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Minimizing workplace violence in LTC facilities

November 4, 2013
by Steve Wilder, CHSP, STS
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The recent U.S. Department of Labor—Occupational Safety and Health Administration (OSHA) National Emphasis Program for Long Term Care and Residential Facilities includes a new compliance challenge for long-term care providers: preventing workplace violence against employees.

In recent years, OSHA has aggressively investigated complaints of workplace violence against healthcare workers, typically in emergency departments and mental health departments of hospitals. In about 25 cases over the past five years, hospital employees lost workdays or were put on restricted duty after being injured by patients and residents. Now, OSHA has expanded this program to include episodes of workplace violence in long-term care. Fortunately, compliance is not as difficult as one might expect.

The common errors that long-term care facilities make, based on OSHA compliance audits, include:

  • Failing to create a stand-alone written violence prevention program.
  • Failing to ensure that the program addresses specific actions employees should take in the event of an incident and the proper reporting procedures.
  • Failing to ensure that staff members trained to deal with aggressive behavior are readily and immediately available to render assistance.
  • Failing to ensure that all residents receiving a psychiatric consultation are screened for a potential history of violence.
  • Failing to use a system that flags a resident’s chart any time there is a history or act of violence.
  • Failing to train staff to understand the resident charting system.
  • Failing to put in place administrative controls so that employees are not alone with potentially violent residents in the facility.

OSHA’s definition of workplace violence is simple: "acts of violence or the threat of violence against workers." Using that definition, it is easy to appreciate how simple it will be for OSHA to invoke citations and fines against long-term care facilities. For our clients, we prefer to use a more focused definition: “Workplace Violence is defined as any incident in which an employer or employee is threatened, intimidated, physically or verbally attacked, harassed, injured or killed.” We have adapted this definition for our long-term care clients in order to allow them to appreciate how liberal the OSHA definition is, and to develop a program that is focused on more specific threats and risks.

So how does a long-term care facility prepare itself to deal with the risk, and minimize the risk of an OSHA visit, citation or penalty? First, I encourage all long-term care facilities to follow the steps outlined in OSHA 3148-01R 2004, titled “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers.”

Under OSHA 3148, “healthcare facilities” include psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment clinics, pharmacies, community-care facilities and long-term care facilities. They include physicians, registered nurses, pharmacists, nurse practitioners, physicians’ assistants, nurses’ aides, therapists, technicians, public health nurses, home healthcare workers, social workers, welfare workers and emergency medical care personnel. The guidelines also may be useful in reducing risks for ancillary personnel such as maintenance, dietary, clerical and security staff in the healthcare and social service industries.

A written workplace violence prevention program, incorporated into the facility’s overall health and safety program, is a critical starting point. At a minimum, workplace violence prevention programs should:

  • Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and related actions.
  • Ensure that managers, supervisors, coworkers, clients, patients, residents, families and visitors know about this policy.
  • Ensure that no employee who reports or experiences workplace violence faces reprisals.
  • Encourage employees to report incidents promptly and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress.
  • Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with law enforcement and others who can help identify ways to prevent and mitigate workplace violence.
  • Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that those responsible develop expertise on workplace violence prevention in healthcare and social services.
  • Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the resident or client.
  • Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting affected employees and facilitating recovery.


Training and education ensure that all staff are aware of potential security hazards and how to protect themselves and their coworkers through established policies and procedures.

Every employee should understand the concept of “universal precautions for violence”—that is, that violence should be expected but can be avoided or mitigated through preparation. Frequent training also can reduce the likelihood of being assaulted.

The training should cover topics such as: