“I’m going to punch you in the mouth”

I was a young PA treating a new patient with a complaint of acne in a small privately-owned dermatology clinic.  The patient demanded some medication – I believe it was an oral antibiotic – which I politely refused in favor of a safer topical alternative.  The patient became angry, started yelling at me (profanity, name-calling, all the things), and culminated by telling me repeatedly, “I’m going to punch you in the mouth.”

He did not punch me in the mouth, but I was certainly scared for my personal safety that day and for some time thereafter.  I reported the incident to my attending physician (the practice owner), who promptly discharged the patient.  I was grateful for her support, but it took some time for me to start feeling safe at my workplace again.

Clinical Advisor published a piece last week about whether hospital facilities are safe places to work [1].  The U.S. Bureau of Labor and Statistics reports that healthcare workers are 5x more likely to experience violence in the workplace when compared to other types of workers [2].  

5x more likely?!  

In 2018, 73% of nonfatal workplace injuries/illnesses due to violence involved healthcare workers [2].  An average of 20 healthcare workers are fatally injured on the job each year, accounting for 4% of all homicides in the workplace [2].  

According to the Joint Commission, workplace violence is described as:

“An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors [3].

Clinical Advisor’s article suggests that workplace violence is likely under-reported by healthcare workers because:

• “Patients who are not in their ‘right mind’ cannot be held accountable for their actions.”

• “Reporting can be time-consuming and difficult for health care employees working under high-stress conditions.”

• “Fear of retaliation from management and/or colleagues who are concerned that reports of violence reflect poorly on a health care team/workplace.”

• “No injury occurred or time was lost because of the incident, or the violence wasn’t physical.”

• “The widespread belief that violence is simply ‘part of the job[1].’”

What measures can healthcare facilities take to prevent workplace violence?

I turned to the person in our household who has been the most educated on mitigating violence – my 10-year-old daughter.  Indeed, children in our public school district are well-trained in ALICE Training (i.e active shooter training and preparedness) [4].  My daughter directed me to ALICE’s website to see their tips for preventing workplace violence.  

According to the ALICE program, there are 12 measures that workplaces can take to reduce and prevent violence:

• Conduct background checks on all employees and new hires.

• Design a harassment prevention policy. 

• Maintain efficient lines of communication between employees and management.

• Provide workplace violence prevention training and awareness programs.

• Develop and enforce strict anti-violence policies.

• Lead by example and accept individual differences in the workplace.  Encourage employees to do the same. 

• Address conflicts quickly so that they do not escalate into violence.

• Provide security and manage how visitors are allowed into the facility.

• Create simple methods for employees to report all acts of violence.

• Limit cash in the facility to deter robbery and theft.

• Regularly assess for organizational risk factors that have the potential to escalate to violence.

• Analyze any “close calls” to see how safety can be improved in the future [5].

(For detailed descriptions of each suggestion, please refer to the complete ALICE publication at:  www.alicetraining.com/alice-institute-training/10-ways-to-prevent-workplace-violence)

Some of these suggestions are easier and less expensive than others (I’m trying to imagine how private practices could feasibly institute affordable security monitoring, etc.), but many ALICE recommendations sound reasonable.  

What do you know about your workplace’s violence prevention strategies?  

Have you ever experienced violence – or the threat of violence – in your workplace? 

Nikki Rataj Casady, DMSc, PA-C

email@appcolleague.org