California’s New Regulation to Reduce Work Place Violence in Health Care

During the last week of October, the State of California’s Occupational Safety and Health Administration (Cal/OSHA) approved regulations to protect health care workers from workplace violence.  These regulations are being heralded by many in the healthcare community, as setting a standard and were passed unanimously by Cal/OSHA. These regulations are seen by the nurses’ unions and many in the health care community as a step towards alleviating a problem that does not get much attention- violence against healthcare workers.

U.S. Occupational Safety and Health Administration  found in a study done between 2002-2013, that healthcare workers were four times more likely to be the victims of serious work place violence than other workers in private industry.  The study found that 21% of registered nurses and nursing students reported being physically assaulted and over 50% of the same group reported being verbally abused in a 12-month period. The Center for Disease Control and Prevention (CDC) also did a study on occupational traumatic injuries among health care workers. The study took reported data from 2012-2014 and found that nurses’ assistance and nurses are most vulnerable to injury and the number of reported incidents rose steadily over the two-year period of the study. As alarming as these numbers are, they may not even reflect the whole story because such injuries often go unreported or under-reported. OSHA’s report states this might be due to certain cultural factors in the health care industry. The report states:

“caregivers feel a professional and ethical duty to ‘do no harm’ to patients. Some will put their own safety and health at risk to help a patient, and many in healthcare professions consider violence to be ‘part of the job.’  Healthcare workers also recognize that many injuries are caused by patients are unintended, and are therefore likely to accept them as routine or unavoidable. Another consideration is unwillingness among healthcare workers to stigmatize the perpetrators due to their illness or impairment.”

The push for action in California came after the tragic death of Donna Gross, a psychiatric technician working at Napa State Hospital. Donna was murdered by a patient while working at the hospital in 2010.

The regulation hopes to lower work place violence in private health care facilities, by requiring such facilities to implement a Workplace Violence Prevention Plan.  The regulation requires health care facilities to implement a plan in writing that evaluates risks to workers. It also calls for the facilities to provide greater training and easier reporting for its employees. The regulation also requires facilities to identify and evaluate patient-specific risk and assess visitors or other persons who are not employees. The regulation also requires facilities to provide procedures for post-incident response and investigation. The post-incident evaluation includes identifying all employees involved, making available individual trauma counseling, conducting a post-incident debriefing, and reviewing whether appropriate corrective measures under the plan were effectively implemented. If plans are not implemented and protocols are not followed leading up to or following an incident, Cal/OSHA can give a citation to the facility.

There has been little discussion so far on how these new regulations will affect patients.

These regulations are a first step in helping to reduce an epidemic of workplace violence that has long permeated the health care profession, but got little attention.