As violence in health care has reached the national consciousness, states across the country have responded by enacting laws and regulations to prevent such violence.
A handful of states have enacted laws requiring health-care employers to implement workplace-violence programs.1 Other states have responded by increasing the criminal penalty for violence against health-care workers.2 Below is a summary of the law in four Western states relating to the problem of violence against health-care workers.
Alaska is in the majority of states without any law specifically requiring employers to implement preventative and/or reporting mechanisms for violence against health-care workers. However, Alaska imposes mandatory minimum sentences for individuals convicted of assault in the fourth degree or harassment in the first degree against medical professionals and emergency responders. Specifically, A.S. 12.55.135(d)(1) provides that an individual convicted of assaulting or harassing a medical professional or emergency responder faces a mandatory minimum term of imprisonment of sixty days—or thirty days, if there was no physical injury to the victim.
Idaho has yet to enact any law relating specifically to the prevention and/or reporting of workplace violence in health care. However, in 2014, Idaho adopted Idaho Code 18-915C, which makes battery against (i) any person licensed, certified or registered by the State of Idaho to provide health care; or (ii) any employee of a hospital, medical clinic or medical practice, a felony punishable by up to three years in prison. However, the statute applies only if the victim was in the course of performing his or her duties during the battery, or the battery occurred because of the victim’s professional or employment status.
In 2007, the Oregon State Legislature passed House Bill 2022, subsequently codified as Oregon Revised Statutes 654.412 to 654.423, requiring health-care employers (meaning hospitals3 and ambulatory surgical centers4) to implement strategies to protect healthcare employees from acts of violence in the workplace.5 More specifically, the law requires healthcare employers to: (i) develop and implement an assault prevention and protection program6; and (ii) maintain records of assaults against employees.7
Assault Prevention and Protection Program. Each health-care employer must develop and implement an assault prevention and protection program, which is based on periodic security and safety assessments.8 The periodic assessments must, at a minimum, measure the frequency of assaults committed against employees in the preceding five years, and identify the causes and consequences of such assaults.9 While the law fails to define “periodic” guidance from Oregon, OSHA suggests employers have substantial discretion, provided assessments are conducted at regular intervals.10
A health-care employer’s program must address the following security considerations: (i) physical attributes of the setting; (ii) staffing, including security staffing; (iii) personnel policies; (iv) first aid and emergency procedures; (v) procedures for reporting assaults; and (vi) education and training of employees.11 As part of its program, each health-care employer must provide assault prevention and protection training to its employees on a regular and ongoing basis.12 The training should address the following topics, taking into account the employee’s job duties:
- General and personal safety procedures
- Escalation cycles for assaultive behaviors
- Factors that predict assaultive behaviors
- Techniques to obtain medical history from patients
- Techniques to de-escalate/minimize assaultive behaviors
- Strategies to avoid physical harm and minimize restraint use
- Restraint techniques
- Procedures for documenting and reporting assaults
- Programs for post-incident counseling and follow-up
- Resources available to employees for coping
- The employer’s assault prevention and protection program13
The training can consist of classes, videos, brochures, or other verbal or written training, and should occur within 90 days of the employee’s initial hiring.14
Required Record of Assaults. Healthcare employers must maintain records, for no fewer than five years, of assaults committed against employees on their premises.15 Oregon Revised Statute 654.416(1)(a)-(i) describes specific information which must be included in the record, but Oregon OSHA has developed a form that satisfies the requirements of the law.16
In 1999, the Washington Legislature enacted RCW 49.19. This law applies in health-care settings (defined as hospitals, home health, hospice, and home-care agencies, evaluation and treatment facilities, and community mental-health programs17) and requires: (i) development and implementation of a workplace-violence plan; and (ii) maintenance of records of violence against employees.18
Workplace Violence Prevention Plan. Each health-care setting must develop and implement a plan to reasonably prevent and protect employees from violence.19 The plan should be based on a security and safety assessment that identifies existing or potential hazards for violence and determines the appropriate preventive action to be taken.20 More specifically, the plan should address the following security considerations: (i) the setting’s physical attributes, (ii) staffing, including security staffing, (iii) personnel policies, (iv) first aid and emergency procedures, (v) reporting of violent acts, and (vi) employee education and training.21 Washington encourages health-care settings to consider any guidelines on violence in the workplace and/or health care issued by state and federal agencies and health-care accrediting organizations.22 As part of the plan, health-care settings must provide violence-prevention training to employees within 90 days of initial hiring.23 Taking into account the particular setting, job duties, and hazards identified in the assessment, the training should address the following topics as appropriate:
- General safety procedures
- Personal safety procedures
- Violence-escalation cycles
- Violence-predicting factors
- Obtaining patient histories from violent patients
- Techniques to de-escalate and minimize violent behavior
- Strategies to avoid physical harm
- Restraining techniques
- Appropriate use of chemical restraints
- Documenting and reporting incidents
- A process for employees/victims to debrief
- Resources available to employees for coping
- The setting’s workplace-violence prevention plan
Violent-Acts Recordkeeping. Each health-care setting must keep a record for five years of any violent act against an employee, patient, or visitor, and include at least the following information.
- Name and address of the setting
- Date, time, and specific location where the violent act occurred
- Identification of both the victim and assaulter as patient/visitor/employee/other
- If the victim was an employee, his or her name, title, and department
- A description of the violent act24
- Identification of any body part injured
- A description of any weapon used
- The number of employees present when the violent act occurred
- The actions taken in response by the setting
Records must be made available for inspection upon request of theWashington Department of Labor and Industries.
Wyoming has no laws specifically addressing the prevention and/or reporting of workplace violence in health care, or imposing specific penalties for violence against healthcare workers. On January 14, 2013, a bill was introduced in the Wyoming legislature to increase the maximum prison term by two years for aggravated assault against health-care workers. The bill was defeated in the Wyoming House of Representatives on February 15, 201PR3.
1 “Workplace Violence,” American Nurses Association, accessed April 13, 2017, http://nursingworld.org/workplaceviolence
3 As defined in ORS 442.015.
5 Oregon OSHA, “Health Care Workplace Violence Assault Log,” Oregon Department of Consumer and Business Services, accessed April 13, 2017, http://osha.oregon.gov/Pages/re/healthcare-assault-log.aspx
6 ORS 654.414(1).
7 ORS 654.416.
8 ORS 654.414(3).
9 ORS 654.414(2).
10 Oregon Occupational Safety and Health Division, “Program Directive,” Department of Consumer and Business Services, accessed April 13, 2017, http://osha.oregon.gov/OSHARules/pd/pd-267.pdf
11 ORS 654.414(3)(a)-(f).
12 ORS 654.414(1)(c).
14 ORS 654.414(4)(b)-(c).
15 ORS 654.416(1)-(2).
16Per ORS 654.416(3); Oregon Administrative Rules, Appendix A, “Instructions for Recording Health Care Assaults,” Oregon Occupational Safety and Health Division, accessed April 13, 2017, http://osha.oregon.gov/OSHARules/div1/div1.pdf#437-001-0706-App-A.
17 RCW 49.19.010(1).
20 RCW 49.19.020(2).
21 RCW 49.19.020(1).
23 Training for temporary employees should take into account the unique circumstances of temporary employees.
24 As described in RCW 49.19.040(6)(a)-(f).
US Department of Labor: Occupational Safety and Health Administration.
Oregon Department of Consumer and Business Affairs: Occupational Safety and Health Administration
Washington State Department of Labor and Industries
National Institute for Occupational Safety and Health
American Federation of State, County and Municipal Employees