March 27th, 2015 9:07 am ET - Dan Hartley, EdD
In the healthcare setting, workplace violence may occur in many forms including: an active shooter, a disruptive patient, or as ongoing incivility from a colleague. The most commonly reported form of violence in healthcare is from the disruptive patient or patient’s family member. In 2013, healthcare workers reported an estimated 9,200 workplace violence incidents requiring time away from work to recover, with the majority of these perpetrated by patients or their family members1. This represents 67% of all nonfatal violence-related injuries from an industry that only represents 11.5% of all workers.
In terms of fatal workplace violence, overall we have seen a decreasing trend over the past ten years while the numbers of homicides in healthcare have remained relatively stable. In each of the past ten years fifteen healthcare workers have been the victims of workplace homicide annually. 2
A 2013 report released by the Federal Bureau of Investigations indicated an increasing trend in workplace active shooter incidents from an average of 6.4 incidents per year for the first 7 years of the study to an average of 16.4 per year in the last 7 years of the study4. Some recent studies have indicated that the healthcare environment is not excluded from the increase in this particular type of violence. One recent study on hospital-based shootings reported an increase from 9 active shooter incidents per year during the 2000 to 2005 time period to almost 17 per year during the 2006 to 2011 time period.5
The US Department of Health and Human Services (HHS) recently released a document entitledIncorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans .6 This document, which was released in December 2014, is designed to assist healthcare facilities in becoming better prepared to prevent and respond to active shooters in the workplace. The document aligns with the three time frames associated with an active shooter incident: pre-incident, incident, and post-incident response. The guide provides definitions of concepts related to five mission areas of preparedness related to these time frames: Pre-incident (prevention, protection, and mitigation) Incident (response and the beginning phases of recovery) and Post-incident (recovery).
The HHS guide recommends training specific to active shooter response in a healthcare environment. This training should be part of a comprehensive workplace violence prevention program. The active shooter incident is still an anomaly in the healthcare setting. However, training in how to prevent and respond to an active shooter incident is very important and should complement training in prevention and response to other more prevalent types of workplace violence.6
In 2013, the National Institute for Occupational Safety and Health (NIOSH) released an on-line workplace violence prevention training for nurses and other healthcare professionals.7 Over ten-thousand healthcare professionals have received continuing education units for completion of the NIOSH online course to date. The training provides the basis for a comprehensive workplace violence prevention program that will be even stronger when combined with information from the HHS guide.
Dan Hartley, EdD
Dr. Hartley is the NIOSH Workplace Violence Prevention Coordinator in the Division of Safety Research.