Author: Dr. Norman Johnson, CEO

I recently reviewed data from our workers compensation reports that involved incidents of workplace
violence. The data included 2012 to the present. We had a total of seven incidents with one report of lost
time. This was with 700 full and part time employees, for an annual incidence of workplace violence of
.14%. My question was, how do we relate to other areas of healthcare.

Recently there was a review article on “Workplace violence against healthcare workers in the United
States” in the New England Journal of Medicine, April 28, 2016. The data in the article was impressive
because it points out that the healthcare sector is statistically among the industries most subject to
violence in the United States. It is noted that there are high rates of abuse toward physicians and nurses
primarily by patients with mental illness or displaying narcotic seeking behavior.

While the emergency department and psychiatric wards are the most violent, home health care workers
report a work place violence of 61% annually. Homicide is the second leading cause of workplace death
in this group exceeded only by motor vehicle crashes. In a large study, 15% of nurses reported some type
of workplace violence during their five most recent shifts. Emergency department nurses reported the
highest rates with 100% reporting verbal assault and 82% reporting physical assault during prior years.

Nursing aides are also at very high risk with 59% reporting weekly and 16% reporting daily abuse in
nursing homes with dementia units. A survey of all staff members in a forensic psychiatric hospital
reported a 70% annual incidence rate of physical assault. Once again, the characteristic that is most
common among the perpetrators of workplace violence is altered mental status associated with dementia,
delirium, substance intoxication, and decompensated mental illness. Certainly, you would think this
would place jail healthcare in a very risky category.

Clearly, this demonstrates that working in jails is safe for healthcare workers in general. The article
points out there are no programs, training, or metal detectors that have been successful in reducing
violence. What are we doing that reduces our risk of staff injury from workplace violence? The answer I
believe is the jails are an institution of heightened awareness. Therefore, we must continue to focus on
the following risk management strategies:

  • Healthcare workers should endeavor to have security with them when they are seeing patients.
  • Verbal abuse should not be tolerated and all instances reported to security. This would include
    threatening language and low-level battery.
  • Look for signs of agitation.
  • Healthcare charts could be flagged to identify previously violent patients.

Clearly, high security and vigilance are the best prevention of workplace violence for jail healthcare
workers. Our data indicates that it works.