Category: Workplace Violence

Abstract

Despite the vast research on workplace violence, reports of violence towards our health care workers continue unabated. The overall image that emerges from the literature suggests health care professionals are regularly exposed to workplace violence and need to conduct additional training in identifying high-risk individuals who have the propensity for violence and measures to deescalate the situation. Employers have a moral and legal obligation to ensure they provide a safe working environment and implement processes to prevent injury or harm to their employees. Risk management processes guide organisations to first understand risk, identify risk mitigation strategies and implement sound control measures to reduce the risk to as low as reasonably practicable. The purpose of this paper is to investigate risk management guidelines to develop risk strategies to reduce the probability of workplace violence towards our health care professionals. The study identified two strategies to assist in de-escalating and identifying high-risk personnel as a measure however further investigation is needed to reduce the high occurrences of violence towards health care professionals.

Introduction

Early on in my career as a Western Australian Police officer I was involved or subjected to violence in the workplace regularly as a general duties officer. On any given shift, there was the potential that I would be dealing with either an overly intoxicated, visually upset, drug-affected, suicidal or mentally ill person/s, all which could become extremely violent either towards me or individuals nearby. To assist in dealing with these types of situations, police officers received first-rate training and are given the necessary equipment and tools to deal with all kinds of situations. Majority of situations are resolved peacefully, either by using de-escalation techniques such as verbal judo, calming the individual down and as a last resort, use of force. Trained police officers are normally armed with various use of force options, handgun, pepper spray, baton, handcuffs, and radio to request additional resources to assist however nurses who are in regular contact with similar individuals don’t have the luxury afforded to sworn police officers. Nurses are also subjected to an overly intoxicated, visually upset, drug-affected, suicidal or mentally ill person/s, however, they are not afforded the same level of protection. It is incumbent of both the worker and employers to work together to eliminate risks in the workplace and every worker deserves to work in a risk-free environment, free from injury. A person conducting a business or undertaking must eliminate risks in the workplace, or if that is not reasonably practicable, minimize the risk as far as reasonably practicable. The principles of risk management involve a multiple-step process that requires management to determine the risk management context and develop risk criteria, identifying the risks to their employees, analysing and evaluating those risks and selecting appropriate risk treatment processes, communicate the process/s and conduct regular reviews. The purpose of this paper is to discuss applying risk management principles, framework and process to the risks associated with workplace violence to nurses and advise on the context, scope, and criteria for a risk management approach to reduce the likelihood of injury both physical and psychological to nurses.

Literature Review

Workplace violence includes incidents that cause physical and psychological harm to employees from abuse, threats, and assaults in circumstances related to their employment. Worldwide, violence in healthcare is estimated to comprise a quarter of all workplace violence incidents and is a major occupational hazard within the health care profession. (World Health Organisation, 2019).

Violence is present in all work environments but nurses are on the frontline of the health care system. They have the closest contact with patients and their relatives, and thus are at greatest risk of being abused. International studies have reported that the prevalence of workplace violence against nurses in the hospital setting varied from 10 to 50 percent, and even up to 87 percent (Kwok, Law, Li, Ng, Cheung, Fung, Kwok, Tong, Yen, Leung, 2006).

Whether its easy access to drugs or people who believe their care or needs takes precedence over everyone else’s in the room either due to the feeling of entitlement, mental illness or sheer frustrations on both ends of the spectrum, health care workers are either the subjected or the perpetrator of workplace violence (Rudge, 2012). In an article, Kaur and Kaur (2015) stated that “professions within the healthcare industry are becoming increasingly violent places in which to work with healthcare professionals being common targets for violent and aggressive behaviour”.

Workplace violence has been studied extensively in mental health and, to a lesser extent, in emergency departments. A study conducted in a Florida emergency department, reported 100 percent of the nurses had being exposed to verbal threats and 82 percent reported being physically assaulted. Justifications for the excessive level of violence in emergency departments included, access to weapons, frustrations with waiting times and hospital policies and the normalisation of violence in the community (Lipscomb & Love, 1992).

According to a study conducted in assessing the effectiveness of clinical education to reduce workplace violence, female health care workers were 78.8 percent more likely to be involved in workplace violence and 58.7 percent of incidents involved a single nurse (Adams, Knowles, Irons, Roddy, & Ashworth, 2017). A recently released social media campaign to highlight the prevalence of occupational violence faced by frontline nurses in emergency departments in South Australian revealed there had been a total of 6,245 calls for security made in 2016-17, which equated to 1,480 more calls the same time last year (ANMF.org.au, 2017).

The effects of workplace violence include absenteeism due to morale issues, increased staff turnover, reduced efficiency and decreased satisfaction at work as well as the effect on spouses, children, and families in general. As such, managing violence in the health sector remains a priority, as seen in the many reports which identify the development of workplace violence prevention programs as organisational priority action strategies for decision-makers and managers to improve quality of work-life for health care professionals as well as quality of care and patient outcomes (Rudy, 2012).

Professional workplace behaviour is an important part of preventing violence and depends on a variety of abilities and understanding of the situation to ensure conflicts do not deteriorate into aggression. The approach to ensure ‘safety of self and others’ and have ‘respect for the individual and his/her unique needs’ is critical to avoid and counteract violence and aggression. An example would be intensive observation, in which the care workers simply focus on observations to reduce the risk of harm to others, rather than involving or interacting with the patient. Increased security including overt video surveillance cameras and monitoring of all entrances and exits and adequate lighting have been shown to contribute to the prevention of workplace violence (Ford, 2010).

A study by Johansen, Morken, & Alsaker (2015) identified the risk of violence increased when care workers were required to work alone. Experiences ranged from working completely alone to situations where co-workers were nearby in the building, but out of sight. The study also emphasised the importance of the ability to sound an alarm or call for assistance when they felt threatened. Although seldom used, an alarm or a distress alert gave them a sense of security however the efficiency of the alarm depended on the security response time.

Crime prevention plan

Employees at a major hospital face victimisation by patients as well as the general public. Occasionally patients or concerned family and friends become aggressive and hostile toward hospital staff. The hospital needs a crime prevention plan to help protect hospital staff and patients from victimisation.

Introduction and Background

While workplace violence affects virtually all areas and categories of employees, health workers are more at risk. Ironically, helping people at risk and providing health to others becomes a dangerous occupation for the providers (Anderson and West, 2011). Violence in this sector may constitute almost a quarter of all violence at work (Nordin, 1995). Health workers are at high risk of violence and most violence is performed by patients and visitors. Categories of health workers most at risk include nurses and other staff directly involved in patient care, emergency room staff and paramedics. Violence against health workers has a negative impact not only on their psychological and physical wellbeing, but it also affects their job motivation.

The risk of inappropriate behaviour and workplace bullying can be eliminated or minimised by taking steps to prevent it from occurring before it becomes a risk to health and safety by responding quickly when it does occur. Interventions to prevent violence against health workers in non-emergency settings focus on strategies to better manage violent patients and high risk visitors. Interventions for emergency settings focus on ensuring the physical security of health care facilities (Who.int, 2019).

The risk of violence occurring in the future is continuously growing yearly with the numerous events in the past (Anderson and West, 2011).

The focal objective is to apply prevention or intervention policies and approached to decrease the occurrence of violence in healthcare settings, while the understanding of practice are known to staff and are able to help staff understand and recognise the violent behaviour and strategies on how to manage the risk factors (Ferns, 2007). Some of these violent acts are directed against those professionals who are in charge of our health care. These professionals, frequently, are “among the first to see victims of violence” World Health Organization (2002).

It is important to recognise the reasons and intentions of the wrongdoers, the role of the situation and the extent of the violence. The main perpetrator in aggression inside hospitals toward workers, are patients and visitors and these individuals perceive health professionals as individuals just doing their job. Violence in the health sector against healthcare professionals refers to intentional verbal and physical actions usually verbal abuse, physical assaults as well as nasty comments, discrimination and bullying. This can also involve psychological harm as it affects the individual’s safety, wellbeing and health outside of the workplace.

All health organisations should have a violence prevention program in place which focuses on the elimination of violence associated possibilities. Where the risks cannot be eliminated, they should be reduced to the lowest possible level using control approaches which the staff are aware of and trained in.

Targets and sources of risk

The risk is the chance, that someone or something could be affected by the recognised individual. Risk is judged in terms of how probable the incident will occur and how bad the incident will be if it happens (NSW Health). Assessing risk in the workplace involves estimating the degree of the danger and determining whether it is tolerable or not. Some areas such as waiting rooms may contribute to a higher risk of violence where there is overcrowding, long waiting times and patients in pain as well as individuals in distress over injured or sick family members. Health care employees face amplified risks of workplace violence due to the stress that patients, their families and others find themselves under. Some risk factors include:

• alcohol and drug abuse by the patient and family members
• a past of violent behaviour
• poorly lit rooms/parking areas
• inadequate training in managing hostile and assaultive behaviour from staff members
• poor environmental design
• lack of security
• lack of crime prevention plans.

Felson (1979) argues that crime is the outcome of three contributers. The coming together at a particular time and place of a motivated offender, a potential target and the absence of capable guardianship. Targets can include not only people, but inanimate objects. Absence of capable guardianship will aggravate the likelihood of a crime occurring (Tillyer & Eck, 2011).

Two Approaches

There are two approaches in regards to workplace violence in the healthcare sector which can contribute to mitigating the fear of crime in hospital settings towards the hospital workers.

An important approach to prevent workplace violence is the approach known as Crime Prevention through Environmental Design (CPTED) (Duarte, Lulham & Kaldor, 2011). an important way to making the environment safer are by changes to the environmental setting, which doesn’t always have to be expensive. There are a set of

Ideologies that CPTED involves which play a significant role in reducing crime and violence and it is related to the design (Hopper, 2013). CPTED is a procedure developed to control the event of crime, violent conduct and inapplicable action through the environmental plan and layout (British Columbia Housing Matters, 2014) based on four key codes such as natural surveillance, access control, territorial reinforcement and management and maintenance and these are constructed on the intention that misconducts against people and property are minimised when under surveillance, whether that be by cameras or other people. If people in public areas and areas are able to see what is going on and if people feel safe in the environment and how to respond to problems, it might help in encouraging the reduction of crime and the urge to engage in criminal behaviour. An effectively designed environment makes people feel safer and minimizes the chances for crime and violent acts to occur.

CTPED is an approach to problem solving that analyses and utilises environmental conditions and the operational opportunities they offer for crime and violence (Zahm, 2007). It is the most well known design-based crime and violence control and prevention theory as it supplies a procedure for a set of design approaches that can be made to suit a particular site or activity based on that space’s specific requirements and problems. It restructures the use of space to integrate barriers, increase space and natural surveillance (Crowe & Zahm, 1994). CTPED is widely tested and proven and the effect can be experienced within a short period of time. If this approach is fully implemented, it will decrease government spending in policing.

The intervention policy includes organisation and managing engineering actions (World Health Organisation, 2002) and engineering implementations involves architecture. Architecture has an important impact in controlling workplace violence (Charney 2010). The CPTED approach proposes that appropriate design standards and use of the built environment and operational organisation can help reduce the risk of violence and the actual incidence of violent activity (Parnaby, 2006). Control strategies that are components could be replacement of dimmed lights to bright lighting both indoors and outdoors, a low number of items and furniture in rooms/waiting rooms to minimise the use of weapons, CCTV, changes in new plans for construction, physical changes or renovations, and comfortable waiting rooms.

Although this approach works great for preventing crime, there are some weaknesses which are common also. This approach is only applicable to a newly planned neighbourhood as it would be hard to apply and modify the design of already developed hospitals. It is resistant to change, so if it does go ahead and hospitals with these designs in mind are built, there is a chance it might need renovations later down the track if crime increases and changes.

Situational crime prevention (SCP) is maintained based on a problem-solving method which is observed as the key to successful crime prevention development and concentrates on diminishing opportunities for crime rather than trying to modify the nature to offend. SCP focuses on preventing the chance for crime to occur by concentrating on issues within a specific issue. SCP counteracts the prospect for future crimes to occur by addressing the environment and setting to which past crimes have occurred. With those opportunities absent, it becomes challenging for further similar crimes to take place. This includes the decrease of characteristics that may make people more susceptible to abuse and harassment because of certain situations. Increasing the effort of offending and rising the danger of being caught are ways to avoid situational crime. Preventing aggravation in hospitals toward health care workers is usually just an individual reacting and responding to a situation around them. SCP examines the circumstances and environment in which individuals commit crimes and why, and identifies further possible risks and explores resolutions specific to those conditions.

A great protection healthcare employers can offer their workers is to establish a zero-tolerance policy toward workplace violence to eliminate excuses, which is a common occurrence within hospital workplace violence (Intranet.nnswlhd.health.nsw.gov.au, 2019) which works under situational crime prevention. A zero tolerance approach means that in all incidents of violence, appropriate action will be taken to protect staff, patients and visitors from the effects of such behaviour with one tactic to non-acceptance of workplace violence. The zero tolerance approach will extend even to verbal and non-verbal threats and removes excuses for committing crime. The operational success of the zero-tolerance approach is based on the principles that all practicable strategies to reduce the probability of violence transpiring are recognised and applied.

Developed by Cohen and Felson (1979), routine activity theory requires three elements for a crime to occur, a motivated offender, a suitable target and the absence of a capable guardian. In hospitals, the motivated offender is usually either a patient or the patients family member or friend as they are in an unlucky situation and probably not in a good state of mine if they are attending the hospital , a suitable target in this case is the healthcare worker as they are very vulnerable to aggressive behaviour and violence, as the motivated offender is usually tired, fed up waiting, or under the influence of drugs or alcohol. The absence of a capable guardian could either be the absence of a security guard, or even use of natural surveillance, or CCTV itself just to at least scare the offender and make them think they are being watched. Routine activity theory is influenced by the pattern and the design of prevention strategies of repeat crime and victimisation. The downfall to this may be the time it will take to observe each violent behaviour and how long it takes to come up with a conclusion on how to manage the situation when it comes across again while the strength of this approach is pin pointing exactly what and how things should be done, and doing them.

Recommendations

The approach most recommended for limiting hospital workplace aggression is situational crime prevention as it comprises a range of measures that highlight the importance of targeting very specific forms of crime in certain circumstances (Clarke, 1997) which involves identifying, handling and controlling the situational or environmental impacts accompanying certain types of crime (Cornish and Clarke, 2003). It is also based upon assumptions regarding the nature of offending and of offenders through crime pattern and routine activity by identifying likely reactions and choosing and applying the most applicable response by concentrating on exact situations in which violence occurs and prevent those situations inclining or intensifying where violence is more possible.

Although situational crime prevention seems similar to crime prevention through environmental design, it is much more effective and cost efficient as you will not be spending too much money on things that may evolve over time, and that may not even have had an issue or participated to crime in the beginning. In comparison situational crime prevention is based off previous situations and it is definite that changing these factors will influence and prevent the crime and violence rate from patients and family members towards workers in the healthcare sector. Doing so by increasing the effort involved in offending, the risk associated with offending and reducing situational factors that influence an individual to offend.

In order to do so you will need to focus on crime patterns and examine all the factors that contribute to the situation that violence occurs (Indermaur, 1999).

It would be impossible to do this without analysis. Creating a safer environment stresses we attend to the circumstances in which hositility occurs and in turn effort to generate social surroundings that mitigate against growth of aggression by helping to diminish the appropriateness and use of violence not only in a hospital setting, but as a whole. The key indicators of success and failure would be the violence rate in the particular hospital. If the rate of aggression is growing, the approach obviously didn’t work, but if it begins to diminish, it is a sign of success.

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Introduction

Workplace violence is violence or the threat of violence against workers. It can occur at or outside the workplace and can range from threats and verbal abuse to physical assaults and homicide, one of the leading causes of job-related deaths. However, it manifests itself, workplace violence is a growing concern for employers and employees nationwide.

Workplace violence refers to incidents where workers are abused, threatened or assaulted, either by people from within or outside their workplace. Workplace violence may have severe negative consequences for the workers affected, their co-workers and families; as well as for organisations and the society. The aim of this article is to: present a conceptual framework of the phenomenon; outline and discuss the main types and antecedents to workplace violence; and, finally, provide an informed commentary on the methods and practices used to manage and, moreover, prevent this work-related issue.

Violence is a complex and heterogeneous phenomenon. The perception of what constitutes violence is diverse in different contexts and cultures. The World Health Organisation defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”.

Types of workplace violence:

Type I: Criminal intent. In this kind of violent incident, the perpetrator has no legitimate relationship to the business or its employee(s). Rather, the violence is incidental to another crime, such as robbery, shoplifting, or trespassing. Acts of terrorism also fall into this category.

Type II: Customer/client. When the violent person has a legitimate relationship with the business—for example, the person is a customer, client, patient, student, or inmate—and becomes violent while being served by the business, violence falls into this category.

Type III: Worker-on-worker. The perpetrator of Type III violence is an employee or past employee of the business who attacks or threatens other employee(s) or past employee(s) in the workplace. Worker-on-worker fatalities accounted for approximately 15 percent of all workplace homicides in 2014.

Type IV: Personal relationship. The perpetrator usually does not have a relationship with the business but has a personal relationship with the intended victim. This category includes victims of domestic violence who are assaulted or threatened while at work and accounted for about 7 percent of all workplace homicides in 2014.

Background of the case

This is a case study of the Las Vegas Valley Postal Service. A semi-structured interview was used to collect information from key postal service management personnel. The person interviewed worked at the main post office administrative offices in the Las Vegas Valley as a Workplace Improvement Analyst of the post office. Knowing how sensitive a subject this can be and especially at the post office, at the on-set of the interview I set parameters that I would observe. In addition to reminding the analyst that the interview could be terminated at their wish at any time, I also explained that my interest was not in soliciting details of any violent events involving this or any other postal station. I had read enough in my research. I explained that I had no intentions of gathering the information to later besmirch the post office. (Cochran, 2000)

Since 1970 and with the introduction of the Postal Reorganization Act, the postal service is a self-supporting agency, independently managed, and operates in a competitive market where it’s no longer a true monopoly. Though independently managed, it is still under the scrutiny and criticism of two very tough and direct congressional subcommittees. The Postmaster General must report annually to the Senate International

Security, Proliferation, and Federal Service subcommittee and the House subcommittee on the Postal Service and explain past, present, and future operations and problems.

The postal service is always under pressure to meet increasing mail volume at affordable rates in an industry that is expanding and getting more competition. The rapid change in technology has been an asset and an adversary. While the postal service uses better automation technology to keep postage rates low, private industries such as banks use advancement in technology, duplex printing to reduce the weight of letters while sending out the same number of pieces. The same is true for the use of the Internet; the postal service uses the Internet to reach more people and to add convenience like parcel tracking. Businesses use the Internet to reduce marketing cost by way of reduced advertising postage charge. (Cochran, 2000) (Henderson, 2000)

Because of growth in mail volume, infrastructure, and numbers of personnel employed, the postal service deals with at least six labour unions, four representing mail operations, one representing nurses, and one representing the postal police. With the increase in staff and increasing mail volume notwithstanding, the postal service is managing to keep the cost of postage down. Given raising labour and fuel cost coupled with the impact of inflation, this is not easily done. (Henderson, 2000)

With good news there’s also bad news for all its success, the postal service, like other government agencies or private businesses has fallen victim to incidents of workplace violence. The postal service is profiled here not because it has the higher number of violent incidents nor because of the notoriety it received from the media. In fact the federal agency with the most violent incidents is the Department of Veterans

Affairs. (Freeman, Fox, Burr, & Santa sine, 1996) Outside the federal government, residential care and nursing home facilities had the highest rates for assault in 1994.

Whether deserved or not, the postal service has taken a pounding from the media. Over the last several years more than thirty postal employees lost their lives in eleven violent incidents in and around their workplace, postal stations. (Nigro & Waugh, 1996) One of these incidences occurred in Las Vegas, Nevada.

Alternatives

Government agencies, especially large ones, are not known for their willingness to change their mode of operation; Slow to change is how a bureaucracy is pictured. After all, this mode of operation has been working for years and everyone has adapted to its way of thinking. This mode of operation may have been that of postal stations in the past, but it is now meeting many challenges and having to change its way of operation to remain a self-supporting agency. The requirement to change extends to methods used to handle people and problems. The change is from an autocratic to a more humanistic management style.

The post office requires that all validated threats be investigated to a conclusion within twenty-four hours after a threat assessment level is determined. The last form used by the threat assessment team outlines the risk abatement plan to bring the process to conclusion. Many resources are used when determining the proper abatement plan: a review of personnel, medical, and disciplinary records as well as the input from the postal inspection report.

Proposed solutions

Employment Process

Recommended practices: Interviewers should conduct interviews that allow an evaluator to determine the true personality of applicants. Since personality characteristics remain consistent over the lifetime of most healthy individuals, a pattern of behaviour can be discerned. Have a thorough background check conducted to evaluate past employment history, criminal record, education, experience, training, military service, credit history, and inquiries regarding general character and reputation. The thorough background check would lay the foundation for a complete review. (Kelleher, 1996)

Post office practice: The post office requires prospective employees to complete its suitability requirement. This requirement consists of a medical examination, a drug screening test, employment information verified, a check by local law enforcement, a five-year residency check (through the courts), fingerprint background check and be interviewed.

Evaluation: The post office pre-employment process exceeds the recommendations by researchers. The drug screening, five-year residency check, and medical examination are added measures use to enhance the possibility of rejecting a potentially violence prone individual. This section exceeds the recommended requirements.

Termination Process

RECOMMENDED PRACTICES: Human Resources personnel should be mindful that the termination process can be a dangerous undertaking. They should treat employees being terminated with respect, sensitivity, and dignity. Standards used to terminate employees should be applied equally. If possible avoid terminating when an employee is undergoing other stressful life situations such as divorce and death in the family. Make it a policy to have at least two members of management and in some cases a member of security present at the termination proceedings. Be ready for the proceedings, complete actions such as collecting keys, badges, parking permit, and company equipment. After the proceedings change passwords as necessary. Handle the process in a confidential manner and use multiple concurring opinions of members who are sensitive to the impact of terminations.

When possible, management should provide post-employment and outplacement support after termination, this support may help relieve the emotions that are bound to be present during a termination. (Kelleher, 1996).

Evaluate the work environment

Recommended practices: Solicit employee input; they are often in the best position to provide valuable information because of daily contact with the work environment. Cultivate this source of information; foster a climate that make employees feel secure in offering suggestions, take all suggestion seriously and encourage input on a continuous basis. Maintain employee interest by providing recognition of employee participation and as well as giving credit for recommendations accepted. Employees should feel as though they are a valued part of the company.

Post office practice: The post office conducts a “Voice of the Employee” survey every quarter. The Voice of the Employee survey results are intended to formulate policy in the areas covered by the survey. Typical questions cover the employee opinion on rating the USPS as a place to work, ability of management to communicate, value of diversity in the workforce, quality of service, job safety, physical working conditions, ideas and innovation, co-worker cooperation, recognition, training, accountability, expectations, meeting goals, union and management labour climate, discrimination, and sexual harassment.

Security Measures

Recommended practices: Identify potential threats, vulnerabilities. Develop and implement a security plan. Educate the workforce on the security plan. (Kelleher, 1996)

POST OFFICE PRACTICE: In response to a prior violent incident the postal station made the following changes. The traffic flow in facility parking lots was changed to a one-way flow through pattern. The postal station implemented a smart identification badge system that electronically allows access to controlled areas such as employee parking and parts of buildings. Access to the building is now restricted to only parts of the first floor for non-badge wearing unescorted visitors. All visitors to the administration section is required to check in at the personnel office before conducting business. Because of the new restrictions, a visitor cannot conduct business without a badge or an escort.

Evaluation: The steps taken by the post office fulfils the recommendation to provide reasonable protection for the workforce and without hindering the customer.

Security systems much like fire alarm systems should be periodically tested. All too often employees grow accustomed to the security environment and undermine their own security. For this reason, unannounced non-punitive security exercises to test employee’s awareness and security system integrity should be conducted. The focus of the test should be to keep everyone focused on security.

Education and Training

Recommended practice: Change the current method of supervisor/employee interaction by training the entire workforce. Supervisors should be trained to change from an autocratic supervisory style. This style of supervision is most present in organizations that experienced high incidences of workplace violence. Enhance interpersonal skills for all employees to instil better understanding and to improve listening skills. Teach employees how to recognize and respond to threats. Provide conflict resolution training to encourage constructive means to deal with stressful situations. Educate the workforce on new policies dealing with workplace violence and to know the consequences of violating the zero-tolerance policy. (Kelleher, 1996)

Post office practice: Consultants are used as needed to provide training to supervisors and employees on any topic deemed necessary. Example, if a complaint or threat is received from an office; a counsellor is sent to that office to provide an educational stand-up talk as appropriate. The subjects are wide ranging and include conflict resolution, interpersonal communication, and how to spot violent tendencies. On a required basis all employees receive training about hostile work environment, under the heading of sexual harassment. Managers and supervisors must also attend a four-hour course on hostile work environments. Employees are given a series of stand-up talks throughout the year approximately every month. The stand-ups last about fifteen minutes in length. Mandatory information briefings are conducted weekly to cover subjects on anything from changes in automation to safety to performance evaluations. Supervisors are required to provide the information to employees not in attendance.

Information regarding policies on violence and policies addressing sexual or any type of harassment are posted on bulletin boards located in well-known places and sent to all offices. The posting of information includes national policies and information of local interest.

Recommendations

Programs and procedures put in place to reduce the potential for workplace violence parallel those recommendations suggested by various researchers. All elements of the basic structure needed to develop an effective workplace violence prevention plan were utilized in its plan. The security enhancements are designed with protection of the employee in mind as well as the one step threat reporting hotline that that assures anonymity.

The postal station has the necessary resources and the will to combat the potential for future workplace violence; specifically, it conducts climate assessments, provides constant training rotates personnel at the workplace improvement office to keep fresh people on board, and makes counselling available for all employees. no reason to believe that the post office would change its policy to address workplace violence, change the mind-set of how it handles people or engage in intervention efforts. The agency was large had been around for a while and expecting them to dig-in and hold their ground against the media and everyone else looking their way. I must admit that I was pleasantly surprised at the level of commitment displayed by the post office as it addresses workplace violence.

With an emphasis on violence prevention, the post office should offer limited outplacement service for employees terminated through no fault of their own. This practice if adopted may further reduce the potential for a violent event stemming from the termination process which is known to evoke emotional stress.

Currently there is no feedback to the employees who completed the Voice of the Employee survey. This practice keeps the employee in the dark and may make them apprehensive about completing surveys in earnest there by reducing the effectiveness of the surveys. This is from the principal that people like to know that they have been heard.

Security systems are only as effective as its weakest component. In most cases that is the human component. I recommend conducting periodic locally managed no-notice non-punitive checks to test employee awareness and response with the emphasis being, keeping the workforce security aware.

Despite the above recommendation, I highly recommend that the postal service’s Las Vegas valley program be evaluated by agencies or business interested in establishing an effective shield against workplace violence. There is no program that can guarantee a one hundred percent safe work environment, however, this program offers a good chance at achieving a safer work environment and peace of mind for employees.

Conclusion

If the Las Vegas Valley Postal Service can be equated to the rest of the government or the private business, we should be relieved that workplace violence mitigation is doing well. However, one cannot generalize or conclude that incidents of workplace violence are being properly attended to throughout the United States or throughout the Postal

Service using one case study. The Las Vegas Valley Postal Service has made giant strides in the effort to reduce the potential for future workplace violence. The interest in violence prevention is evident from the highest level of management.

Bibliography

1. www.osha.gov/dte/library/wp-violence
2. www.cos-mag.com
3. www.jointcommission.org
4. www.workplaceanswers.com/resources
5. www.pshsa.ca.com

Objective

Since the establishment, CYX corporation has been firmly committed to its core business values with trust, integrity, transparency, and accountability. To proceed the oversight focus, each employee must carry standard the mentioned company’s core values once been accepted. CYX will use the following incident management plan to address workplace violence and harassment or other threats, in case of any even of actual violence that may occur in the workplace during related business activities. The release of incident workplace violent plan is about making sense out of the corporate counterpart process, plan, strategies, policies.

Scope of an incident management plan

All members of the CYX company.

What is Workplace Violence

Uncomfortable behavior such as physical attacks, threatening behavior or verbal abuse that appears in the workplace. These behaviors are not limited to tapping, stabbing, self-killing, gun killing, rape, near suicide, psychological injury includes threats, obscene phone calls, coercion, moreover, and all kinds of other harassment include being followed, stalked (OSHA, 2019).

Types of workplace violence

[bookmark: OLE_LINK1][bookmark: OLE_LINK2]National Institute for Occupational Safety and Health (NIOSH) classified workplace violence by the following four directions of violence (NIOSH, 2019).

• Customers or Clients harms employees
• Intimate partner violence
• Employees harms each other
• Strangers harm employees

Strategies & Process

• Take threats and threatening behavior seriously; Employees may not raise their concerns if they think management will address them.
• Answer each report seriously and objectively, and deal with the seemingly insignificant allegations (and concerns based on misunderstanding).
• Training. All employees must attend training on warning signs and violent resistance and conduct evacuation drills.
• Take disciplinary measures when necessary.
• Support victims and other affected workers after an accident.
• Strive to restore the working environment to normal after the accident.

Organizational perspective precautions

Establish a safety and threat assessment team

One of the CYX’s most valuable assets is the highly skilled workforce. To better protect the rights and interests of employees, CYX will need to unswervingly provide a safe and health working environment. Therefore, the first step is that the company needs to treat all employees fairly and equitably. It’s worth noting that CYX will takes any kind of risks seriously, importantly the company will re-formulate the work environment crisis factors of CYX according to the four basic types of office violence mentioned above.

At the same time, it needs to unite all departments in the business areas. That is why CYX has decided to establish the workplace violence prevention working group, which is the safety and threat, assessment team. The team includes the workforce from department managers, legal departments, safety and risk management, human resources, security department. Roles of team members are to identify and implement appropriate interventions, practices, and policies to reduce risks in the workplace. The safety and threat assessment team won’t only involve no single department, the reason why is to avoid any kind of potential protection actions to avoid any cover-up. Hence, union is necessary. Additionally, the published of employee survey to evaluate the workplace fairly and impartially, then base on the feedback to make the final business decisions on which areas are necessary to ensure employee safety. Yet, the renew, restyle, rethink of company policy revision and the issue of ethical codes listed above may be concurrent or deleted as required or the order of the proposed agenda varied as circumstances dictate.

The development management process will continue involve the department mentioned above, yet, the human resources, risk management, and legal departments will take more major access rights and responsibility to be the head leader. Responsibilities include, but are not limited to:

• Protecting the security process and confidentiality agreements for reporting employees.
• Investigate all direct or indirect threats to determine all information relevant to the incident.
• The immediate investigation of any reported illegal ACTS or suspected violations of OSHA’s office violence by the regular update from the code of conduct.
• The provision of communication between safety and threat assessment team members must share on the mutual trust level. To provide an environment when employees discover violence situation in the office, has the courage to report immediately to their superiors or report it to the security team.

Ultimately, the threat assessment team participation should extend to the develops and updates on the BCP and BIA under the incident management plan. Determine the impact and probability that the threat may occur, and the severity that it may happen, then gather the collect information to determine, review, and prioritize the final threat identification (OSHA,2019). Afterward to achieve the safety work environment purpose by reducing and eliminating the risk of violence.

Document decisions making

The establish, discuss and release of the management plan should be officially recorded. A workable policy issued by the management team will base on fair and clear standard standards of conduct. The point of the record is to let the employees knows what behavior is not allow by the company, and any non-compliance or non-compliance will be officially record and warn.

Although each company do not need to provide 100% of the security protection to avoid workplace violence, but each company must adopt all kinds of preventive measures and punishment decision, from prevention, control to reduce the potential risk factors of violence, this speech was carried out by the occupational safety and health administration organizations regulations, along with judicial bureau about the workplace violence evolving business environment (Speer, 1998). As a result, official records of education, prevention, evaluation, action will be issue and accessible to ensure that basic correct handling behavior when exposed threat events.

Emergency plan (communication, reaction)

In case of a crisis or emergency, people need detailed information and clear instructions (OnSolve, 2019). Also, companies need to establish an effective communication system to create a safe environment that employees feel supported in the workplace when any form of violence occurs, said by Carol Fredrickson, a workplace conflict resolution specialist (Lebron, 2019). As a result, CYX’s emergency communications program provides a searchable contact list to help employees find the right contact. Second, carry out emergency evacuation exercises regularly and continuously. Third, regularly follow up injured employees. Fourthly, provide psychological counseling after the event. Last but not least, as recommend from OSHA mid-market companies like CYX corporation will also need to incorporate local law enforcement and regulatory agencies (OSHA, BLS) into the company’s communication patterns during and after incidents (Dunning, 2012).

However, in the event of extreme danger, call 911 immediately and seek a haven. Moreover, in addition to provide contact information, emergency plans also need to observe the surrounding environment when extreme violence and crisis conflict occur. See if an attempt can be made to evacuate and prevent access to the area where the shooter or armed person is active, evacuate the workplace at the appropriate time.

Safety and mental health training

CYX corporation makes it mandatory for all employees to introduce safe evacuation, safety precautions, and mental health training. The company expects these kinds of regular training to reduce the likelihood of office violence, and the company believes that the above-mentioned scope of training education can train all employees more clearly and let the muscle memory it. In case of a crisis does occur, the subconscious action of all employee to make the biggest protection action but minimum the injury are CYX’s expectation. Meanwhile, when all employees get together to train and receive the prevention guidance on specific threats, employees could have the probability to show empathy, so that they can help each other when needed to get through difficulties without ignoring their own.

Conclusion

Although workplace violence is difficult to predict, it can be prevented from an organizational and individual perspective. The organizational perspective includes identifying potential violent employees, training management on how to deal with conflict, and how to prevent violence. On the staff side, training of employees includes mandatory and develop ongoing training programs, besides, creation of confidential reporting systems for employees. Measures to improve prevent violence against individuals include psychotherapy and positive communication.

Reference

1. Dunning, M. (2012). Managing workplace violence requires crisis communication. Retrieved from https://www.businessinsurance.com/article/20120513/NEWS05/120519944/managing-workplace-violence-requires-crisis-communication
2. Lebron, A. (2019). Workplace Violence: Why Improving Emergency Communications is Key to Employee Safety. Retrieved from https://www.ravemobilesafety.com/blog/workplace-violence-why-improving-emergency-communications-is-key-to-employee-safety
3. NIOSH. (2019). Workplace Violence Types. Retrieved from https://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Unit1_5
4. OSHA. (2019). Workplace Violence. Retrieved from https://www.osha.gov/SLTC/workplaceviolence/
5. OSHA. (2019). Hazard Identification and Assessment. Retrieved from https://www.osha.gov/shpguidelines/hazard-Identification.html
6. OnSolve, (2019). Easy, Flexible, and Reliable Emergency Notifications and Alerting. Retrieved from https://www.onsolve.com/solutions/use-case/emergency-notification-system/?legacy_domain=SWN
7. Speer, R. (1998). Can Workplace Violence Be Prevented?. Retrieved 21 July 2019, from https://www.ehstoday.com/news/ehs_imp_32820

PICOT question: For nurses working in psychiatric hospitals (P) how does formulation and implementation of security policies (I) compare to workplace education (C) minimize workplace violence cases in their practice period (T)?

Evidence-based solution

The best solution for workplace violence for nurses in the psychiatric setting is the formulation of policies by the hospitals. The hospital administration, nurses, and staff tend to see violence as an acceptable part of their work which should not be the case. This has resulted in the institutional tolerance for violence, which should not be the case. Workplace violence shows the administration that there are system failures which call for some evaluation. Nurses should not be blamed for the behavior of these patients, but they must be accountable for their competence in attending their roles (Hamblin Et al. 2017). The administration should formulate a security policy to address prevention and ways of managing workplace violence if it occurs. It is the role of the institution to ensure zero tolerance for workplace violence.

Nursing intervention

Nurses have a role in managing workplace violence as they suffer the most. First, they should not consider threats from their patients or abuse of any kind as acceptable. Once a patient threatens a nurse, he/she must take action and report these incidences to the administration so that action can be made. Nurses also have a role in getting as much information as possible from the family once a patient is brought to the hospital (Hamblin Et al. 2017). With information about how violent the psychiatric patient is can help them be careful while handling them.

Patient care

Patient care is an essential factor in managing workplace violence. Patients in psychiatric settings are violent since most of them abuse drugs and bipolar conditions; therefore, they have no sobriety. These people have a history of violence, coercive personality style or are not happy with their length of stay in the hospital and therefore they become violent. It is, therefore, essential for nurses to know the history of their patients to understand what to expect. Secondly, there should be therapists to provide therapies to these patients to manage their metal conditions (Ridenour et al. 2015).

Healthcare agency

Healthcare agencies are responsible for ensuring the nurse’s safety by preventing and managing workplace violence. The occupational safety and health act (OSHA) is one of these agencies. This agency sets and enforces standards, provides training, education, and outreach to encourage workplace safety, especially for nurses (Friend & Kohn, 2018). Psychiatric institutions should implement policies and standards put in place by organizations such as OSHA to ensure their nurses are safe from violence. Also, they can call on OSHA to train their nurses on how to take care of themselves and ensure they are safe.

Nursing practice

Nurses association must help build an environment that facilitates effective communication and interpersonal skills between nurses, patients, and their family. There also must be clear guidelines regarding supervisors responsible for workplace behavior regarding documentation, reporting, and actual patients engaging in workplace violence (Lantta et al. 2016). Nurses must be informed about the guidelines when they are being oriented and during the yearly review. All nurses must work collaboratively to support any nurse being victimized or abused by the patients. Finally, there must be security measures put in place to secure nurses from the abusers who may cause harm to them. This can be enabled through having security officers and CCTVs in patient’s wards.

References

1. Ridenour, M., Lanza, M., Hendricks, S., Hartley, D., Rierdan, J., Zeiss, R., & Amandus, H. (2015). Incidence and risk factors of workplace violence on psychiatric staff. Work, 51(1), 19-28.
2. Friend, M. A., & Kohn, J. P. (2018). Fundamentals of occupational safety and health. Rowman & Littlefield.
3. Lantta, T., Anttila, M., Kontio, R., Adams, C. E., & Välimäki, M. (2016). Violent events, ward climate, and ideas for violence prevention among nurses in psychiatric wards: a focus group study. International journal of mental health systems, 10(1), 27.
4. Hamblin, L. E., Essenmacher, L., Luborsky, M., Russell, J., Janisse, J., Upfal, M., & Arnetz, J. (2017). Worksite Walkthrough Intervention: Data-driven Prevention of Workplace Violence on Hospital Units. Journal of occupational and environmental medicine, 59(9), 875-884.

Violence impact on community in this essay my main focus will be impact of violence on workplace work place aggression can have very disastrous impact on output of any institution its impact can be decreased productivity, increased stress on employee, reduced customer satisfaction and costly property damage. Because of workplace aggression there is estimation of 4.2 billion$ loss in 1992. Also I would like to emphasize on violence impact on our society the total loss in 2000 in US because of violence was more than 70 billion $ which affect health, welfare, low productivity and healthcare coast. As obvious we can see bad impacts of violence so, later in my discussion I would like to give some keys on how to handle workplace and society violence My first objective in this essay will be to describe how fetal violence is for our society and second objective is to give some solutions for it.

Violence impact on the community can be very fatal sometimes like mortality or morbidity. Mortality rate according to WHO – 1.66 million violence-related deaths (28.8/100,000) – 520,000, Homicide – 815,000, Suicide – 310,000, War-related of these 1.66 million deaths:

• 1.51.. Low and middle income countries (32.1/100,000)
• 0.15.. High-income countries (14.4/100,000)

Morbidity is a not-fatal violence it can have stressful and psychological impacts, loss of work potential and quality of life, any physical injury which doesn’t require medical care. Violence is something which can be seen in every age group but among all age groups its most commonly seen in youth for example consistent with America’s children: key national indicator of well-being, a report released in 1997 by the federal interagency forum on child and family statistics in Washington D.C., almost 2.6 million youth of ages 12 to 17 were victim of violent crime in 1994. For this study violent crime were defined as simple and assault, rape and robbery. Every year, many American workers report having been victims of workplace violence. In 2017 assaults resulted in 18,400 and 458 fatalities, consistent with injury fact. Certain industries like healthcare providers, service providers and education, are more susceptible to violence than others.

The organization’s official report of workplace aggression incidents like physical assaults and other sever incidents at each office during 14 month period [1995-1996] which was recorded by organization’s own security force and from statements of witness these assaults include credible threats like gun shoot threat, throwing dangerous object at any other employee and harm to employ property. Workplace aggression in first half of 14 month period are more often than in second half 312 workplace aggression in which 59 were physical assault and 253 other type of aggressions were reported in 140 workplaces all these incidents were raise against fellow employ and 36% were against supervisors.

The key reasons of workplace aggression is lack of pre-employment screening, workplace stress, lack of employ assistant program, denial, disgruntled customers and formers employees.

Solution to this problem is pre-employment screening company it’s a proactive approach, organization should have anti-aggression and anti-violence policies if person know about the policies and punishment against it there will be less incidence and while training employs should be practiced how to cope with heavy work load and stress.

At the glance as my topic is violence impact on the community and emphasizes on its effect on workplace which have a very disastrous impact on organization and country economic status also the main key reason are stress, denial, disgruntled customers and formers employees and lack of pre-employment screening and solution to these problems are anti-aggression, anti-violence policies, legal punishments and training for how to cope with high work load stress.

Implications from my research to peoples who are working with high stress and workload in any organization are that violence is not the answer of everything by acting it out one person will not only harm the opposite one but also get in trouble by himself, and if we view this as a wide range violence will decrease output of organization which will give negative effect to not only that organization but also to economic status of country too.

In future my research can be further extended by deep digging into workplace violence impact on socio-economic status of a country and also how finding towards decreasing violence by different procedures and techniques.