More than half the violent attacks workers suffered on the job were in hospitals, rehab facilities, group homes and other healthcare and social service facilities, according to reports collected by the federal government for 2014, and data collected over the previous decade suggests the problem continues to grow.
Concern for these workers prompted a coalition of diverse national labor unions – the AFL-CIO, American Federation of Teachers, Communications Workers of America, Teamsters, steelworkers, and groups representing government employees, among others – to join forces and call on the federal government to create a “comprehensive workplace violence prevention standard” to better protect those in healthcare and social service fields. The Health Professional and Allied Employees, New Jersey’s largest healthcare union and an affiliate of the AFL-CIO and AFT, also joined the campaign.
In a petition sent Tuesday to U.S. Secretary of Labor Thomas E. Perez, the labor groups said the increase of workplace violence in the healthcare sector demonstrates the inadequacy of the current Occupational Safety and Health Administration (OSHA) policy, which includes voluntary guidance for employers on how to reduce the threat of on-the-job attacks. Seven states – including New Jersey – have their own laws requiring employers to have prevention programs and New York has adapted a statewide standard for public facilities, they wrote.
In New Jersey, the 2006 Violence Prevention in Health Care Facilities Act requires hospitals to create a violence prevention plan to help protect patients, visitors and staff. The law calls for facilities to establish an oversight committee, a training protocol and a written plan; officials at the Department of Health can cite operations that don’t have these elements in place.
But the labor coalition said this patchwork effort falls short and it insisted that a federal mandate is needed to ensure frontline workers are safe. The plan calls for the Labor Department to implement a national standard that would require all facilities to have a written plan, a process for identifying risks, strategies for mitigating those risks, training for staff and various reporting and follow-up mechanisms.
“Current voluntary guidelines for violence prevention in healthcare have clearly not stemmed the rising tide of assaults on nurses and healthcare workers,” said Bernie Gerard, a nurse and HPAE vice president. The growing violence “is a crisis, and it demands a clear standard that can be enforced by the Occupational Safety and Health Administration.”
According to the petition, federal data showed there were 13 fatal assaults in healthcare and social service settings in 2014, and an average of nearly 18,000 attacks on these workers each year from 2011 to 2013. The rate of injuries from workplace violence was high as 383 incidents per 10,000 workers for psychiatric aides, compared with 14.4 per 10,000 for private-sector employees in general.
These figures include at least eight assaults at Bergen Regional Medical Center, New Jersey’s largest hospital, a pattern that has sparked concern among state legislative leaders, healthcare advocates and union officials. An investigation by NorthJersey.com found police have been summoned to the 1,000-bed facility in Paramus – the only hospital in the state to provide acute care, inpatient psychiatric services and residential treatments – nearly 300 times last year. Reports describe staff members brutally beaten by patients, violence against elderly residents with dementia and sexual attacks on patients as young as six.
“If we had an enforceable standard in place, the long, drawn-out expensive appeals and delays by facilities like Bergen Regional Medical Center would instead become positive actions to keep workers safe,” HPAE’s Gerard said. For months, the union has been locked in a battle with management at hospital – which is owned by Bergen County, but operated by a private, for-profit company – arguing over staffing levels and other safety issues as they negotiate a new contract. Nurses there have complained for several years about violent incidents at work.
But Donnalee Corrieri, a vice president at Bergen Regional, said that while OSHA may not have a uniform standard for violence prevention, the hospital’s worker safety protocol has been reviewed by the state health department and the national Joint Commission, a non-profit that accredidates hospitals, and neither issued “a single substantive finding” about the facility’s prevention plan.
A DOH spokesperson confirmed that BRMC has been cited for an insufficient plan, but the problem has since been corrected; OSHA has also sanctioned the facility in the past. Information on other hospitals that were cited by DOH was not available yesterday afternoon.
Corrieri said the level of violence at BMRC is actually lower than the national average when it comes to assaults that result in injuries and it has fewer violent incidents than New Jersey’s state psychiatric hospitals. In addition, the rate is trending downward, she said.
Also, a 2011 change in Bergen County police policy – requiring cops be called when any assault was alleged, even if it was just “touching and poking” – led to the high number of visits reported, Corrieri explained. Many of the incidents were investigated by other agencies and considered unfounded, she added.
“Bergen Regional Medical Center (BRMC) is the largest provider in New Jersey of inpatient and outpatient mental health services for children, adolescents and adults of all ages. It is one of the few such providers in the nation of this continuum of care for a vulnerable population,” Corrieri said. The hospital also offers long-term care, medical detoxification and traditional acute care and ambulatory services.
Working with these units “has inherent challenges, as many patients are dealing with psychiatric issues and have been committed involuntarily because they are a threat to themselves or others. BRMC recognizes this reality and, thus, has developed a program that addresses the additional exposure of this type of work while also creating a nurturing environment in which patients can recover,” she said.
State and county officials have also stepped in to try and improve safety at the facility, which has been operated by the for-profit Bergen Regional Medical Center LP for nearly 20 years. (The company’s contract is up in March and a dozen potential operators, including members of the current team, have indicated to county officials they are interested in taking over.) Observers have criticized operators for putting profits before quality.
In a proposal championed by Senate Majority Leader Loretta Weinberg (D-Bergen) and other lawmakers from the region, the Bergen County Improvement Authority – which currently oversees the hospital’s contract – would be replaced by an 11-member board comprised of the County Executive and experts in hospital management. The measure sailed through both houses of the legislature in the weeks before they broke for summer recess and now awaits Gov. Chris Christie’s signature to become law.
State health department officials have also renewed their focus on workplace violence. In October DOH sent a memo to all healthcare facilities reminding them about violence prevention and reiterating the regulations for reporting accidents and assaults. In late June, the department held a violence prevention and patient safety webinar that attracted some 200 hospital and nursing home staff.
“Health and safety are vital components of quality care workplaces,” said Dawn Thomas, with DOH. “The Department is committed to ensuring workplaces are hazard-free and workers understand how to protect themselves and others on the job.”