Workplace Violence Rampant in Healthcare
Workplace violence against healthcare workers is rampant, but solutions remain unclear, largely as a result of underrecognition and underreporting of the problem and poor-quality research, according to a review article published in the April 28 issue of the New England Journal of Medicine. The article stems from the tragic death of a surgeon at Brigham and Women's Hospital in Boston, Massachusetts, in January 2015. The surgeon was shot and killed by the son of one of his patients, who had died. The homicide gained widespread attention, but follow-up reports failed to represent the full extent of workplace violence in healthcare, according to review author James Phillips, MD, from Harvard Medical School and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Far more common than homicide are the daily encounters with lower-level violence, such as verbal abuse, physical assault, intimidation, stalking, and sexual harassment, experienced by healthcare workers but often overlooked almost 75% of all workplace assaults between 2011 and 2013 happened in healthcare settings;
In fact, underreporting represents a major hurdle to tackling the problem. Just 30% of nurses report workplace violence, whereas 26% of physicians do, according to one study. The professional culture of healthcare, which often considers violence as "part of the job," likely contributes. Underreporting is an "iceberg problem," according to Dr Gillespie. "You can see the tip of the iceberg, but you can't see everything underneath," he said, "There's so much underreporting that the problem is a lot worse than what the statistics show."
Uncertainty about what actually counts as violence may also play a role, especially in patients without full control of their faculties. Whether the act is intentional or not, it should always be counted as violence, according to Dr Gillespie.
"No violence should be tolerated, ever," he said, "If we made the assumption that all patients or visitors have the potential to become violent, we would interact with them differently, and we would be safer." Discounting unintentional violence can contribute to underreporting, he explained. Acknowledging and reporting even unintentional violence can help staff identify which patients have been violent in the past and take precautions, such as flagging a patients' chart, to avoid violence when the patient returns.
"The difference between intentional and unintentional are the consequences," Dr Gillespie added, "For the confused older adult, person with low blood sugar, or a child, there's no intent. It won't have a consequence, but you can still do a prevention plan."
No "One-Size-Fits-All" Solution Exists
"It would be difficult to expect our administrators to provide the limited funds toward something that may not work," Dr Phillips stressed, "If we're able to encourage researchers to find programs that work, we'll have a better chance of getting our administrators to buy-in and provide budgets that allow us to put those changes into place."
The authors and Dr Gillespie have disclosed no relevant financial relationships.