Managing the Risk of Workplace Violence to Healthcare and Community Service Providers
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4. The Nature of the Problem
The Range of Employees at Risk
Health facilities are high-risk situations for violence due to the presence of multiple risk factors. This best practice document will have application for people working in the following settings:
- hospitals and clinics
- accident and medical clinics
- drop-in centres
- general practice
- all-night shelters
- day programmes
- aged care facilities
- community-based residential services
- home-care services
- vocational services such as community participation, supported employment and sheltered workshops
- private homes
- alcohol and drug services
- youth offender homes
- services provided under Intellectual Disability Community Care legislation.
The document is not intended to cover the work of police or employees in the Department of Corrections, although similar issues exist in these occupations and the same principles of risk management apply.
Risk Factors
Risk factors associated with health care and social service providers being exposed to violence have been identified. Some occupational groups are at higher risk than others. These include:
- caregivers and support workers
- social workers, allied health and social professionals & needs assessors; etc
- and teachers in these environments
- health professionals and community health workers
- family members
- volunteers
- support staff
- mental health assistants
- security, porters
- telephonists, receptionists and secretaries, etc.
Defining Violence
Violent episode: means any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, wellbeing or health. The violent episode can be instigated by a patient, another staff member or a member of the public.
Physical assault: means an assault which results in actual physical harm.
Physical threats: means attempted physical assault that does not result in actual harm.
Verbal/written threats: means verbal or written communication where the individual perceives a risk of harm to their person or property.
Damage to property: means items damaged that belong to a person or an organisation.
Examples of violence occurring to employees include:
- violence with the potential to result in harm such as pushing, pinching, hair pulling, obscene language and verbal abuse (sometimes highly personalised) including threatening behaviour, sexual and racial assaults
- stalking, intimidation, invasion of privacy, which have also been recorded as precursors to incidents of serious harm
- incidents with the potential to cause serious harm such as kicking, biting, spitting, scratching, strangleholds, the use of knives, knitting needles and other weapons, head butting and punches to all parts of the body.
The injuries sustained by caregivers within the NZ context as investigated by the Department of Labour include: lacerations, puncture wounds (from bites and weapons), fractures and head injuries. Psychological harm has also occurred, including quite severe mental health problems for the staff member, such as post-traumatic stress disorder.
Some of the injuries sustained by caregivers, nurses and community service providers, have required weeks for recovery. In other cases, a full recovery has not occurred, or staff have chosen to leave the sector because of their fears and/or concerns. In New Zealand, some cases have proven fatal.