Hospitals, remarkably, are one of the most hazardous places to work. According to the U.S. Bureau of Labor Statistics, hospital workers have an estimated rate of 8.3 assaults per 10,000 workers compared to an estimated 2 assaults per 10,000 workers in the overall work environment. With this background in mind, the Occupational Safety and Health Administration (OSHA) recently cited Brookdale University Hospital and Medical Center (Brookdale) for willfully failing to protect its employees from assaults by patients and visitors.

OSHA proposed a $70,000 fine for Brookdale’s failure to develop and implement adequate measures to protect its employees from the recognized likelihood of physical violence by patients and visitors. Violence can occur anywhere in a healthcare facility, according to the National Institute for Occupational Safety and Health (NIOSH), but tends to occur most frequently in psychiatric wards, emergency rooms, waiting rooms and geriatric units. Nurses and aides, who have the most direct contact with patients, are at higher risk of violence. The violence ranges in intensity and outcome, from minor to severe.

At Brookdale, OSHA found approximately 40 incidents of patient and visitor violence against Brookdale’s employees within a three-month period, including the full range of severity from minor abrasions to, in one instance, a nurse who sustained severe brain damage when she was attacked while attending to a patient.

While no federal standard specifically requires workplace violence prevention programs, OSHA requires hospitals to furnish a place of employment free from recognized hazards that are likely to cause death or serious physical harm to employees. 29 USC 654. Based upon this, OSHA found Brookdale’s workplace violence program to be ineffective to protect employees from serious harm. In fact, many employees were not even aware of the program’s existence. In its citation, OSHA suggested possible actions Brookdale could have taken, including developing and implementing an effective workplace violence prevention program, which typically includes management commitment, employee participation, worksite evaluation, hazard prevention and control, health and safety training, recordkeeping and program evaluation. These programs’ requirements are more specifically described by OSHA and NIOSH. OSHA also recommended that Brookdale employ engineering controls, such as installing panic alarm systems and protective barriers, distributing personal alarm systems for staff, as well as securing furniture and other items that could be used as weapons. Additionally, OSHA recommended training all employees on the workplace violence program and on recognizing potentially aggressive or violent behaviors. In addition, OSHA recommended that Brookdale develop post-incident procedures and provide services to treat traumatized employees.

Several states have implemented laws specifically requiring employers to establish comprehensive workplace violence prevention programs for healthcare employees. Some states have increased penalties for those convicted of assaults of a nurse or other healthcare personnel.

OSHA’s citation of Brookdale highlights the importance of developing and implementing an effective and comprehensive workplace violence prevention program in healthcare facilities, as well as periodically evaluating existing programs. Although risk factors for violence vary among healthcare facilities, the suggested remediation actions for Brookdale provide insight for other healthcare facilities to evaluate the effectiveness of their own workplace violence prevention programs.