Home healthcare clinicians (HHCs) are susceptible to workplace violence (WPV), which can include sexual and verbal abuse, threats, racial harassment, bullying, and physical assault. In 2016, the Bureau of Labor Statistics reported 20,030 occupational injuries related to WPV involving days away from work for healthcare and social service sector workers, with 930 of these injuries experienced by HHCs. Unfortunately, these numbers do not represent the full magnitude of WPV in the home care setting. One reason for the underestimation of WPV in home care is underreporting of WPV incidents.
Reporting of WPV incidents is a critical part of risk assessment and hazard control processes that assists with calculating incidence and prevalence, determining the severity of the problem, identify risk factors and trends, developing effective interventions, identifying patterns of violence, and identifying locations with known WPV incidences (Lipscomb & London, 2015; Occupational Safety and Health Administration [OSHA], 2015). When WPV is underreported, prevention efforts are hampered and there is a false sense that the problem does not exist.
Clinicians may underreport WPV incidents due to difficulty in reliving the trauma, accepting of WPV, especially when the assailant is confused, time constraints with the reporting process, and ambiguity in reporting (Byon et al., 2020). Also, HHCs may underreport due to the perception that no action will be taken and "it's part of the job." Therefore, many believe WPV comes with the territory of being a healthcare worker, even more so when care is provided in the patient's home. Similarly, agency administrators found ambiguity in reporting WPV, unclear definition of WPV, and an unstandardized reporting process (Byon et al.).
When care is provided in the home, there is the potential for role confusion. Clinicians may feel like "visitors" and the patient may view clinicians as "visitors" instead of professionals there to provide healthcare services. Therefore, out of politeness, negative behaviors such as racial slurs, cursing, requesting sexual favors, or displaying pornography during the visit can go unaddressed. It is imperative that HHCs set boundaries, be assertive, and report the behavior to the proper authorities established by management. Reporting WPV incidents alerts other HHCs and agency administrators about WPV incidents so they can be prepared and make sound decisions about HHC assignments.
HHCs are motivated to report WPV incidents when reporting behaviors are perceived as beneficial, accepted as workplace practice norms, and management is supportive. There should be clear guidelines and policies on WPV as well as a clear definition of WPV. Policies should ensure that no reprisals are made against workers who report incidents and near-misses (OSHA, 2015). The process for reporting WPV incidents and near-misses should be clearly written and conveyed. A reporting process should be fast and simple, and HHCs should be required to report WPV incidents. Investigation should be prompt, with results reported to the individual who filed the complaint (Lipscomb & London, 2015).
To fully understand underreporting in the home care environment, research is needed to examine factors that contribute to the decision-making process of HHCs who chose not to report WPV. Accurate and complete reports of WPV incidents is essential for effective WPV interventions and strategies to promote workplace safety.
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