Violence Prevention Programs
OSHA published voluntary, generic safety and health program management guidelines for all employers to use as a foundation for their safety and health programs in 1989. These guidelines can include
workplace violence prevention programs.
OSHA's violence prevention guidelines build on these generic guidelines by identifying common risk factors and describing some feasible solutions. Although not complete, the workplace violence
guidelines include policy recommendations and practical corrective methods to help prevent and mitigate the effects of workplace violence.
The goal is to eliminate or reduce worker exposure to conditions that lead to death or injury from violence by implementing effective security devices and administrative work practices, among other
The guidelines cover a broad spectrum of workers who provide health care and social services in:
- psychiatric facilities
- hospital emergency departments
- community mental health clinics
- drug abuse treatment clinics
- community-care facilities
- long-term care facilities
The guidelines include:
- registered nurses
- nurse practitioners
- physicians' assistants
- nurses' aides
- public health nurses
- home health care workers
- social workers
- welfare workers
- emergency medical care personnel
Written Violence Prevention Programs
A written program for job safety and security, incorporated into the organizations overall safety and health program, offers an effective approach for larger organizations. In smaller establishments,
the program does not need to be written or heavily documented to be satisfactory.
Clear goals and objectives are needed to prevent workplace violence. It should be suitable for the size and complexity of the workplace operation and adaptable to specific situations in each
establishment. Employers should communicate information about the prevention program and startup date to all employees.
At a minimum, workplace violence prevention programs should:
- Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and related actions. Ensure that managers, supervisors, coworkers, clients, patients
and visitors know about this policy.
- Ensure that no employee who reports or experiences workplace violence faces reprisals.
- Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress.
- Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with law enforcement representatives and others who can help identify ways to prevent
and mitigate workplace violence.
- Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that the team or
responsible individuals develop expertise on workplace violence prevention in health care and social services.
- Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the patient or client.
- Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting affected employees and facilitating recovery.
Elements of an Effective Violence Prevention Program
The following five main components of any effective safety and health program also apply to the prevention of workplace violence:
- management commitment and employee involvement
- worksite analysis
- hazard prevention and control
- safety and health training
- recordkeeping and program evaluation
Management commitment and employee involvement are complementary and essential elements of an effective safety and health program. To ensure an effective program, management and frontline employees
must work together, perhaps through a team or committee approach. If employers opt for this strategy, they must be careful to comply with the applicable provisions of
the National Labor Relations Act.
Management commitment, including the endorsement and visible involvement of top management, provides the motivation and resources to deal effectively with workplace violence. This commitment
- demonstrating organizational concern for employee emotional and physical safety and health
- exhibiting equal commitment to the safety and health of workers and patients/clients
- assigning responsibility for the various aspects of the workplace violence prevention program to ensure that all managers, supervisors and employees understand their obligations
- allocating appropriate authority and resources to all responsible parties
- maintaining a system of accountability for involved managers, supervisors and employees
- establishing a comprehensive program of medical and psychological counseling and debriefing for employees experiencing or witnessing assaults and other violent incidents
- supporting and implementing appropriate recommendations from safety and health committees
Employee involvement and feedback enable workers to develop and express their own commitment to safety and health and provide useful information to design, implement and evaluate the program.
Employee involvement should include:
- understanding and complying with the workplace violence prevention program and other safety and security measures
- participating in employee complaint or suggestion procedures covering safety and security concerns
- reporting violent incidents promptly and accurately
- participating in safety and health committees or teams that receive reports of violent incidents or security problems, make facility inspections and respond with recommendations for corrective strategies
- taking part in a continuing education program that covers techniques to recognize escalating agitation, assaultive behavior or criminal intent and discusses appropriate responses
Associates at St. Vincent’s Medical Center wear badges with alarms that alerts the security office if they feel threatened.
St. Vincent’s Medical Center: training to minimize the risk of violence
The threat of violence is elevated at St. Vincent’s Medical Center in Bridgeport, Connecticut, because the hospital frequently treats “forensic” patients from nearby
correctional institutions. Some of these patients are known to be violent, but all such patients must be considered a threat because they may view the hospital as an escape opportunity.
St. Vincent’s director of safety and security has implemented a multi-pronged strategy to minimize risk to employees, patients, visitors, and the community.”
- St. Vincent’s has established protocols that must be followed before any forensic patient can be sent to the hospital for treatment. These protocols have been arranged with local correctional institutions
and include an exchange of information about the patient, his/her condition, medications, and precautions to be taken. Where necessary, additional security support is put in place in advance of the patient’s
- Patients enter the unit through a locked vestibule system. All patients are required to disrobe and change into hospital attire while being observed by trained staff through a one-way mirror.
- Staff identification badges in the unit feature an automatic paging alert. A staff member who feels threatened can simply tear off their card to activate the alert. The alert goes directly to the nearby
security office. The security office can also page all unit employees with situational updates or instructions on what to do if an incident occurs.
- Staff on the unit undergo extensive training, including training on managing aggressive behavior, incident de-escalation, and active shooter response. Drills are held frequently to test procedures and
evaluate training effectiveness.
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