Workplace Violence

1
Workplace Violence

• Deborah Hellyer MD, Ivan Bauer BScN, Veronica
  Kaschalk
• December 6, 2005

2
Historic Perspectives

• 1989 Ecole Polytecniques
• 1996 Theresa Vince
• 2004 Thualifikar Alattiya
• 2005 Lori Dupont

3
Objectives

• Increased awareness of workplace violence
• Identify risk factors
• Sector specific situations
• Legislation
• Prevention strategies
• Recommendations for moving forward

4
What Is Workplace Violence
any act in which a person is abused, threatened,
intimidated or assaulted in place of employment
5
Workplace Violence

• Many faceted and complex set of interactions
• Canadian workers are rarely killed in a violent
  incident at work, but are very often injured as a
  result of violent acts

6
Types of Workplace Violence

• Violence committed by clients or patients
• Violence associated with robbery or other crimes
• Violence among co-workers or managers
• Domestic violence that spills over into the
  workplace

7
What is Workplace Violence?

• Threatening behaviour (shaking fists, throwing
  objects
• Verbal or written threats
• Direct, conditional or veiled
• Harassment any behaviour that is designed to
  trouble or worry the victim, coercive or fear
  inducing
• Verbal abuse
• Physical attacks

8
What is Workplace Violence

• Bullying
• Threatening behaviour
• Verbal or written threats
• Harassment
• Verbal abuse
• Physical attacks

9
Forms of Workplace Violence

• Rumours
• Swearing
• Pranks
• Arguments
• Property damage
• Vandalism
• Sabotage
• Pushing
• Verbal abuse

• Theft
• Physical assaults
• Psychological trauma
• Anger related incidents
• Rape arson
• murder

10
Workplace Violence Can Be Caused By

• Fellow employees
• Supervisors
• Managers
• Customers
• Clients

• Patients
• Students
• Members of the public
• Unauthorized intruders
• Outside contacts

11
At Risk Occupational Groups

• Health care employees
• Correction officials
• Social services employees
• Teachers
• Municipal housing inspectors
• Public works employees
• Retail employees

12
Workplace violence is not limited to the
workplace. It includes off site business related
functions conferences, trade shows, social
events, and in clients homes
13
Why the Increase in Workplace Violence?

• Increased societal tolerance of violence
• Increased accessibility to weapons
• Less control over the work environment
• Lack of careers, commitment and loyalty
• Downsizing, reengineering

14
Why the Increase in Workplace Violence?

• Substance abuse
• Psychological factors
• Increasing stress
• Breakdown of support systems
• Change

15
Factors That Increase Workplace Violence

• Working with public
• Handling money, valuables, prescription drugs
• Inspection/enforcement duties
• Providing service,care, advise or education
• Working with unstable, volatile persons
• Premises where alcohol is served

16
Factors That Increase Risk for WPV

• Working alone/small numbers
• Community based settings
• Mobile workplace (taxi)
• Working during periods of intense organizational
  change (downsizing, strikes)

17
Two Myths About Workplace Violence

• It Cant Happen Here
• It Cant Be Prevented

18
Who Are the Perpetrators of Workplace Violence?

• 80 are male, usually white and over 30
• only 3 are former employees
• 20 are current employees
• Over two-thirds come from strangers/customers
• Domestic violence spillover fastest growing
  category of WPV

19
POSTAL

• Profile
• Observable Warning Signs
• Shotgun
• Triggering Event
• Always Lethal

20
Profile

• Previous history of violence
• Loner
• Emotional Problems
• Career Frustration
• Antagonistic Relationships with others
• Some type of obsession

21
Observable Warning Signs

• Violent and threatening Behaviours
• Strange behaviour (reclusive, deteriorating
  appearance)
• Emotional Problems
• Performance Problems
• Interpersonal problems
• At the end of the rope

22
Warning Signs Identified

• Intimidation
• Harassment
• Depression
• Extreme behaviour changes
• Numerous conflicts
• Idle threats
• Veiled threats
• Statements of desperation

• Verbal threats
• Physical threats
• Bullying
• Intimidation
• Inflexibility
• Paranoid, unreasonable expectations
• Coworker fear
• Weapons or firearms references

23
Triggering Event

• Being Fired, laid off, suspended
• Disciplinary action
• Bank or court action
• Benchmark date
• Failed or spurned romance
• Personal crisis

24
The 10 Most Frequent Acts of Workplace Aggression

• Spreading false rumors
• Interrupting a person while they are speaking
• Acting in a condescending manner
• Ridiculing a persons opinions in front of others
• Failing to return calls or memos
• Giving the silent treatment
• Engaging in verbal sexual harassment
• Staring dirty looks
• Damning with false praise
• Showing up late for meetings

25
Bullying/Mobbing

• Bullying repeated, malicious, verbal
  mistreatment of a target by an instigator, that
  is driven by the bullys desire to control the
  Target
• Mobbing a malicious attempt to force a person
  out of the workplace by co-workers

26
Bullying

• Is it a real issue?

27
Bullying

• Is it a real issue?
• 2 cant imagine what we mean
• 98 announce Boy, have I a story for you!

28
Workplace Bullying
29
Workplace Bullying

• Over 80 of bullies are bosses, some are
  co-workers and a minority bully higher ups
• A bully is equally likely to be a man or woman
• The target chosen capable, dedicated, well like
  by others
• Productivity loss, leave work
• Poisoned work environment
• Canada Safety Council

30
Workplace Bullying

• Newly hired, asked to operate dangerous equipment
  without sufficient training
• Unpredictable outbursts and verbal attacks by
  co-worker leave support staff on high alert
• Locked into a low level job by a supervisor who
  devalues her contributions
• Expected to be on call 24/7, approaching burnout,
  pleas of help on deaf ears

31
Canadian Perspectives

• Fatalities 14 workers in 2002 (1.5 of workplace
  deaths), 9 in 2001, 10 in 2000
• Injuries 5,021 accepted time loss injuries in
  2002 (1.4) 4,920 in 2001 4,836 in 2000
• Association of Workers Compensation Boards of
  Canada

32
Canadian Perspectives

• Hostile and Threatening actions
• 2 victim of physical violence
• 21 harassed on the job at least once
• 49 directly serve the public
• 17 victims of discrimination (sex, ethnicity,
  age, disability)
• Public Service Commission of Canada 2002

33
Health Effects

• Acute Injuries
• Bruises, lacerations, fractures
• Death
• Chronic Effects
• Post Traumatic Stress Disorder

34
ILO World Ranking for Workplace Aggression

• Argentina
• France
• England and Wales
• Canada
• Finland
• Uganda
• United States
• Romania
• Netherlands
• Northern Ireland

35
Statistics 2002

• 1,747 lost time claims in Ontario
• An increase of 10-15 over each of the previous
  six years
• Hitting, kicking, biting the top three
• Source CUPE

36
Statistics

• More than 50 of Registered Nurses have been
  physically assaulted in the workplace
• Registered Nurses Associations of Manitoba and
  Ontario

37
Statistics

• Of 400 Nurses surveyed, 63 had experienced
  verbal abuse in the past year
• 35 experienced attempts at physical harm
• 21 had been victims of physical attack
• Nova Scotia study

38
Statistics

• Of 800 Ontario Nurses surveyed, 59 had been
  physically assaulted on the job in their career
• ONA 1995

39
Statistics

• Younger clinicians and nurses are more often the
  target of client aggression, due to limited
  experience and training
• Health care workers face similar level of risk to
  that of the police
• Boyd 1995

40
Health Care Scenario
41
Violence in the Health Sector

• In 1993-1999, an average of 1.7 million violent
  crimes were committed against persons 12 years of
  age or older while on duty at work
• In this same time frame, nurses were victims of
  violence 429,100 times
• This is a total of 3.5 of the total work
  population behind only the police

42
Violence in the Health Sector

• Nurses specifically experienced 72 more acts of
  crime in the workplace that others of the same
  field
• The time of occurrence for violent crimes were
  committed during the day and more specifically
  from Noon 6pm
• Mental health and medical workers were victimized
  with a weapon 25.4 of the time
• Only 39.6 of violent crimes were reported to the
  police

43
Expectations For Prevention

• Management of Abuses by Nurses
• Manage an abusive situation in safe effective
  manner by assessing the potential cause, consider
  the impact of clients present health state,
  create a care plan, involve the client in the
  care plan, seek resources and assistance to deal
  with the situation
• Protect yourself in situations that threaten
  personal safety and have a plan to protect
  yourself
• Reflect on the abusive incident.

44
Expectations for Prevention Contd

• Report all incidents to appropriate source that
  will help you
• Develop personal and team competencies in
  anticipating and managing abusive situations
• Become directly involved in creating, evaluating,
  and improving workplace process for eliminating
  abuse
• Advocate with employer to provide mechanisms for
  reporting and following up on abuse

45
Potential Risk Factors for NursesA client is
more likely to become abusive if

• There is a history of violent behaviour
• Suffers from dementia, delirium, head/brain
  injury, emotional disorders
• Has active drug or alcohol addiction or is coming
  down from high
• Is overly tired/stimulated

• Cannot communicate and becomes frustrated
• Appears tense or anxious
• Appears fearful, unsettled, confused or
  disoriented
• Speaks in loud aggressive tone
• Has aggressive physical stance
• Is being placed in restraints

46
Environmental Factors that Affect Potential Abuse
Include

• Inflexible rules and policies
• Inadequate staffing
• Restrictions on clients activities
• History of domestic violence, illegal drugs or
  use of alcohol in the home
• Unfamiliar or high crime neighbourhoods when
  delivering care in a home setting
• High noise areas

• Poorly lit areas, isolated hallways, unlocked
  empty rooms
• Busy or high activity times during the day
• Lack of personal space for client
• Workplaces that lack policies for prevention of
  violence
• Socioeconomic factors such as poverty

47
Staff Characteristics that Create Risk Factors
Include

• Lack of awareness of how to anticipate violent
  situation
• Clients perception that nurse is using
  threatening tone of voice or body language
• Clients perceptions that nurse is not listening
  or not offering choice

• Conflict with other staff members
• Working alone or isolated from others
• High stress level, workload
• Identifiably of a different culture from the
  client

48
Case Study

• Scenario Managing Aggressive Behaviour
• Its Friday night and the ER is full of clients,
  including Ian. He smells strongly of alcohol and
  is swearing loudly. His arm is bleeding from a
  deep laceration sustained in a bar fight. His
  friends insist he stay in the ER and be treated,
  yet the client is determined to leave. The group
  is rowdy and soon attracts an audience of
  onlookers. Seeing the commotion, other clients
  in the ER are fearful that a fight will break out.

49
Case Study

• The ER nurses are concerned that if Ians
  aggressive behaviour escalates, it will
  compromise the safety of the clients, the public
  and the nurses.
• What would you do in this situation?

50
Case Study Discussion

• Approach the client with a partner or security
  officer
• Redirect the client to a quiet place
• Establish limits for Ians behaviour
• Finish triage and treatment quickly
• Avoid confrontational questioning
• Use a calm, controlled approach
• Alert security about the situation
• If escalates and cannot be controlled by the
  in-house staff, alert the police

51
Regulations

• No regulation in Ontario for violence
• OHS Act 252 (h) requires employers to take every
  precaution reasonable under the circumstances to
  ensure a safe and healthy workplace
• OHS Act 433 Right to refuse

52
Other Jurisdictions

• Quebec
• Amendment to the Labour Standards Act
• Nova Scotia
• Guidelines on workplace violence prevention
• British Columbia and Saskatchewan
• Specific workplace violence prevention
  legislation
• Source WHSC

53
Federal

• Part II of the Labour Code
• Tripartite group has drafted a Violence
  Prevention Regulation
• Has been submitted to the Justice Department

54
Responsibility for Providing a Safe Workplace

• Employers have a legal and moral obligation to
  provide a safe workplace
• Employees have a comparable duty and obligation
  to bring potentially violent situations to the
  attention of the company

55
How Do I Know if My Workplace is at Risk?

• Review any history of violence in the workplace
• Ask employees about their experiences
• Determine if your workplace has any of the risk
  factors associated with violence
• Conduct a visual inspection of your workplace,
  focus on workplace design, and administrative
  practices
• Source CCOHS

56
Prevention

• Identify and recognize the problem in the
  workplace (Joint Health and safety)
• Management commitment and development of WPV
  policies
• Education and training
• Work organization and workplace layout
• Mandatory detailed reporting and investigation

57
Prevention

• Inspect workplaces regularly
• Provide support for victims
• Specific interventions
• Workplace design
• Administrative practices
• Work practices

58
Policy Management Commitment

• Developed by management and employee
  representatives
• Apply to all (management, employees, clients,
  independent contractors
• Define wpv in precise terms
• Provide clear examples of unacceptable behaviours
  and working conditions
• Organizations view clearly stated

59
Policy

• State the consequences
• Outline the process of preventative measures
• Encourage reporting of all incidents
• Confidentiality
• Assure no reprisals against reporting
• Outline procedure for investigating and resolving
  complaints

60
Policy

• Describe communication strategies
• Provide support services to victims of violence
• Offer confidential EAP
• Commitment to violence prevention training
• Commitment to monitor and regularly review policy
• State applicable regulatory requirements

61
Workplace Design

• Positioning of the reception area
• Positioning of office furniture
• Installing physical barriers
• Minimizing number of entrances
• Using coded cards to control access
• Adequate exterior lighting
• Strategically placing fences to control access

62
Workplace Design

• Signage Employees only, all visitors must be
  escorted beyond this point
• Provide a locked secured area for employees to
  store personal belongings
• Ensure the receptionist can clearly see incoming
  and outgoing staff and visitors
• Panic buttons, intercom, code pink

63
Administrative Practices

• Keeping cash register funds to a minimum
• Electronic payments
• Install and use a locked drop safe
• Arrange for regular cash collection by a licensed
  security firm
• Visitors sign in and out
• Establish set visiting hours

64
Waiting Areas

• Provide distractions
• Welcoming, calming surroundings
• Acknowledge clients
• Provide regular information about delays
• Minimize number of objects that can be thrown

65
Waiting Room
66
Workplace Layout

• Minimize physical contact
• Arrange furniture
• Provide a clear exit
• Minimize amount of furniture
• Rolling chairs for staff, fixed for clients

67
Work Practices

• Prepare a daily work plan
• Check credentials of clients
• Use a buddy system
• Working alone policy
• Do Not enter any situation or location where you
  feel threatened or unsafe
• Source CCOHS

68
Video Clip
69
DOGSDefusing of Grievance Safety

• Understand the mindset
• Practice active listening
• Avoid confrontation
• Allow total airing of the grievance
• www.workplace-violence-hq.com

70
DOGSDefusing of Grievance Safety

• Move toward a win-win resolution
• Allow aggrieved party to suggest a solution

71
Internal Resources
72
Anger Management
73
External Resources
74
Reduce Personal Stressors
75
Resources

• CCOHS Violence in the Workplace Prevention
  Guide
• CDC Workplace Safety and Health
• Canada Safety Council www.safety-council.org
• HRSDC www.hrsdc.gc.ca
• NIOSH Violence on the Job
• Workplace Violence Prevention A Practical Guide