My summer vacation is over so I jumped right back into work by doing four webinars on workplace violence in the last four days.   I have been very concerned about the trend toward violence toward healthcare and hospital workers.

Having just researched and presented on this subject two days ago, I was greatly saddened to see it AGAIN, 30 miles from my home, at the prestigious Johns Hopkins Hospital.   Local media and CNN covered it extensively because the man shot his mother’s doctor in the stomach, apparently after his mother was paralyzed as a result of spinal surgery.  He then barricaded himself into his mother’s hospital room and eventually shot and killed her and then shot himself.

With a staff of over 30,000,  this was a major incident.  I would love to calculate how much the hospital might have lost from having the staff vacate the building for at least two hours.

This incident once again opens the debate about how to ‘secure’ hospitals, or at least to have a better way to ensure the safety and security of both the staff and the patients.  Hospital administrators continue to maintain an ‘open environment’, and don’t seem to understand that this problem will continue to increase, if there is not way to better manage access in hospitals.

On the radio today, I heard that Baltimore City Council President Bernard C. “Jack” Young said that John Hopkins security is adequate and that using metal detectors would create a hazardous situation for patients entering the building.   “Why would they want metal detectors going into the hospital?” Young said. “People go to the hospital because they got shot. People wouldn’t go to the hospital because of the metal detectors. They would stay away and die rather go through metal detectors.”  He also mentioned during the same interview that the hospital has over 80 entrances.

This exact problem is raging at hospitals all over the country, because violence is dramatically increasing in healthcare.  The NIOSH study from 2004 reported that  violence in hospitals was over four times the national average for non-healthcare workplaces.  Of course, it is now 2010 and that is a long way from 2004 – AND – we have had a terrible recession raging since 2008….

The results of an Emergency Nurses Association survey released in 2009 found that more than 50% of ER nurses had experienced violence by patients on the job and more than 25% had experienced 20 or more violent incidents in the past three years. Research showed long wait times, a shortage of nurses, drug and alcohol use by patients, and treatment of psychiatric patients all contributed to violence in the ER. 

There has been only sporadic interest in this phenomenon and no standard has emerged.  For example, a NIOSH (National Institute for Occupational Safety and Health) Publication in 2004 is called Guidelines for Preventing Workplace Violence for Health Care and Social Services . OSHA Publication 3148-01R (2004). This guide describes the special considerations surrounding workplace violence in the environments of health care and social services.

After my last column on Workplace Violence issues in healthcare, I got a few angry letters from associations and organizations saying they had been working on creating standards for this – FOR THE LAST FOUR YEARS… but amazing, they have not been published.  

There is NO standard or requirement for preventing workplace violence, only the vague requirement for employers to maintain a safe workplace.   Twenty-seven states have come up with their own ‘guidelines’.  Remember – standards are Required, guidelines are only recommended.  That means if the incident happens, the management has no liability because they did not disregard a requirement.

My regular readers will remember that I recently visited a hospital that had a murder about two years ago and even two years later, it was still having a traumatic impact on the staff who witnessed the incident. 

I am a big believer in risk assessments and I think having a workplace violence assessment REQUIRED of every hospital, and having that information aggregated nationwide and studied, would be a big step that improve our knowledge of why this continues to increase, and would also point to more effective solutions to safeguarding our hospitals.

Maybe people will start to press hospitals on this issue – after all – they may end up in a hospital some day, and probably would like to be safe and secure during their visit.

Maybe the aging baby boomers will finally demand more security in their hospitals.  I hope so.