Understaffing Can Lead to Increased Workplace Violence Incidents

Health care workers are subject to aggressive behavior from patients, and when a facility is understaffed it puts both the workers and patients at risk.

nurse was attacked this month when she was transferring a patient from a restraint board to a bed with restraints in a psychiatric facility in Pembroke, Mass. The patient nearly tore off her ear, and tried to gouge out her eye. The nurse is recovering, but had to have stitches to reattach her ear.

Workers at the hospital say that it is understaffed, especially on the weekend. OSHA inspected the facility in May 2015 and noted the hospital had recorded an increased number of worker injuries due to violent behavior from patients – with 13 injuries in the first five months of 2015- and asked for a corrective action plan by November 2, 2015, but the hospital has not yet responded.

Washington’s largest psychiatric hospital, Western State Hospital, is in danger of losing federal Medicaid funding.  Western State has been beleaguered with staffing issues, concerns about mismanagement and patient and staff safety. When federal inspectors were scheduled to visit, two doctors who had been vocal about their concerns regarding staffing, say they were told to work from home. State officials in charge of the operations of Western State Hospital deny this is the case.

The Seattle Times’ editorial board says of the situation at Western State:

“The mess at Western State Hospital is untenable, putting patients, employees and the public in peril.”

It reports that as of January 300 jobs were unfilled out of 1,800.

Michael Sekulic, a former nurse at Western State, says he was fired after reporting two incidents of restraint of a patient using excessive force.  Sekulic sued the state for wrongful termination, and the jury awarded him $110,000 in damages.  The state, disappointed with the jury’s findings, will meet with their legal counsel to determine if they will file an appeal.

Sekulic’s claim highlights high levels of frustration and tension at Western State, two factors that can lead to workplace violence.

Apart from understaffing issues, health care workers are particularly at risk due to the following factors:

  • Health care facilities are sometimes public places (not locked facilities)
  • Patients and visitors can experience a high level stress while at the health care facility
  • There is an increased availability of drugs
  • Health care workers who work at night or overnight experience a higher rate of workplace violence

If you are threatened with violence, use the following techniques to respond effectively:

  • Project calmness, don’t respond to anger with anger
  • Maintain a relaxed posture
  • Encourage the person to talk
  • Show respect and acknowledge feelings
  • Ask for small favors
  • Use delaying tactics
  • Don’t challenge, criticize or dare
  • Don’t make promises you can’t keep
  • Don’t take sides

There are certain protocols that need to be followed in order to safely restrain a patient, and every worker should be trained on the proper technique for both the workers’ and patient’s safety.  Attempting to restrain a patient when there is not adequate staff to do so is dangerous for everyone involved.  Unfortunately, when staffing is low, sometimes patients are left in restraints or by themselves longer than is intended or safe, which can lead to higher levels of anxiety, frustration and anger- which can then lead to aggressive behavior and violence. It’s a very unfortunate cycle that can only be broken when the appropriate resources and training are available.

If you notice an increase in worker or patient injuries, it is important to do analyze the reasons for the increase.  Inadequate staffing is just one of the possible contributing factors. Insufficient training, breaches in physical security, high workloads/stress levels, and ineffective procedures can all contribute to incidences of injuries.

Once the contributing factors have been identified, management should create and implement a corrective action plan, train staff accordingly, and incorporate the plan into the safety program. Incidence levels should then be closely monitored, and evaluated to make sure that the corrective action plan is having the desired effect. When new information or contributing factors come to light, the safety program should be adjusted to address them.

A coordinated approach between staff and management, with emphasis on reporting, training, and a dynamic safety program will reduce risk and injury to patients and workers.

If you would like more information on workplace violence prevention in health care or OSHA compliance, please call us at (877) 399-1698.