VA Nebraska-Western Iowa Health Care System
Violence in the Workplace/Disruptive Behavior
"All employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm." — OSHA Act of 1970
Healthcare workers experience the highest rate of injuries from workplace assault in the United States according to the Occupational Safety and Health Administration (OSHA). Employers, such as VA, must promote hazardous-free work environments for all employees and trainees.
The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty." Most of the violent situations at the VA involve mentally ill or confused patients directing violence toward a healthcare worker. Delays in registration, admission, discharge, treatments, and appointments, or mistakes or delays in receiving benefits, appointments, and prescriptions may cause anger. To find out if a patient has had a history of violent behavior, look for a "patient record flag" in the patient’s medical record. The flag is a notice (progress note) generally placed on the cover sheet of the patient’s electronic record and will alert you to a history of violent behavior.
Note: Disruptive behavior by a patient, family member, employee, or trainee is generally considered a vocalization or action out of the norm of usual conversations and actions that may impede patient care and may lead to or involve workplace violence. Disruptive behavior is not necessarily physically violent. For example, a patient refusing to take his or her medicine can be considered disruptive behavior. Family members arguing in a raised voice with hospital providers or being verbally abusive to the patient or staff also constitute disruptive behavior.
There can also be cases of staff–on–staff violence. When confronted with a VA employee or patient who brags about past violence, who handles a weapon (or simulates handling a weapon), or who has outbursts in the facility, excuse yourself from the situation and notify your supervisor as soon as possible. An active workplace violence prevention program, such as the one in VA, includes three key activities:
- documenting incidents when they occur;
- knowing the procedures to take in the event of violence; and
- maintaining open communications between employers and workers, supervisors and trainees.
All workers and trainees should assess the risks for disruptive behavior and violence in their workplaces and take appropriate action to reduce those risks. A good start is to discuss these issues with your immediate supervisor.
Websites for further information:
U.S. Department of Labor / Occupational Safety & Health Administration
National Institute for Occupational Safety and Health