Looking at the root causes of workplace violence

Workplace incidents and injuries often occur as a result of inadequate resourcing in staff and time but few OHS consultants are comfortable recommending to clients that additional staff are required or that shifts should be reconfigured or, possibly, that a certain business activity (or the business itself) should be cancelled.  Yet identifying the “root cause” and eliminating the hazard is the aim of the safety profession and, sometimes, a legislative obligation.

A blog article from the National Institute of Occupational Safety & Health in the United States illustrates many of these issues.  In a post entitled “Assaults on Nursing Assistants” unacceptable levels of assault and biting were experienced by aged-care nurses in one survey sample. But the blog not only reported the research results, it recommended some control measures:

“Improving staffing levels may reduce the risk of assault by reducing workload demands and allowing staff more time to spend with each resident and avoiding the need to rush care.” (emphasis added)

These seem sensible control measures in this work situation but will any business really take the recommended actions based solely on safety concerns?

“Improving staffing levels” would require additional expenditure from increased income, which is difficult in the aged care industry without reducing the quality patient care.  Of course, the staff costs could be covered by reinvesting profits but most companies baulk at this type of move.

“Reducing workload demands” in an aged care facility would mean fewer patients or at least reducing the demands of the patients, which would seem a big ask.  In the situation above, violence would be reduced with a more compliant client base but how does one achieve this when part of the client base is demented and applies a different set of values to the workers and general community?

“Allowing staff more time” will result in decreased productivity or a reduction in the likelihood of accepting additional patients.  The staff/patient ratio is a crucial OHS matter that is often shoved into industrial relations or human resources.  These sorts of ratios are a benchmark of quality in industries such as teaching, but the quality of service is directly linked to the healthiness of the care giver.  Stressed workers provide poor service and poor service will lead to decreased demand and reduced revenue.  OHS professionals need to “take back” the issue of staff/client ratios or, if not possible, explain their interest in the area to HR professionals so that the OHS professionals are not perceived as busybodies or threats.

“Avoiding the need to rush” is concomitant to “taking safety shortcuts”, a phrase often heard uttered by frustrated production, operations managers and in the aftermath of a workplace incident.  Rushing comes directly from the other issues listed above – unreasonable workloads, and insufficient staff.

Workplace violence is one of those psychosocial hazards that the OHS profession is still coming to terms with.  Violence can generate substantial long-term psychological damage, not the mention the physical impacts.

Also workplace violence can go both ways.  In a recently purchased book, Vaughan Bowie quotes one researcher (Kohnke) who wrote about abusive nurses in 1981:

“The nature of the abuse delivered by nurses to patients is often subtle:  rarely…do we see actual physical abuse.  The more primitive, isolated and poor the institutions, the more likely they harbor the actual physical abusers.  The better financed, more modern institutions where patients are more in control of the environment, see the more subtle forms of abuse.”

Let’s hope these comments were of the time and do not reflect current practices.

Kevin Jones

Categories book, evidence, health, occupational, OHS, psychiatric, research, risk, safety, Uncategorized, violenceTags , , ,

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