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									Workplace Violence

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

          1989 –Ecole

          1996 – Theresa Vince

          2004 – Thualifikar

          2005 – Lori Dupont

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

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

         • Many faceted and
           complex set of
         • Canadian workers are
           rarely killed in a
           violent incident at
           work, but are very
           often injured as a
           result of violent acts
   Types of Workplace Violence
• Violence committed by clients or patients
• Violence associated with robbery or other
• Violence among co-workers or managers
• Domestic violence that spills over into the
  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
       What is Workplace Violence

•   Bullying
•   Threatening behaviour
•   Verbal or written threats
•   Harassment
•   Verbal abuse
•   Physical attacks
       Forms of Workplace Violence

•   Rumours           • Theft
•   Swearing          • Physical assaults
•   Pranks            • Psychological trauma
•   Arguments         • Anger related
•   Property damage     incidents
•   Vandalism         • Rape arson
•   Sabotage          • murder
•   Pushing
•   Verbal abuse
    Workplace Violence Can Be Caused     By

•   Fellow employees   • Patients
•   Supervisors        • Students
•   Managers           • Members of the public
•   Customers          • Unauthorized
•   Clients              intruders
                       • Outside contacts
    At Risk Occupational Groups

•   Health care employees
•   Correction officials
•   Social services employees
•   Teachers
•   Municipal housing inspectors
•   Public works employees
•   Retail employees
Workplace violence is not limited to the workplace.
It includes off site business related functions:
conferences, trade shows, social events, and in clients homes
      Why the Increase in Workplace
•   Increased societal tolerance of violence
•   Increased accessibility to weapons
•   Less control over the work environment
•   Lack of careers, commitment and loyalty
•   Downsizing, reengineering
     Why the Increase in Workplace
• Substance abuse
• Psychological factors
  – Increasing stress
  – Breakdown of support systems
• Change
      Factors That Increase Workplace
• Working with public
• Handling money, valuables, prescription
• Inspection/enforcement duties
• Providing service,care, advise or education
• Working with unstable, volatile persons
• Premises where alcohol is served
    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)
Two Myths About Workplace Violence

                 • It Can’t Happen Here

                 • It Can’t Be Prevented
  Who Are the Perpetrators of Workplace
80% are male, usually white and over 30
only 3% are former employees
20% are current employees
Over two-thirds come from
Domestic violence spillover fastest growing
  category of WPV

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

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

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

•   Intimidation                • Verbal threats
•   Harassment                  • Physical threats
•   Depression                  • Bullying
•   Extreme behaviour           • Intimidation
    changes                     • Inflexibility
•   Numerous conflicts          • Paranoid, unreasonable
•   Idle threats                  expectations
•   Veiled threats              • Coworker fear
•   Statements of desperation   • Weapons or firearms
             Triggering Event

•   Being Fired, laid off, suspended
•   Disciplinary action
•   Bank or court action
•   Benchmark date
•   Failed or spurned romance
•   Personal crisis
     The 10 Most Frequent Acts of Workplace

•   Spreading false rumors
•   Interrupting a person while they are speaking
•   Acting in a condescending manner
•   Ridiculing a person’s 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

• Bullying – repeated, malicious, verbal
  mistreatment of a target by an instigator,
  that is driven by the bully’s desire to control
  the Target

• Mobbing: a malicious attempt to force a
  person out of the workplace by co-workers

• Is it a real issue?

Is it a real issue?

2% can’t imagine what we mean

98% announce “Boy, have I a story for you!”
Workplace Bullying
             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
• The target chosen – capable, dedicated, well
  like by others
• Productivity loss, leave work
• Poisoned work environment
Canada Safety Council
          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
• 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
          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
          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
               Health Effects

• Acute Injuries
  – Bruises, lacerations, fractures
  – Death

• Chronic Effects
  – Post Traumatic Stress Disorder
ILO World Ranking for Workplace

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

More than 50% of Registered Nurses have
 been physically assaulted in the workplace

Registered Nurses’ Associations of Manitoba and Ontario

• 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

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

ONA 1995

• 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
Health Care Scenario
    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
   Violence in the Health Sector

• Nurses specifically experienced 72% more acts of
  crime in the workplace that others of the same
• 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
   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.
      Expectations for Prevention Cont’d

 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
     Potential Risk Factors for Nurses
  A client is more likely to become abusive if…
• There is a history of        • Cannot communicate and
  violent behaviour              becomes frustrated
• Suffers from dementia,       • Appears tense or anxious
  delirium, head/brain         • Appears fearful, unsettled,
  injury, emotional              confused or disoriented
  disorders                    • Speaks in loud aggressive
• Has active drug or alcohol
  addiction or is coming       • Has aggressive physical
  down from high
                               • Is being placed in
• Is overly tired/stimulated     restraints
    Environmental Factors that Affect Potential
               Abuse Include…
• Inflexible rules and policies        • Poorly lit areas, isolated
• Inadequate staffing                    hallways, unlocked empty
• Restrictions on clients activities     rooms
• History of domestic violence,        • Busy or high activity times
  illegal drugs or use of alcohol in     during the day
  the home                             • Lack of personal space for
• Unfamiliar or high crime               client
  neighbourhoods when                  • Workplaces that lack policies
  delivering care in a home              for prevention of violence
  setting                              • Socioeconomic factors such as
• High noise areas                       poverty
 Staff Characteristics that Create Risk Factors

• Lack of awareness of how     • Conflict with other staff
  to anticipate violent          members
  situation                    • Working alone or isolated
• Client’s perception that       from others
  nurse is using threatening   • High stress level,
  tone of voice or body          workload
                               • Identifiably of a different
• Client’s perceptions that      culture from the client
  nurse is not listening or
  not offering choice
                   Case Study

• Scenario – Managing Aggressive Behaviour
   It’s 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.
                Case Study

  The ER nurses are concerned that if Ian’s
   aggressive behaviour escalates, it will
   compromise the safety of the clients, the public
   and the nurses.

What would you do in this situation?
          Case Study Discussion

•   Approach the client with a partner or security officer
•   Redirect the client to a quiet place
•   Establish limits for Ian’s 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

• No regulation in Ontario for violence
• OHS Act 25:2 (h) requires employers to
  take every precaution reasonable under the
  circumstances to ensure a safe and healthy
• OH&S Act 43:3 Right to refuse
             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

• Part II of the Labour Code

• Tripartite group has drafted a “Violence
  Prevention Regulation”

• Has been submitted to the Justice
     Responsibility for Providing a Safe

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

• Review any history of violence in the
• 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

• 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

• Inspect workplaces regularly
• Provide support for victims
• Specific interventions
  – Workplace design
  – Administrative practices
  – Work practices
 Policy = Management Commitment

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

• Describe communication strategies
• Provide support services to victims of
• Offer confidential EAP
• Commitment to violence prevention
• Commitment to monitor and regularly
  review policy
• State applicable regulatory requirements
             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
          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
      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
Waiting Areas
       • Provide distractions
       • Welcoming, calming
       • Acknowledge clients
       • Provide regular
         information about
       • Minimize number of
         objects that can be
Waiting Room
Workplace Layout

        • Minimize physical
        • Arrange furniture
        • Provide a clear exit
        • Minimize amount of
        • Rolling chairs for
          staff, fixed for clients
                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
Video Clip
            Defusing of Grievance = Safety

• Understand the
• Practice active
• Avoid confrontation
• Allow total airing of
  the grievance
         Defusing of Grievance = Safety

• Move toward a win-
  win resolution

• Allow aggrieved party
  to suggest a solution
Internal Resources
Anger Management
External Resources
Reduce Personal Stressors

• CCOHS – Violence in the Workplace –
  Prevention Guide
• CDC – Workplace Safety and Health
• Canada Safety Council
• NIOSH Violence on the Job
• Workplace Violence Prevention A Practical Guide

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