Noting that healthcare and social service workers are almost four times as likely to be injured as a result of violence than the average private sector worker, the Occupational Safety and Health Administration has issued updated guidance for how employers in those industry sectors might reduce the risk of violence. The guidance is available at:

"It is unacceptable that the people who dedicate their lives to caring for our loved ones often work in fear of injury or death," said OSHA Assistant Secretary Dr. David Michaels in a statement accompanying the April 2 release of the guidance. "This updated booklet will help employers implement effective measures to reduce or eliminate workplace violence hazards." 

From 70 percent to 74 percent of workplace assaults that took place annually between 2011 and 2013 occurred in healthcare and social service settings, according to the guidance document. The guidelines, which update OSHA advisories from 1996 and 2004, cover a broad spectrum of workers, including those in psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment centers, pharmacies, communitycare centers and long-term care facilities.

“[E]pidemiological studies consistently demonstrate that inpatient and acute psychiatric services, geriatric long term care settings, high volume urban emergency departments and residential and day social services present the highest risk,” the document stated. 

The guidance identifies 15 risk factors, including eight related to patients, clients, and settings, and seven others described as “organizational risk factors.” Organizational risk factors consist of lack of facility policies and staff training, understaffing, high worker turnover, lack of adequate security personnel, long waits and overcrowding in uncomfortable waiting rooms, unrestricted movement of the public in healthcare settings, and the perception that violence is tolerated and victims will not be able to report the incident.

OSHA’s answer is implementation of a workplace violence prevention program. It consists of five elements: management commitment and employee participation, worksite analysis, hazard prevention and control, safety and health training, and recordkeeping and program evaluation. Each is described in detail in the guidance.

“A written program for workplace violence prevention, incorporated into an organization’s overall safety and health program, offers an effective approach to reduce or eliminate the risk of violence in the workplace,” OSHA said. 

The document also includes checklists designed to help individuals or workplace violence/crime prevention committees evaluate the workplace and job tasks to identify situations that may place workers at risk of assault.

OSHA states the guidance is voluntary, advisory, and informational only. Accordingly, it creates no new legal obligations and does not alter existing requirements in OSHA’s standards and regulations. However, OSHA on occasion has cited employers for workplace violence hazards under the Occupational Safety and Health Act’s General Duty Clause (section 5(a)(1)), which requires employers to provide each of their employees with employment and a workplace free of recognized hazards that are causing or are likely to cause serious physical harm or death. Employers seeking to develop a violence prevention program should consider consulting counsel to assure their programs do not run afoul of OSHA requirements, including the agency’s antidiscrimination mandates.