PrintUnions use worker mobilization, contract language and legislation to combat workplace violence
Three years ago, Rosamund Elbourne, a registered nurse with New York’s Visiting Nurse Service (VNS), was on her way to a home visit in a project of East New York. As she entered the building, a man followed and got on the elevator with her.
“I smelled alcohol on him and immediately knew something was wrong,” says Elbourne. Panicked, she got off on the wrong floor. The man followed and then pulled out a knife.
“He took my money and told me he was going to kill me,” says Elbourne. At that moment, calm came over her. “I don’t know where I got the courage but I asked him why would he kill me when I’m doing so much in the community.”
He slipped away and Elbourne began screaming and knocking on doors. Finally, a woman opened the door to her apartment and let Elbourne in.
Elbourne, a member of the Federation of Nurses/UFT, did not immediately report the incident to the union. But when she did, she was offered counseling and support. On the flip side, when she told the VNS what happened, “they made it seem like it was no big deal.” In fact, their only concerns were the safety of her laptop and when she would return to work.
Elbourne has 30 years of experience, 14 of them with the VNS. She readily admits that she made mistakes that evening three years ago. She did not take advantage of the escort service negotiated by the union and provided by the VNS, even though she was going to see her patient after hours.
“I should have had an escort to go with me, but I felt comfortable going inside. I was naïve and I didn’t think it could happen to me,” says Elbourne, who is still haunted by the incident. “It happened three years ago but it is still fresh in my mind. What happened enlightened me. I could not do those things again. Now, I preach to others about safety.”
Health and safety take a back seat
Violence is a major threat for all workers. Healthcare workers, however, are at a particular risk. The healthcare sector leads all other industry sectors in incidence of nonfatal workplace assaults. According to a special report issued by the federal Bureau of Justice Statistics in 2001, about 429,100 nurses are victims of nonfatal injuries on the job each year. Yet, healthcare facilities are doing very little to address the problem.
Nurses and healthcare workers in mental health wards, emergency rooms and nursing homes experience a high incidence of violence, notes Kate McPhaul, assistant professor and workplace violence project manager at the University of Maryland’s school of nursing.
“Occupational health and safety issues often take a back seat to patient concerns. Hospitals are lean, mean business machines focused on taking care of patients,” says McPhaul.
Most of the time, hospital management is willing to discuss violence among co-workers, but the data show that most healthcare workers are hurt by patients and sometimes visitors,” McPhaul points out.
While the number of violent incidents in healthcare is significant, the actual magnitude of the problem is probably much greater because many workers believe such incidents are just part of the job and do not report them.
“The perception of violence is a huge obstacle,” says Jonathan Rosen, director of the New York Public Employees Federation’s (PEF) health and safety division. “Crime and terrorism behind hospital walls don’t get the same kind of attention they do in the streets or in the community. You have to fight to get people educated that violence is not part of the job.”
Jill Dangler, a registered nurse at Mohawk Valley Psychiatric Center in Utica, N.Y., has been advocating for violence prevention programs ever since she was brutally assaulted nine years ago. Dangler was virtually on her own in the admissions unit of the facility when a transfer patient with a long and violent criminal history snuck out of the dining hall and attacked her. He came at her and began choking her, then repeatedly punched and kicked her. It was another patient who heard the attack and came to her rescue. “He saved my life,” says Dangler, who suffered facial fractures, a loosened jaw and teeth, temporary blindness in one eye and short-term memory loss.
Dangler summoned the courage to return to work two months later, but found nothing had changed.
“I thought I had gone through all this for nothing, and it ate at me.”
Dangler, who is a member of PEF, began talking with the union to press for changes at the state-run facility. She worked with state legislators and testified in Washington, D.C., before a congressional subcommittee to take a stand on workplace violence. Her efforts resulted in training and personal safety alarms for staff at her facility and other state psychiatric facilities as well. In addition, new structural safety measures were put in place along with improved law enforcement response and a support network. She continues to work at Mohawk Valley and conducts workshops with Rosen.
“I like my job. That has never changed,” says Dangler. “It was awful to go through, but good things came from it.”
Over the years, PEF has helped dozens of assaulted RNs through its workplace violence program. The union has managed to get a foothold on the problem with grass-roots activism. It has not been easy.
“Trying to change the culture and mindset takes years of effort,” says Rosen. “You must be able to show the incredible cost of violence, whether it’s workers compensation, retraining or the disruption of the quality of care.”
In New York, the violence prevention program negotiated by the Federation of Nurses/UFT for the members of the city’s Visiting Nurse Service has evolved over time. The union has developed a very cooperative relationship with the VNS, says Anne Goldman, special representative for the Federation of Nurses/UFT and a member of AFT Healthcare’s program and policy council.
The nurses’ union contract requires the VNS to provide training through the New York Police Department to teach the visiting nurses “street smarts” and to employ an escort service so that nurses can be accompanied on visits to high-crime, high-risk areas.
“The nurses are taught to blend in and assess any given situation and know when to get in and when to get out,” says Goldman. “The program is as a good as you can get, but we remain vigilant and revisit policies to make them better.”
Currently, there are no national standards or regulations in place to address workplace violence—only guidelines issued by the Occupational Safety and Health Administration (OSHA). In addition, only a handful of states have pursued legislation to address the problem, which makes facilities that have comprehensive workplace violence prevention programs uncommon.
Hospitals don’t grasp problem
“Hospitals are not 100 percent clear on what to do about workplace violence. In the absence of regulations, there are no real incentives for the healthcare industry to change,” says McPhaul.
The result: Workers must be the ones to agitate for change. A unionized environment offers some structure for labor and management to sit down across the table and discuss the problem.
A good program requires management commitment and the input of direct care staff, notes McPhaul. “You must have labor involvement in order to chip away at solutions.”
Unions can focus on workplace violence prevention through contract negotiations, workplace mobilization and legislation, says Rosen of PEF.
A union interested in creating a program needs to start with a core of activists committed to working on the problem. Rosen encourages workers to exercise their existing rights to consult their hospital’s or healthcare facility’s OSHA injury and illness log to gather data on injuries that result from incidents of violence to assess the frequency and severity of the problem.
“The data can be used to support the need for a comprehensive workplace violence program.” says Rosen. “Union activists can use them to force hospitals to do the right thing.”
The next step would be to develop a report with recommendations for the hospital. If the hospital or facility doesn’t respond, Rosen suggests using the report to gather allies and pressure the hospital for change. Allies could include other unions at the hospital, middle managers, the hospital’s board of visitors, patient advocates and legislators.
“Healthcare is a competitive environment when it comes to getting patients in hospitals,” says Rosen. “Unions can be creative in using those sensitivities to get management to the table and recognizing the value of having a prevention program.”
Once management is on board, the health and safety committee can tailor the program to the culture of the organization.
“A big mistake most hospitals make is looking for a canned violence prevention program,” says Rosen.
Every hospital’s workplace violence issues are unique, and each hospital will have different issues and policies, says McPhaul. However, there are universal precautions that can be taken. Workers can start by using the OSHA guidelines as a framework for creating violence prevention programs.
“Once you identify through an assessment what needs to be changed, implement changes whenever you have the opportunity,” says Rosen.
Because most hospitals have limited finances, the health and safety committee may have to start with a very narrow target to be effective, says Rosen. The committee can focus its efforts on wards or units where people are getting hurt, he points out.
States stepping up
Despite a significant increase in the number of incidents of job-related violence, there has been no effort by OSHA to issue a federal standard. A number of states, however, have stepped up their efforts to address the issue through state legislation. California and Washington have passed laws, and several other states, including Oregon and New York, have introduced legislation.
Last year, PEF worked with state legislators to pass a measure that would have required public employers to develop and implement violence prevention programs. The measure was vetoed. PEF launched a campaign called “Stop Workplace Violence” to reintroduce the legislation this fall.
“Workplace violence often falls off the radar screen until something happens,” says McPhaul. Unions can make workplace violence a bargaining issue, but they have to understand that there are no easy fixes, she adds. “Training is not going to work by itself. The entire organization needs to be thinking about violence prevention.”
