The United Kingdom’s Department of HealthÂ announced last week that it was providing an additional Â£97 million ($198 million US) to its National Health Service for programs toÂ protect healthcare workers from violence and abuse.Â The Health Secretary noted:
“Over 58,000 NHS staff were physically assaulted by patients and relatives in England in 2005-06. This is completely unacceptable. NHS staff working alone and in the community are particularly at risk.Â Â NHS staff dedicate their lives to caring for the sick and in return they deserve respect. Anybody who abuses our staff must face tough action and the possibility of jail.”
I don’t know how many thousands of healthcare workers are assaulted on the job annually in the U.S., but I’m sureÂ there’s no comparable federal effortÂ afoot in our country to provide this same kind of protection for our health-service workers.
The most recent data I could find on workplace violence incidents among healthcare workers appeared in a 2002 NIOSH document entitled, “Violence: Occupational Hazards in Hospitals.”Â Â It referred to Bureau of Labor Statistics (BLS) data (and on hospital workers only) and reported 2,637 nonfatal assaults in 1999.Â (AÂ rate of 8.3 assaults per 10,000 workers, compared toÂ a rate of 2 per 10,000 workersÂ forÂ all private-sector industries.)
These BLS rates are significantly less than those reported by public health researchers.Â A study by Peek-Asa, et al (1998) estimated a non-fatal annual assault rate of 465 per 100,000 hospital workers and a study by LaMar et al (1998) reported that nurses accounted for 7% of the total number of workers compensated (through the Minnesota Workers’ Compensation system) for work related assaults [1,2].
A bit more recently, May and Grubbs (2002) surveyed nurses working at a large (770-bed) acute care medical centerÂ in Florida.Â 88 percent of the nurses survey reported being verbally assaulted in the previous yearÂ and 74 percent reported being physically assaulted, most often fromÂ perpetrators suffering fromÂ cognitive dysfunction or substance abuse.Â The researchers reported that the assaults were just as often instigated by a family member or visitor, as the immediate patient. Â In a survey of 4,918 State-licensed RN’s and LPN’s in Minnesota,Â Gerberich and colleagues reportedÂ annual rates of 13.2 per 100 nurses for physical violence andÂ 38.8 for non-physical violence .
TheÂ UK’s investment of $198 million toÂ better protect their healthcare workersÂ focuses on aÂ few specific solutions, such asÂ providingÂ 30,000 safety alarm devices for healthcare providers, especially those who work alone.Â The small device includes an alarm that the worker can sound when she or he is threatened or assaulted.Â It includes an electronic tracking device to helpÂ locate the at-risk or injuredÂ healthcare worker and summon help.Â Portions of the $198 millionÂ will fundÂ additional security personnel, a special reporting system to track incidents and target prevention efforts,Â conflict resolution training for staff, and resources to prosecute those who assaultÂ healthcare workers.
UNISON, the largest trade-union in Britain,Â welcomedÂ the announcement which was made by the Health SecretaryÂ at aÂ speech to the Labour party conference.Â Â The union also applauded legislation moving through the House of Commons which would make it a punishableÂ offense for “a person causing a disturbance to refuse to leave NHS premises.”
“Karen Jennings, UNISON head of health, said: ‘Aggressive behaviour in any form is distressing for NHS staff, patients and visitors, and should not be tolerated. So-called nuisance behaviour is often highly offensive and can easily escalate to more serious offences such as assault. …This legislation provides another weapon for hospitals to use to protect their nurses and other NHS staff.'”‘
In the U.S., it is action on the State-level which may make a difference for the safety of healthcare workers.Â Nurses in Massachusetts, for example, are lobbying support in the State legislature for a law requiring hospitals to implementÂ comprehensive workplace violence prevention programs, and provide counseling toÂ worker-victims ofÂ violence.Â The bill was the brainchild of the Massachusetts Nursing Association’sÂ (MNA) Congress on Health and Safety Task Force on Workplace Violence.
In a June 2007 news release issued by the MNA, nurses described their first-hand experiences with assaults on-the-job.
“Ellen MacInnis, a nurse at St. Elizabeth’s Medical Center, described her ordeal to the committee. She was attacked by an intoxicated patient who swung at her and in doing so dislodged her own IV. As a result, MacInnis was exposed to HIV and Hepatitis C. ‘I still have anxiety. It’s been a life-changing event. I just want to be safe while I’m doing my job.'”
Patricia Duggan, who at the time worked at Mt. Auburn Hospital, described her encounter with a patient who became belligerent, attacked her and threatened to wait for her until her shift was over. She contacted her nurse manager who specifically told her not to call the police.Â Duggan called the police anyway and when the officers escorted her to her car at the end of her shift, they found the assailant waiting in the parking lot. ‘My managers were furious at me for calling the police,’ Duggan said, ‘and I was reprimanded.'”
In the Occupational Health News Roundup, I learned that Kentucky adopted a new lawÂ earlier this year to provide better protections,Â such as electronic safety alarms,Â for certain State employeedÂ in the Department of Community-Based Services.Â The bill was named to honor Boni Frederick, a 67 year-old social workerÂ who was murdered in October 2006 whileÂ taking a 10-month old baby for a scheduled visit with the infant boy’s mother.
âThis bill will make working conditions safer for human services workers,â said Rep. Tom Burch (D- Louisville), a sponsor of the bill. âOur authorization of neutral visitation centers, extra staff and enhanced safety tools will mean significant changes in the way staff can help families. These workers see things and help people in situations most of us could never imagine, and they deserve this support.â (here)
The other kind of support that health- and family-service workers deserve is recognition by management officials of the severity of the problem.Â Craig Slatin ScD, MPH, an associate professorÂ at UMass Lowell, notes thatÂ “managers don’t understand the seriousness of these issues and how they relate to the safety of their workers.”
Which brings me back to the UK’s new initiative to protect the NHS staff from violence on-the-job.Â In the Health Secretary’s announcement, he reported “over 58,000 NHS staff were physically assaulted by patients and relatives in England in 2005-06,” suggesting they have at least some mechanism to track these incidents.
But in ourÂ nation’s disjointed health care-, workers’ comp- and workplace safety and health systems, we don’t have national-level statisticsÂ on incidents of violence against health care or social workers (as mentioned above, the latest Bureau of Labor StatisticsÂ data on the topic is dated: 1999) —which might be a key reason why managers andÂ national-level lawmakers have failed toÂ recognize the seriousness of the problem of violence against healthcare workers, and do something about it.Â
 Peek-Asa C, et al. Incidence of nonfatal workplace assault injuries determined from employers’ reports in California. J Occup Environ Med, 1997; 39: 44-50. (abstract)
LaMar W, et al. Work-related physical assault. J Occup Environ Med, 1998; 40: 317-324.Â (abstract)
Â May DD,Â Grubbs LM.Â The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center JÂ Emerg Nurs, 2002; 28(1):Â 11-17.Â Â (abstract)
 Gerberich SG et al. An epidemiological study of the magnitude and consequences of work-related violence: the Minnesota Nurses’ Study. J Occup Environ Med, 2004; 61: 495-503. (abstract)