the strategies to reduce and end it. This can help change perceptions that violence is normal.