Workplace Violence Fact Sheet

	For more information: Visit the Canadian Initiative on Workplace Violence. Thanks to the Occupational Health Clinics for Ontario Workers Inc. and Lori Brown, RN, who assembled this fact sheet for SEIU Local 1.on.

Definition:

Any aggressive behaviour (physical assault, threat or harassment) aimed at inflicting harm and/or discomfort on its victims, whether they are intentional targets or innocent bystanders.

Many people in health care believe that violence is part of the job. The risk of experiencing violent behaviour has been labeled a feature of day-to-day work in providing health-care services. The research literature shows that health-care workers in particular face dramatically higher risks for nonfatal assaults and that there is a high incidence of assaults against caregivers.

Potential Risk Factors:

While there is sometimes no warning of abuse, there are indicators and situations associated with increased risk of a nurse being abused. Here are some of the warning signs for abusive situations drawn from the literature on the prevention of abuse.

A client may be more likely to become abusive if he or she:

• has a history of aggressive or violent behaviour, including threats or verbal abuse
• suffers from dementia, head trauma, hypoglycemia, emotional disorders, or substance abuse
• cannot communicate clearly and is frustrated
• appears unsettled, confused or fearful
• cannot sit still, e.g. rocks back and forth in a chair, or paces around his room or in the halls
• appears excessively tense (e.g. sitting on the edge of a chair/bed; clutching the armrests, table, bed rail, their clothes; etc.)
• speaks in a loud or aggressive tone

Environmental factors also affect the potential for abuse. The factors may increase the risk of abuse include:

• inflexible institutional rules and policies, such as strict times for bathing or meals
• inadequate staffing - especially during high activity times
• restrictions on activities - use of seclusion or restraints
• high noise areas - PA announcements, banging doors, people shouting
• poorly lit areas where a client may surprise you or you may surprise a client
• busy or high activity times of the days
• lack of personal space for clients - lack of respect for a client's privacy during bathing or intimate care
• lack of priorities or programs aimed at prevention and reducing the incidence and impact of violence in the workplace.

Staff characteristics can also be risk factors for the abuse of nurses. Nurses may be more likely to be abused if they are:

• Ambivalent about the prevention and management of abuse
• Perceived as having a passive or threatening tone of voice
• Have aggressive or threatening body language - crossed arms, standing square to the client
• Overtly aggressive actions or language - door slamming, throwing objects, raised voice
• In conflict with other staff members
• Working alone or isolated from other workers
• Experiencing a high level of work stress, workload, or work pace

- College of Nurses, 1999

Sources of Violence:

The major source of injury is the health-care patient. It is difficult for workers to protect themselves because of necessary proximity to patients. Violence from patients is often unpredictable and healthcare workers are not trained to deal with explosive situations. The literature proves that violence is a major hazard for untrained staff.

There are many possible combinations of abuse in relation to patients, staff and others.

The psychological impact may be more traumatic than the physical injuries, especially when caregivers are attacked by those they are treating.

Worker Rights:

Workers have the right to withdraw to safety and use reasonable force. The force used should only be enough to ward off an attack and protect yourself or others. Workers do not have a right to retaliate physically or verbally.

If you feel threatened:

• Be aware of your surroundings (know where the exits are, how to call for help)
• Project a calm, attentive manner
• Actively listen and acknowledge the aggressor
• Position yourself for safety
• Try to politely and calmly terminate the interaction in a non-threatening manner, if possible.
• Get help: Use a silent alarm or code word

Report Workplace Violence:

It is crucial that you report any violence, verbal or physical, to your organization. Employers have an obligation to provide for your safety and your workplace should have an anti-violence policy. If your workplace has a policy, you are only doing your job by following it. Reporting violence is a positive contribution to the well being of everyone that works there!

Preventing Workplace Violence:

Working with Patients

• Approach patients in a non-threatening, respectful manner.
• Provide the right information at the right time. DO NOT overload patients or family members with too much medical or technical jargon.
• Review the patient's profile prior to meeting with the patient. Take note of any potential concerns and take appropriate precautionary measures, e.g. use the "buddy" system or increase natural surveillance.
• Clearly and fully explain to the patient, before and during procedures:
  • what is involved
  • how long will it take
  • whether it will hurt
  • If you feel threatened, DO NOT conduct intimate examinations of patients alone. Arrange to have a colleague in the room or close by.

If a patient resists and becomes hostile during a procedure:

• stop what you are doing, if possible ask the patient to identify what is wrong if you can, correct the situation, otherwise, explain why you cannot

• Limit information given to outsiders regarding the condition or status of hospitalized victims of violence.
• Supervise the movement of psychiatric clients at risk of violence in accordance with your facility's procedures and policies.
• Consider transferring aggressive patients to a more secure or restrictive setting, if available.

Administrative Tips:

• Establish a system to identify patients and clients who may present a violence risk due to factors such as personality, medication and type or degree of illness. Keep in mind patient confidentiality and employee safety issues.
• Assign more experienced staff, or staff with a demonstrated ability to handle potentially violent situations, to areas or patients that pose a higher risk of violence.
• Use time-out or a separate area for segregating potentially violent patients.
• Identify the circumstances in which use of medication to prevent or control anxiety is appropriate.
• Identify the circumstances in which physical restraint is appropriate and obtain training.
• Establish procedures for monitoring high-risk patients at night.
• Establish lock-up procedures for pharmaceuticals.

- CCOHS, 1999

Support Services:

Immediately after an incident of violence, first-aid/medical attention should be provided to any person requiring it, ASAP.

Staff directly involved should be given the option of being relieved and given time and resources to defuse any remaining anger or tension.

Any worker who is affected by violence, either personally or as a witness, should be referred to counseling services to discuss the event and any potential consequences. Critical incident de-briefing and counseling may help to prevent the development of Post Traumatic Stress Syndrome and other adverse health outcomes (i.e. depression, anxiety etc). Social support may also increase recovery and contribute to a quicker return to work.

Remember to contact your local union should you have any questions or concerns about workplace violence.