In October of 2010, a psychiatric technician was strangled by a patient at Napa State Hospital and a Registered Nurse working at a Contra Costa County jail in Martinez, California died as a result of being assaulted by an inmate.

These two deaths were not isolated incidents; health care and social assistance workers are nearly five times more likely than average employees in other sectors to experience a nonfatal assault or violent act by another person, according to the U.S. Bureau of Labor Statistics.

The fatalities “raised the visibility of the issue of workplace violence as a serious  hazard for health care workers,” according to Cal-OSHA, which is proposing new regulations to reduce that risk. “The deaths of theses health care workers demonstrate the need for better security measures, procedures, and practices.”

Unions filed petitions

The standard comes after two health care worker unions filed petitions requesting the Board to amend the General Industry Safety Orders by adopting a new standard to provide health care workers with specific protections against workplace violence. Richard Negri, Health and Safety Director, Service Employees International Union (SEIU) and Katherine Hughes, Liaison for SEIU Nurse Alliance of California, filed Petition 538 requesting the Board to adopt a new workplace violence prevention standard that would cover all workers employed in all health care settings.

A similar petition, Petition 539, was submitted by Bonnie Castillo, Director of Governmental Relations for the California Nurses Association (CNA) requesting that the Board adopt a new workplace violence prevention standard that would cover all health care workers employed by general acute care hospitals licensed pursuant to subdivision (a), (b), or (f) of Section 1250 of the Health and Safety Code (HSC) in all units, including inpatient and outpatient settings and clinics on the license of the hospital.

SEIU proposes the adoption of a new standard to reduce the risk of exposure of health care workers to workplace violence as defined by OSHA.

The proposed regulations would implement a state bill (SB 1299) passed last year.

Who and what

The regulations would cover workplace safety for workers in home health, home-based hospice, outpatient medical offices, paramedic and emergency medical services, and other health facilities

The regulations define workplace violence broadly to encompass actual acts of violence as well as the threat of violence. The regulations require employers to develop a Workplace Violence Prevention Plan that emphasizes prevention and involves worker participation.

Among other things, that plan must include:

• Procedures to identify environmental and patient-specific risk-factors
• Procedures to correct workplace violence hazards, including engineering and work practice controls such as implementing adequate staffing, removal of sight and communication barriers, provision of surveillance systems, use of a buddy system, reconfiguration of facility spaces, removal or securing of objects that may be used as improvised weapons, installation of alarm systems, and other effective means
• Procedures for post-incident response and investigation, including providing individual trauma counseling to all employees affected by the incident
• Employee involvement in the development, implementation, and review of the plan
• The regulations require employers to provide an initial training for all employees, which emphasizes preventative measures such as how to recognize the potential for violence, how to counteract factors that lead to the escalation of violence, how to seek assistance to prevent or respond to violence, and strategies to avoid physical harm. The regulations also require the employer to conduct an annual review of the Workplace Violence Prevention Plan and to correct any problems that are uncovered.

Nursing organizations are pleased

"When implemented these new rules will help RNs completely focus on the health and healing of our patients without feeling vulnerable because we work in a workplace that is unprepared,” said Zenei Cortez, Co-President, California Nurses Association.

"The proposed regulations will serve as a national model and we are very proud of the part we have played to bring them to fruition," said Deborah Burger, Co-President, National Nurses United and the California Nurses Association.

Cal-OSHA will hold a public hearing on the proposed regulations on Dec. 17 and collect comments from stakeholders.