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Seeking safety on the job

Summer 2014
Feature Story

Healthcare workers are at high risk for experiencing violence on the job.

It was close to midnight on Oct. 12, 2012, when Pamela Neuberth, a registered nurse at Springfield Hospital Center in Sykesville, Md., was leaving at the end of her shift. She noticed a patient who seemed to be agitated pacing by the door. Normally, Neuberth would have requested help from security to get the patient back to her room, but the guards were gone. There were, however, other staff members nearby. “We asked her to move away from the door, and she acted as if she were complying,” says Neuberth. But the patient grabbed her and began slamming her head into the cement wall. It took four colleagues to restrain the patient, but not before Neuberth sustained injuries that required surgery. She now has vertigo, problems with her jaw and post-traumatic stress disorder. Despite her injuries, Neuberth is determined to remain on the job—but she is also very aware of the potential for violence.

Springfield needs to have a system in place to better protect its workers, says Neuberth, a member of AFT Healthcare-Maryland. She wrote to several state lawmakers asking them to consider reclassifying the psychiatric hospital as a forensic psychiatric hospital, which would make it a maximum security facility staffed with correctional officers 24 hours a day. “A police officer has a bulletproof vest,” she says. “A firefighter has fireproof equipment. What does a psychiatric healthcare worker have?”

Neuberth says she feels compelled to advocate for safer work environments not just for staff members but for patients too. That’s why, when she recovered from her injuries several months later, she did what many nurses don’t do: She pressed charges against the patient.

Workers often don’t report violence in healthcare settings either because they don’t know the hospital policy on reporting such incidents, they fear their competence will be questioned, or they think dealing with such behavior is part of the job. But Neuberth believes documenting incidents of patient violence is important. “You have to hold patients accountable,” she says. “Without documentation, it is as if the incident never happened—it gets brushed under the rug.”

A number of states have enacted laws upgrading the penalty for assaults on healthcare workers from a misdemeanor to a felony. AFT Healthcare members have lobbied for such legislation in several states, including Connecticut, New Jersey, New York, Washington, Wisconsin and, most recently, Ohio, where members of the Ohio Nurses Association teamed up with the Ohio Emergency Nurses Association to get a bill passed. The legislation, which was signed into law by Ohio Gov. John Kasich, went into effect in March 2013. Hospitals in Ohio now post signs warning that abuse or assault of hospital staff is not tolerated and could result in a felony conviction.

A legislative priority

The Occupational Safety and Health Administration reports that nearly half of all nonfatal injuries from workplace assaults and violent acts occur in healthcare settings, and that nurses are the most likely of all health workers to be assaulted. Unfortunately, there is no federal standard that requires workplace violence protections, although some states have enacted legislation or regulations aimed at prevention.

In Maryland, for example, the number of violent attacks directed against healthcare workers in the state prompted AFT Maryland to make getting a bill to address workplace violence a legislative priority.

AFT Healthcare-Maryland President Debra Perry met with lawmakers to lobby for support of the Nursing Homes and Health Care Facilities Workplace Safety Assessment and Safety Program, a bill that would force healthcare facilities to create protections against workplace violence by establishing violence prevention programs with committees to conduct annual assessments of workplace safety issues and make recommendations to address the issues.

Perry’s local and its members tried to get the same bill passed last year, but it didn’t have enough sponsors. This year was different. “More people are becoming aware of the kind of violence that’s taking place in our healthcare facilities,” says Perry. “It’s becoming harder to ignore because it’s apparent that violence is a problem.”

AFT Healthcare-Maryland worked in coalition with the American Federation of State, County and Municipal Employees, and the Service Employees International Union 1199, to lobby lawmakers to support the measure. In addition, union members testified before Senate and House committees urging support for the legislation. In March 2014, the bill passed in both chambers. “This was done with the help of all interested parties,” says Perry. “We were totally united.” At press time, Maryland Gov. Martin O’Malley was expected to sign the measure, which would go into effect on Oct. 1, 2014.

It’s about time

“It’s about time that the state has stepped up,” says Gail Gaughan, a registered nurse at Thomas B. Finan Hospital Center in Cumberland, Md. Gaughan has been at Finan, a state-operated psychiatric facility, for 18 years. Like many health professionals, she has been subject to violence on the job. Her first experience came when she was a new hire: She witnessed a patient attack a co-worker. “It was scary and very upsetting,” says Gaughan.

She adds that the patient population at Finan has changed during her tenure. “We are seeing more forensic patients, but we are not equipped to handle them,” she notes. “Patients are free to come and go. There is not enough staff or security, and there has been no training on how to deal with forensic patients.”

Gaughan could envision something bad happening even before it did. In October 2013, a psychiatric patient plunged a seven-inch metal spike into the head of a nurse who was trying to restrain him. The nurse survived. After the attack, the hospital began to implement changes, beginning with not allowing patients to leave the facility on their own. AFT Healthcare-Maryland and the hospital’s administration banded together to establish a workplace safety task force, which Gaughan joined. “I decided to get involved because it was an opportunity to advocate for the staff.”

Neuberth says she would definitely join a committee if the Maryland law goes into effect, but she also hopes her hospital will focus on what she calls the basics. “We need to address the lack of staff, and we need to change the training to be more effective in dealing with our current patient population. If we do that, then maybe we could retain more of our staff,” says Neuberth.

Pushing for federal legislation

Ensuring that frontline caregivers and staff are well-prepared and supported so that they can provide safe and efficient care is part of the AFT’s effort to reclaim the promise of high-quality healthcare. That’s why the AFT has been working for a number of years to push for federal legislation and regulations to address the problem of workplace violence. Earlier this year, the Government Accountability Office agreed to investigate the effectiveness of the Occupational Safety and Health Administration’s voluntary guidelines for workplace violence prevention in healthcare. The GAO agreed to the investigation thanks in large part to the AFT’s recommendation to key members of Congress. Last fall, AFT staffers met with the staffs of Rep. George Miller (D-Calif.) and Rep. Joe Courtney (D-Conn.), who are members of the House Committee on Education and the Workforce, to discuss the possibility of requesting a study by the GAO. Following the meeting, the lawmakers sent a letter to the GAO about the OSHA guidelines.

“States have tried to address the problem, but we need federal leadership on this issue,” says Darryl Alexander, director of the AFT’s department of health, safety and well-being. “We’re excited to get things going. Ultimately, the goal is to work with Congress to come up with an effective strategy to create comprehensive federal legislation and regulations to curb the violence.”