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National Nurses Week will be celebrated from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing. While the requisite lunches are being ordered, trinkets with Nurses Week logos are being purchased and healthcare public relations departments are cranking out news releases about the importance of their nursing staffs, I'd like to offer a challenge to healthcare executives to step up and take a renewed stand about one of the oft-hidden nursing workplace hazards -- workplace assaults.

According to a recent NCCI Workplace Brief called Violence in the Workplace, despite the national decline in the rate of workplace assaults, assaults on healthcare workers have increased. Although anyone working in a healthcare setting may become a victim of violence, staff that have the most direct contact with patients are at the highest risk. These important caregivers--registered nurses, licensed practical nurses and aides/assistants--experience the highest rates of injuries due to violence aimed at workers. While only 2 percent of all U.S. workplace injuries are due to assault, 61 percent of all assaults occur in the healthcare arena with patient on nurse violence.

As you can imagine, when it comes to incidence of lost time from work, assaults per 10,000 full-time workers per year, psychiatric and substance abuse hospitals lead the pack at 75. Residential mental health facilities have 38.5. Nursing homes and community care facilities for seniors rate 34, hospitals come in at 7.7 and ambulatory healthcare service settings at 1.8.

Healthcare employment is expected to explode over the next 20 years, so the composition of the U.S. workforce will further skew these numbers if the trends continue. The Bureau of Labor Statistics estimates that nursing employment will grow by more than 22 percent.

However, it also appears that the ineffectiveness of current anti-violence education efforts may also be a contributing factor. Many workplace violence training programs were formulated in the late 1990's -- following the two landmark reports released in 1996: the National Institute for Occupational Safety and Health's Violence in the Workplace; Risk Factors and Prevention Strategies and Occupational Safety and Health Administrations' Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers.

Since the 1990's 18 states have enacted or adopted legislation which requires education programs and/or established penalties for violence against healthcare professionals.

The American Nurses Association, by virtue of its role in promoting the nursing profession, is a champion of safety and anti-violence efforts in the healthcare industry. Its official position on workplace violence, according to its website is:

"The American Nurses Association upholds that all nursing personnel have the right to work in healthy work environments free of abusive behavior such as bullying, hostility, lateral abuse and violence, sexual harassment, intimidation, abuse of authority and position and reprisal for speaking out against abuses."

Also according to ANA site:

"In 2009, more than 50 percent of emergency center nurses experienced violence by patients on the job. There were 2,050 assaults and violent acts reported by RNs requiring an average of four days away from work. Of these acts, 1,830 were inflicted with injuries by patients or residents, according to the Emergency Nurses Association. From 2003 to 2009, eight registered nurses were fatally injured at work, according to the BLS."

Using the NCCI brief and other alarming statistics on nurse assaults as a rallying cry, instead of buying trinkets and snacks for this year's Nursing Week celebration, shouldn't we take a hard look at improving safety and antiviolence efforts in the healthcare setting?

Similar to the healthcare industry's national efforts to track and learn from "adverse events" where patients were harmed during the provision of care, the industry needs to better track, monitor and learn from patient to nurse violence instead of accepting it as an inevitable part of the nursing occupation.

As Nurses' Week begins, how about dusting off those anti-workplace violence training manuals, putting a task force in charge of producing more effective guidance, and attempting to make a dent in patient to nurse violence. Or better yet, let's promote a national task force to study and generate best practices in eliminating patient to nurse violence in all healthcare settings. Increasing workplace safety for nurses is the best gift we can offer these increasingly important healthcare professionals.

MARK NOONAN is a managing principal and the senior knowledge manager for workers' compensation for the Casualty Practice within Integro Insurance Brokers.

May 3, 2012

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