Violence in the workplace: it's closer than you think - steps to prevent violence inside long-term care facilities

Nursing Homes, August, 1999 by Maximina Ludeke

In our quest to provide a "home-like" atmosphere for clients in long-term care, we encounter families, visitors, delivery/sales personnel, community organizations and volunteers daily. There might also be spouses, children and friends of employees coming and going for various reasons. Such informality seems to contribute to a decrease in safety awareness. The possibility of danger is obscured by "familiarity" and can result in less vigilance. Although healthcare workers already face the obvious threat of violence from residents, violence from other sources is sometimes treated with less importance and decreased awareness.

Domestic violence, carried into the workplace, has also increased the danger to workers. Disgruntled employees, former employees or their family members might exhibit hostility for a perceived or actual slight, introducing an escalating anger into the work environment.

Alcohol and other substance abuse clearly adds to loss of control. Suggesting a cooling-down period will not work if the time is used to dwell on anger-inducing thoughts. Brooding can lead to high levels of rage that make people incapable of rational thought.

Violence is a deadly serious reality. It can occur anywhere, anytime; we no longer have the luxury to dismiss strong behaviors or ignore obvious signs. An angry person might originally focus on a specific individual, but circumstances can shift attention to anyone attempting to interfere or deter the person from the primary objective.

Management and staff must take the initiative to protect themselves, and every facility should implement a written safety plan. The plan might incorporate the following basic safety tips:

1. Become aware of strangers, as well as residents. Ask for identification, direct them to a waiting area or lobby or accompany them to the resident's room. Do not permit strangers to wander around the facility unattended. And never assume "someone else" will take care of everyone's safety.

2. Know who is seeking entry and why. Ask! Instruct staff to discourage personal visitors. Have a designated, well-identified entrance for nonemployees. Mark those entrances and areas reserved for employees only.

3. Install and maintain well-lighted parking and congregating areas.

4. Intercept and question anyone who is unknown or seems to have purposeless intentions. Visually identify anyone seeking after-hours entry. Former employees should be discouraged and prevented from nursing care areas and employees' break areas.

5. Lock all doors and set alarms. Have a policy stating when the facility doors will be locked, and assign responsibility for locking up.

6. Employees should not give out lock codes or combinations to any doors accessing the facility. These locks should have periodic code changes, at least quarterly.

7. Minimize the presence of shrubbery and tall bushes near doors, windows or staff entrances.

8. Keep parking and outside patio/congregation areas in clear view. Do not screen them from view of the facility or staff.

9. Be alert for signs of anger (shouting, pounding, demands, etc.)

10. Watch what is being carried (bags, cases, etc.) or for any unlikely or unusual bulges in these. Clothing that is too large or inappropriate for the weather could be used to conceal dangerous objects, as well.

11. Stay out of the direct line of access of anyone exhibiting anger or violent behavior. If someone is out of control or on the verge of losing control, don't threaten or divert him or her. Get help. Notify security or police agencies.

12. Assess your facility's general employee safety plans for appropriateness and compliance. Formulate new solutions to fit specific needs. Reassess effectiveness at least annually.

Because a serious incident has not happened at your facility does not mean it never will. Do not be fooled by the appearance of safety or assumptions of a safe work environment. Have a plan, and never take safety for granted.

Maximina Ludeke, RN, BA, MEd, is staff developer and educator at the Kingman Health Care Center, Kingman, Arizona.