California Workplace Violence Prevention in Health Care Regulations
Workplace violence is a serious and growing issue affecting nurses and other health care workers and their patients. The California Nurses Association/National Nurses United fought for Senate Bill 1299, which requires California health care employers to ensure a safe environment for patients and nurses by preventing workplace violence before it happens. Cal/OSHA developed a standard that is the model for the nation. California health care employers are required by law to have a comprehensive, unit-specific workplace violence prevention plans in place by April 1, 2018. National Nurses United is fighting for the same standard of protection for all nurses. Read more about NNU’s federal bill here.
What kinds of violence does the standard cover?
Workplace violence means any act of violence or threat of violence that occurs at the work site. This includes any threat or use of physical force against an employee and any incident involving a firearm or other dangerous weapon (including when common objects are used as weapons), regardless of whether an injury is sustained. Some examples of workplace violence covered by the California Standard include: a confused, geriatric patient hit staff; a family member upset about a patient pointed to four employees and said “If anything happens, I’ll come back and get each one of you”; a patient bit a nurse on the arm; a patient pulled a nurse’s hair when she was taking vital signs.
Where does the standard apply?
- General acute-care, special, and psychiatric hospitals, including all hospital-based outpatient clinics and all off-site operations within the license of the health facility
- Skilled nursing facilities and nursing facilities
- Intermediate care facilities and congregate living health facilities
- Correctional treatment centers
- Hospice facilities
- Home health care and home-based hospice
- Emergency medical services and medical transport
- Drug treatment programs
- Outpatient medical services to the incarcerated in correctional and detention settings
Employers are required to:
- Establish a clear process for employees to report all incidents and threats of workplace violence
- Obtain the active involvement of employees on workplace violence risks and selection of effective prevention measures on each unit and in each facility, on the development of procedures required under the Standard, and on developing and administering training on each unit and in each facility.
- Implement the following prevention measures in every unit where they would effectively prevent workplace violence:
- Ensuring sufficient numbers of trained staff are available to respond immediately to workplace violence, without conflicting job assignments, on all shifts.
- Assigning sufficient numbers of staff to reduce patient-specific workplace violence (e.g., sitters).
- Creating a plan to prevent the entry of weapons into the facility by patients or visitors.
- Installing, implementing, and maintaining an effective alarm system that can be used without barrier during workplace violence incidents.
- Ensuring that parking lots and walkways around the facility are safe.
- Develop a transparent plan to respond effectively and immediately to all workplace violence incidents.
- Record information about every workplace violence incident, regardless of whether an injury occurs, in a Violent Incident Log.
- Implement a training program, which should cover the employer’s workplace violence prevention plan, how to report incidents, and other topics.
Under the Cal/OSHA Workplace Violence Prevention in Health Care Standard, covered employers must:
By April 1, 2017
- Implement a Violent Incident Log to record information about every violent incident that employees experience, regardless of whether an injury occurs.
- Comply with record keeping sections of the standard.
By July 1, 2017
- General acute care, special, and psychiatric hospitals must report certain violent incidents directly to Cal/OSHA through a special webform.
By April 1, 2018
- Implement their comprehensive workplace violence prevention plan at all times in all units, services, and operations. To create and implement these plans, employers must:
- Obtain the active involvement of employees and their union in all steps of creating and implementing the plan, identifying and preventing workplace violence hazards, and designing and implementing training.
- Conduct environmental assessments to identify risks for workplace violence in the facility, including in all units and on all grounds and parking structures.
- Create procedures to assess patients and visitors for workplace violence risk factors and procedures for employees to communicate these risks to other shifts and units. Implement prevention measures in a timely fashion, including where applicable:
- Ensuring sufficient numbers of trained staff are available during each shift to respond to workplace violence incidents, without conflicting job assignments.
- Assigning sufficient numbers of staff to reduce patient-specific workplace violence;
- Redesigning facility spaces to decrease risk for violence.
- Creating a security plan to prevent the entry of weapons into the facility by patients or visitors.
- Installing, implementing, and maintaining an effective alarm system.
- Establish an effective response plan for workplace violence emergencies, including mass casualty threats.
- Establish post-incident response procedures, including making individual trauma counseling available to all affected employees and reviewing staffing and other conditions at the time of the incident.
- Prohibit employer from prohibiting employees from seeking assistance from local law enforcement when a violent incident occurs or disciplining employees for doing so.
- Implement a training program, which includes three categories of training:
- Initial training should be given to all employees who work in the facility and should cover the employer’s workplace violence prevention plan, how to report incidents, etc.
- Refresher training should be given to all employees with patient contact activities at least annually, and should include a review of the initial training.
- Responder training should be given to employees whose assignments involve responding to alarms or confronting / controlling persons exhibiting aggressive or violent behavior. This training should be in-person and should include verbal de-escalation techniques, physical maneuvers to defuse and prevent violent behavior and to prevent physical harm, an opportunity to practice these maneuvers, in addition to the topics covered by the initial training.