Recently, there has been growing attention given to violence in the workplace. This new attention is extremely important because previously there was relative silence about violence against nurses and other health care workers, although it happens very regularly in our work settings. Personally, I have worked in a wide range of health care settings, including home care. Safety was a priority in home care because nurses must travel alone, often in unknown areas and situations. Do you know, however, that most workplace violence occurs in the hospital setting, particularly in psychiatric units and emergency departments? According to a recent study, 80% of emergency nurses reported that they experienced some level of violence in the past year, for home care that was 60%. As you are reading this, you may not think this is possible, but I suggest that you answer the following question to see if you have experienced workplace violence.

While performing your role as a nurse in a clinical, administrative, management, or education role, has a patient, resident, family member, or coworker ever: yelled at you, harassed you, threatened you, hit, punched, or scratched you, spit or thrown any other bodily fluid or waste at you?

Workplace violence, according to the Occupational Health and Safety Administration (OSHA), covers a range of behaviors from bullying to committing homicide, and it also covers actions that are from patients or residents who may be fully aware of their actions, as well as those who may have dementia, delirium, drug or alcohol intoxication, or mentally incompetence. Unfortunately, OSHA has no specific standards that they are requiring of all employers to prevent workplace violence.² What exists is a general duty of employers to ensure safety and prevent workplace injury and illness.²

Preventing Workplace Violence
First, it is very important to understand that as a nurse, or any type of employee, you have a right to be safe at work. Safety concerns at work were taken very seriously since 1970 when the United States Congress passed the Occupational Safety and Health Act, which set mandatory standards to prevent injury to employees for all types of causes, including violent acts. The OSHA website contains links to several health care and professional organizations and government agencies that provide guidelines for workplace violence prevention.

Recommendations include:

• Employers should assess and mitigate risk, providing employee training, implementing safety programs, and report incidents.³
• Your workplace may be at high risk for if you and your colleagues do not have training in early recognition and management of potentially violent situations; your facility does not have policies to ensure safety, like zero tolerance rules on violence, firearms, and carrying other weapons; or if the organization is frequently staffed inadequately and/or lacks security personnel.
• OSHA relies on nurses and nursing administrators to speak out and report serious concerns about workplace safety, and protects those who report issues with whistle-blower laws.² 
• Nursing organizations, including the American Association of Critical Care Nurses and the American Nurses Association, have also advocated for protection of nurses from workplace violence and have published position statements on the topic – Workplace Violence Prevention and Incivility, Bullying, and Workplace Violence, respectively.
• Tap into your member organization for assistance with violence prevention programs in your workplace.

The Center for Disease Control and Prevention (CDC) is one of those government agencies that has resources to assist employers and workers in keeping their workplaces safe. For example, Workplace Violence Prevention for Nurses is a free course for nurses that is available on the CDC website. With so many factors that contribute to violence in health care settings, there is no single resource or solution that can be implemented to resolve the problem. Therefore, it is best to stay informed about the available resources and perhaps start by reading some of the workplace safety articles on Lippincott NursingCenter.com and take advantage of a National Nurses Week CE Collection discount this week.

References
1. Phillips, J. Workplace Violence against Health Care Workers in the United States. New Engl J Med. 2016; 374(17):1661-1669.
2. Occupational Safety and Health Administration. (n.d.) Workplace Violence: Enforcement. Retrieved on May 3, 2016 from https://www.osha.gov/SLTC/workplaceviolence/standards.html
3. The National Institute for Occupational Safety and Health (NIOSH). June 26, 2014 Recent NIOSH Research on Occupational Violence and Homicide, Retrieved from http://www.cdc.gov/niosh/topics/violence/traumaviol_research.html