1. By: Shawn Bolen and Carol Rajala
Work Place Violence
By: Shawn Bolen and Carol Rajala

2. Introduction
Violence against healthcare workers is not an uncommon problem. “Compared with workers in other industries, hospital workers have high rates of non-fatal workplace assault injuries, most of which result from violent acts by patients” (Arnetz et al, 2014). Research has identified the prevalence of violence against healthcare workers but there are few documented studies to identify the root cause of this problem (Arnetz et al, 2014). The safety of all healthcare workers should be a priority. Understanding what the triggers are that perpetuate this violence is the key to safety.
Violence against healthcare workers is not an uncommon problem.
“Compared with workers in other industries, hospital workers have high rates of non-fatal workplace assault injuries, most of which result from violent acts by patients” (Arnetz, et al, 2014)
Research has identified the prevalence of violence against healthcare workers but there are few documented studies to identify the root cause of this problem (Arnetz, et al, 2014).
Understanding what the triggers are that perpetuate this violence is the key to safety.

3. Learner Objective
To understand what the causes of violence against healthcare workers are and how to implement strategies for optimal workplace safety.
Understanding what the causes of violence against healthcare workers are and how to implement strategies for optimal workplace safety.

4. Assessment of the healthcare environment:
Research: Lack of empirical knowledge of the causal dynamics and circumstances surrounding patient-to-worker violence (Arnetz et al, 2014). In-depth analysis of documented incidents would provide insight into specific catalysts and situations involved in patient violence, thus identifying potential targets for data-driven intervention (Arnetz et al, 2014).
According to Arnetz, research shows there is a lack of empirical knowledge of the casual dynamics and circumstances surrounding patient-to-worker violence.
In the same article Arnetz offers that in depth analysis of documented incidents would provide insight into specific catalysts and situations involved in patient violence, thus identifying potential targets for data-driven intervention.

5. Assessment of the healthcare environment Continued:
Policies: Identifying dominant themes concerning patient-to-worker violence informs hospital administrators about potential targets for intervention (Arnetz et al, 2014). Resources: Regular safety and health training for all healthcare workers, creating workplace violence prevention programs and strategies. Financial: “Workplace violence results in physical, personal, emotional, professional, and organizational consequences. Furthermore, it has potentially serious impacts on job performance and productivity, job satisfaction, staff retention, and staff morale”(Speroni et al, 2013).
Arnetz indicates that identifying dominant themes concerning patient-to-worker violence informs hospital administration about potential targets for interventions.
Some resources to consider are regular safety and health training for all healthcare workers, and creating workplace violence prevention programs and strategies.
According to Speroni this issue has financial implications as well. “Workplace violence results in physical, personal, emotional, professional, and organizational consequences. Furthermore, it has potentially serious impacts on job performances and productivity, job satisfaction, staff retention, and staff morale”.

6. Assessment of the healthcare environment Continued:
Political: Legislation introduced at state level making assaulting a healthcare professional a felony and punishable with higher fines and longer jail sentences (Michigan Nurse, 2014). Nursing practice and/or quality and safety: Patient safety is always a priority, keeping workers safe should also be a priority. An unsafe environment is unhealthy for everyone involved.
This has to be addressed on a political level as well. Legislation has been introduced making assaulting a healthcare professional a felony and punishable with higher fines and longer jail sentences (Michigan Nurses, 2014).
Nurses are expected to practice safely and with quality in mind. Working in an unsafe environment puts not only workers at risk but patients as well. Patient safety is always a priority, keeping workers safe should also be a priority. An unsafe environment is unhealthy for everyone involved.

7. Root Cause Analysis: PT Care PT Behavior Workplace Violence
Lack of Preparation
Situational Events

8. Inference
Violence against healthcare workers can have detrimental consequences for patients, staff and administration. The implications and consequences encompass much more than a physical injury.
Violence against healthcare workers can have detrimental consequences for patients, staff and administration. The implications and consequences encompass much more than a physical injury.

9. Implications and consequences
There is a variety of consequences of violence toward healthcare workers that can have an effect on multiple facets of the healthcare care environment. This is not only about an injury to an employee.
Patient care can be compromised during a violent episode.
Staff suffers physically, mentally and emotionally.
Employee morale can decline.
Loss of man hours.
Administration is diverted and tied up with many man hours dealing with the aftermath.
These episodes are about much more than a physical injury.
Patient care can be compromised during a violent episode
Staff suffers physically, mentally, and emotionally
Employee morale can decline
Loss of man hours
Administration is diverted and tied up with many hours dealing with the aftermath

10. Implications and consequences continued
Ultimately, the purpose of exploring the topic of workplace violence is to ensure a safe working environment for healthcare workers. It can increase healthcare costs for employers, psychological effects on employees. Research shows that factors influencing workplace violence are multifactorial. The current attitude toward violence against healthcare workers is that it is part of the job. Often nurses are discouraged from reporting incidents either due to lack of hospital administration support or lack of judicial support. Even with the support of hospital administration the judicial system proves an additional barrier. “In another instance, a judge said to a nurse, ‘Well, isn't that the nature of the beast, being in the emergency room and all?’” (Wolfe, Delao &Perhats, 2014).
The current attitude toward violence against healthcare workers is that it is part of the job.
Often nurses are discouraged from reporting incidents either due to lack of hospital administration support or lack of judicial support. Even with support of hospital administration the judicial system proves an additional barrier.
“In another instance. A judge said to a nurse, ‘Well, isn’t that the nature of the beast, being in the emergency room and all?’”.

11. Recommendations for quality and safety improvements
Legislation
Currently MCL d is in the process of being amended to include health care employees to the list of personnel it will be a felony to assault, batter, resist or obstruct while they are performing their duty.
Many states have already passed this law. It has overwhelmingly been approved by the Senate in Michigan.
There is legislation in Michigan to include healthcare employees to the list of personnel it will be a felony to assault, batter, resist, or obstruct while they are performing their duty.
Many states have already passed this law. It has been overwhelmingly approved by the Senate in Michigan and is awaiting further approval from lawmakers.

12. Recommendations for quality and safety improvements
Employee Training
Crisis Prevention Intervention(CPI) Training is being recommended to healthcare facilities to properly train their employees in “de-escalation strategies, debriefing protocols, and personal safety techniques” (Stea, 2013).
Crisis Prevention Intervention (CPI) training is being recommended to healthcare facilities to properly train their employees in “de-escalation strategies, debriefing protocols, and personal safety techniques” (Stea, 2013).

13. Conclusion
Violence towards healthcare employees comes at a high cost. It ultimately affects morale, costs millions of dollars which is passed along to the public and can have a negative effect on patient care. The attitude about violence toward healthcare employees had been complacent in the past. It was accepted that violence was part of the job. Recently, changes in this attitude have shifted in the other direction due to the awareness of the implications. Through legislation amendments to punish violators to the fullest extent of the law and proper employee training that teaches employees to prevent and defuse escalations, we should see a downward sloping trend in the violence towards healthcare workers.
Violence towards healthcare employees comes at a high cost. Ultimately it affects morale, costs millions of dollars which is passed along to the public and can have a negative effect on patient care. The attitude about violence toward healthcare employees had been complacent in the past. It was accepted that violence was part of the job.
Recently, changes in this attitude have shifted in the other direction due to awareness of its implications. Through legislation amendments to punish violators to the fullest extent of the law and proper employee training that teaches employees to prevent and defuse escalations, we should see a downward sloping trend in the violence towards healthcare workers.

14. References:
Arnetz, J., Hamblin, L., Essenmacher, L., Upfal, M., Ager, J., & Luborsky, M. (2015). Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. Journal of Advanced Medicine 71(2). DOI: /jan Michigan Compiled Law §750.81d Michigan Nurse (2014). Workplace violence: MNA partners with Wayne State University, implements three-pronged strategy to address growing problem. Retrieved from Speroni, K.G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients. or patient visitors. Journal of Emergency Nursing 40(3). doi: /j.jen Stea, K. (2013, June 5). Reducing Healthcare Violence. Retrieved March 13, 2015, from Wolf, L. A., Delao, A. M., & Perhats, C. (2014). Nothing changes, nobody cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care. Journal of Emergency Nursing, 40(4),