WORKPLACE

VOILENCE

Ms.Sarita Mehta
Chief Nursing
officer AIIMS,DELHI
 Goals /
Objectives
 The attendees will understand and be able to articulate
the scope and depth of the workplace violence
problem as it relates to healthcare.
 The attendees will be provided tools to assess
their organization for security risks.
 The attendees will be able to create a
comprehensive plan to address the risks associated
with workplace violence.
 Insurance concerns surrounding workplace violence
will be explored and the attendees will be provided
with options to better deal with insulating these
exposures.
What is Workplace
Violence
O “A violent act (or acts) including physical assaults
or threats of assaults directed towards a person
at work or while on duty”
(The National Institute for Occupational Safety
and Health (NIOSH))
 Four Types of Workplace
Violence
The person who came to commit the
crime
• Has no relationship to the workplace
• Is the recipient of a service
• Has an employment relationship with a current or former
employee
• Has a personal relationship with a current or former
employee

4
Types of
Violence
 Factors Leading to Workplace
Violence

• Employee
Disenchantment
• Absenteeism
• Turnover
• Three Levels of Violence
• Aggressive Behavior

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 The Three Levels of
Violence

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 Levels of Violence: Level
One

•The employee
• Refuses to cooperate with immediate supervisor
• Spreads rumors and gossip
• Consistently argues with co-workers or
management
• Is belligerent toward customers
• Swears at others
• Makes unwanted sexual comments

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 Levels of Violence: Level
Two
•The employee
• Refuses to obey company policy
• Sabotages equipment and steals property
• Verbalizes wishes to hurt co-worker(s) or
management
• Writes sexually violent notes
• Sees self as victimized by management

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 Levels of Violence: Level
Three
The employee
Has suicidal thoughts
Has physical fights on the
job Uses weapons
Commits violent acts/crimes

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Difference Other Workplaces Vs
Hospitals
O The circumstances of hospital violence differ from
the circumstances of workplace violence in general.
O In other workplaces such as Banks, Malls, General
Stores and Taxi-Rikshaw, violence most often
relates to robbery.
O Violence in hospitals usually results from patients
and from their family members who feel frustrated,
vulnerable, and out of control.
It‘s a Violent
World
 An elderly patient verbally abused a nurse and pulled
her hair when she prevented him from leaving the
hospital to go home in the middle of the night.
 An agitated psychotic patient attacked a nurse,
broke her arm, and scratched and bruised her.
 A disturbed family member whose father had died
at hospital walked into the emergency department
and fired a small-caliber handgun, killing a nurse
and an emergency medical technician and
wounding the emergency physician.
 Physician repeatedly slapped anesthetized patients,
hospital fined
 Who is at
risk?

O In general, anyone who works in

a hospital or health care setting
O Doctors
O Sisters
O Ward-boys & Ayahs
O Reception & Office Staff
O Security Guards
O Any Health care provider
O Pathologist, Radiologists,
Where violence may
occur?

O Violence may occur anywhere in the hospital, but

it is most frequent in the following areas:
O Emergency rooms
O Billing Counters
O During transportation/shifting
O Waiting rooms
O Psychiatric wards
O Consulting
O Ward
Rooms O Waiting
s
room
O Reception
Counters
 Direct Effects of
Violence
O Minor or major physical injuries
O Temporary or permanent physical
disability
O Psychological trauma
O Death
 Indirect Effects of Workplace
Violence
O Low worker morale

O Increase in job stress

O Increase in worker turnover

O Reduced trust of management/co-

workers

O A hostile work environment

Violence
Prevention
O Develop a comprehensive prevention
program that includes:
• Zero tolerance policy
• Management commitment/enforcement
• Employee participation
• Hazard identification
• Training
• Hazard prevention
• Accurate and timely
reporting
 Environmental
Designs

O Develop emergency signaling, alarms, and

monitoring systems.
O Install
security devices such as metal
detectors to prevent armed persons
from entering the hospital.
O Install
other security devices such as
cameras and good lighting in
hallways.
O Provide security escorts to the parking lots
at night.
 Environmental
Designs

O Design waiting areas to accommodate and assist

visitors and patients who may have a delay in
service.
O Design the triage area and other public areas
to minimize the risk of assault:
O Provide staff restrooms and emergency exits.
O Install enclosed nurses' stations.
O Install deep service counters or bullet-resistant
and shatterproof glass enclosures in reception
areas.
O Arrange furniture and other objects to minimize
their use as weapons
Administrative
Controls
• Comprehensive, written procedures for
reporting and for responding to
• occurrences
• Enforce zero-tolerance policy
Update program as necessary (continuous
improvemen
• Design
t staffing patterns to prevent personnel
from
working alone and to minimize patient
• waiting time.
Restrict the movement of the public in hospitals
• by card-controlled access.
Develop a system for alerting security
personnel when violence is threatened.
Prevention
Strategies
O Changing Behavior

• Create “buddy system”

• Provide security escorts to parking
• lots Prevent personnel from working
alone movement of public using
• Restrict
controlled- access cards
• Training in hazard awareness, resolving
conflicts,
• Recognizing potential
• signscounseling available to reduce workers’
Make
fear
• Have open communication with workers
Dealing With the Consequences of
Violence
O Violence may occur in the workplace in spite
of preventive measures.
O Employers should be prepared to deal with the
consequences of this violence by providing an
environment that promotes open communication
and by developing written procedures for
reporting and responding to violence.
O Employers should offer and encourage counseling
whenever a worker is threatened or assaulted
 Safety Tips for Hospital
Workers
O Watch for signals that may be
associated with impending
violence:
O Verbally expressed anger and
frustration
O Bodylanguage such as threatening
gestures
O Signs of drug or alcohol use
O Presence of a weapon
 Maintain behavior that helps diffuse
anger:
O Present a calm, caring attitude.
O Don't match the threats.
O Don't give orders.
O Acknowledge the person's feelings (for
example, "I know you are under
stress").
O Avoid any behavior that may be interpreted as
aggressive (for example, moving rapidly,
getting too close, touching, or speaking loudly
 Steps to take, if you can't
defuse the situation

quickly :
O Remove yourself from the situation.
O Call security for help.
O Report
any violent incidents to your
management.
O Call
for Police help with the
permission of
Management
 Response
Recommendations

Remember the “Three

R’s”: R ed Flags
R esources R
ecovery
Once we identify the problem (red flag) and consult with the
right people (resources), it’s time to “fix it and make it
better”
(recovery).

RRR
 To Prevent WPV --- Go
LOCO

Go LOCO

Listen to
employees O
bserve employees
C ompare notes with
colleagues O btain help
 Summa
ry
O No universal strategy exists to
prevent violence
O Risk factors vary from facility to
facility
O Healthcare facilities should form
multidisciplinary committees to identify
risk factors
O All workers should be alert
and cautious
O Workers should actively
participate in safety
training programs
Questions
or
Comments
?