The elephant in the room: Violence in the workplace

Here are some real-life examples from the dialysis workplace that NN&I readers may have experienced.

A patient is not put on the dialysis machine on time and in a rage, threatens to blow up the clinic and kill the manager.

A patient pulls a knife on a unit driver.

A social worker is stalked by the mentally ill son of a patient.

Racial tensions escalate at a clinic due to reactions to police shootings.

These are the kinds of incidents that do not make the news. Then there are the ones that do make the news.

In South Carolina, a man was hit in the head with a large rock at a dialysis center following an argument.

In Florida, a woman shot a man in the abdomen while he was undergoing dialysis in a spillover of domestic violence.

In New York, a former patient of a dialysis center walked into the clinic and opened fire, critically wounding a nurse. The gunman was upset that he had been involuntarily discharged from the clinic because he repeatedly showed up with a large knife and threatened that one day he would return with a gun.

In Kansas, a bomb threat at a clinic required patients undergoing dialysis to be evacuated.

In Kentucky, two senior citizens fought in a dialysis clinic over football; police were called to break it up.

Despite our mission to bring optimal health, hope, and quality of life into the lives of our patients, staff in dialysis and transplant settings are at risk on a daily basis. Preliminary results of a national survey we are conducting suggest a workplace violence rate that rivals or exceeds what Department of Justice statistics typically show in health care settings.¹ Although staff deal with distraught patients and family members, alcohol and drug dependent patients, and some with mental illness, current security measures and staff preparedness may not be sufficient to protect staff and patients. Seventy-two (72%) of respondents report there is no on-site security.

OSHA defines workplace violence as violence or the threat of violence against workers.^2,3 It can occur at or outside the workplace, and can range from threats and verbal abuse to physical assaults and homicide, one of the leading causes of job-related deaths. Staff and patients alike can be subjected to inappropriate actions, including verbal and physical aggression along a continuum of severity. Violence can be within a clinic or hospital, or, can be either a targeted or random event that involves an outsider invading a center and using a firearm (active shooter). Rau (1999) ⁴ proffered categories of patients that may harm nephrology staff members along with espousing the gold standard of “zero tolerance for violence” within the work environment. The FBI reported last year that the incident of active shootings has tripled in the last few years, with workplaces as the most common locations for these tragic events.⁵ Nephrology professionals have experienced stalking, physical assault, sexual assault, as well as violence resulting in significant property damage, hospitalization, and death.

Spurred by the investigators’ personal experiences, an informal survey was conducted among a group of dialysis professionals attending the NKF 2014 Spring Clinical Meeting in Las Vegas. To our surprise, almost all had experienced some type of violence in the workplace. This is the elephant in the room ––it is happening around us and in the news.

In order to further explore these issues, we released a national survey in the fall of 2014 with the final deadline to be in early 2015. All dialysis and transplant staff, including MDs, physician extenders, nurses, dieticians, social workers, patient care technicians, clerical staff, and managers are invited to participate, and can find the survey at https://www.surveymonkey.com/s/BG2L7N8

Preliminary data indicate:

90% of respondents know of threats to direct care staff.

Slightly over 50% of respondents report experiencing some type of workplace violence.

Slightly over 50% of respondents believe that reporting workplace violence is taken very seriously.

The survey showed 72% respondents have no on-site security.

Threats to kill a staff member were identified by over 30% of the respondents as compared to over 7% of threats to kill a patient, and most of those were related to staff members needing to provide direction or set boundaries.

At our session, the data from the survey will be examined as we look at perception vs. actual violent events, and compare the data to the U.S. Dept. of Justice data on violence in the workplace. Characteristics of potential perpetrators will be identified, and participants will learn about the steps needed to prevent or minimize violent acts in the workplace. -by Jane Kwatcher, MSW, LCSW and Mathias Stricherz, EdD

References

1. http://m1.healio.com/~/media/nni/content/pub/pdf/wv09.pdf

2. https://www.osha.gov/OshDoc/data_General_Facts/factsheet-workplace-violence.pdf OSHA cit.

3. http://definitions.uslegal.com/w/workplace-violence/

4. Foster MR. Violence in the dialysis unit revisited. Nephrology News & Issues 13:5, 1999.

5. leb.fbi.gov/2014/january/active-shooter-events-from-2000

The NKF pre-conference workshop, “Violence in the Dialysis and Transplant Settings: Prevention, Immediate Intervention, and Post-Incident Management” takes place Wednesday, March 25, from 1:00 pm – 5:00 pm.