One Year Later – ANA Continues the Fight for Workplace Violence Prevention

  

As workplace violence (WPV) in health care continues to rise, nurses cannot wait for solutions. Last year, the Occupational Safety and Health Administration (OSHA) finally started work on a WPV prevention standard. According to OSHA’s own data, health care and social assistance workers now face six times the risk of WPV than all other industries. This is an increase from 2018 data which showed a risk of five times that of other industries.  

Yet it has been over a year and no further progress has been made.  

To urge action from the agency, ANA led a sign-on letter to OSHA from nearly 60 nursing organizations across the country last month. Acting Secretary of Labor Julie Su was questioned about the lack of progress on this standard in a Congressional hearing on May 1st of the Committee on Education and the Workforce.  

During the hearing, Rep. Joe Courtney, champion of the Workplace Violence Prevention for Health Care and Social Service Workers Act, underlined the importance of the standard’s quick release by highlighting the murder of nurse Joyce Grayson late last year. Joyce Grayson was a home health nurse killed by her patient despite many previous warnings to her employer that the patient was aggressive and dangerous. While OSHA did expedite an investigation into this case, and has cited the employer for failing to protect their employees from known hazards, it comes too late for Joyce Grayson.   

Nurses need and deserve a safe workplace. This requires robust evidence-based prevention programs nurses can rely on, no matter where they work. We are extremely disappointed that OSHA continues to deprioritize this live-saving standard and will not stop advocating for nurses’ safety and for OSHA to do its job.  

In addition to the regulatory work, ANA kept up the pressure and conversation on a state level through collaboration with the National Lieutenant Governor’s Association (NLGA). The NLGA represents the elected officials first in the line of succession to the governors in all 50 states and five U.S. territories. The bipartisan organization’s mission is to promote interstate cooperation and knowledge sharing as well as improve the efficiency of the office of lieutenant governor.  

At the April 2024 NLGA meeting hosted by Lieutenant Governor (LG) Pamela Evette, the Executive Committee and other attending LGs unanimously approved our Consensus Resolution on Workplace Violence Prevention in Health Care. The resolution acknowledges the severe nature of workplace violence in health care, urging members to recognize and support programs aimed at mitigating the issues.  

The consensus resolution demonstrates ANA’s commitment to addressing workplace violence through state and national advocacy and, supporting the implementation of comprehensive prevention strategies. This continued effort is vital to ensure the safety and well-being of nurses and other health care professionals. 

From left to right: Top Row: LG Kim Driscoll (D-MA), LG Tahesha Way (D-NJ), LG David Zuckerman (P/D- VE), LG Stavros Anthony (R-NV), LG Sabina Matos (D-RI), LG Jeanette Nuñez (R-FL), LG Deidre Henderson (R-UT), LG Larry Rhoden (R-SD), LG Josh Tenorio (D-Guam). Bottom Row: Secretary of State Omar Marrero (Puerto Rico), LG Garlin Gilchrist (D-MI), LG Pamela Evette (R-SC), LG Adam Gregg (R-IA), LG Aruna Miller (D-MD), Secretary of State Chuck Gray (R-WY) 

You can urge your federal legislators to support the Workplace Violence Prevention for Health Care and Social Services Workers Act through our Action Center. You can also sign up for alerts on all our campaigns at RN Action and stay tuned for more work on this issue at every level of government.

OSHA Slowly Moves Forward on Workplace Violence Prevention 

  

Workplace violence continues to be a profound concern for nurses across the country. 

  • 1 in 4 nurses are assaulted at work.  
  • Health care and social assistance workers face nearly six times the risk of workplace violence (WPV) than other industries.  
  • We hear often that the COVID-19 pandemic has only exacerbated this risk. In a 2022 ANA survey of nurses, 29 percent reported experiencing a violent incident at work in the previous year.

ANA has advocated for decades that the Occupational Safety and Health Administration (OSHA) strengthen WPV protections for health care workers. OSHA is a sub-agency in the U.S. Department of Labor and OSHA’s standards are regulations that require employers to have safety protections in place for their employees. In 1996 OSHA published voluntary guidance for health care employers to help them create effective WPV prevention programs. As research evolved, OSHA updated this guidance, with the most recent edition released in 2016. From the statistics, it does not appear that voluntary guidance has had a significant impact protecting nurses from violence on the job.  

There has never been a federal regulation requiring these prevention programs and clarifying the legal responsibilities of health care employers. When there is no specific standard on a workplace safety issue, OSHA can still hold an employer accountable if inspectors find the employer violated the “general duty clause”. This clause is the basis of the Occupational Safety and Health Act of 1970 which created OSHA. The general duty clause states that employers must maintain “a place of employment which [is] free from recognized hazards that are causing or are likely to cause death or serious physical harm to…employees.” OSHA has held employers accountable for failure to protect workers from WPV under the general duty clause, but WPV prevention has been very hard to enforce without a specific standard. 

OSHA finally moved forward in creating a WPV prevention standard early this year. The first step was to gather feedback on a proposed standard from a Small Business Advocacy Review (SBAR). The Small Business Regulatory Enforcement Fairness Act of 1996 installed this first step in OSHA and other federal agencies’ rulemaking process. Small business employers apply to be on SBAR panels that review and give feedback on the proposed standard to OSHA and the Small Business Administration. The panels are open to the public to listen in, and public comments on the feedback are allowed. This review was completed at the end of March 2023. ANA staff listened to the proceedings and then submitted comments reinforcing the need for this prevention standard so that employers can be held accountable for building an organization specific prevention program. 

OSHA released a report about the SBAR review on May 1, 2023. ANA was disappointed to see that the report gives no timeline on next steps for the rulemaking, but rather recommends further research on many pieces of the proposed standard. OSHA also reopened public comments on the proposed standard and the report until July 3, 2023.

You can visit regulations.gov and submit your own comments. Let OSHA know: Why is this standard necessary? What are the biggest WPV risks you have experienced? What prevention strategies have you seen to be effective in your workplace? 

OSHA’s rulemaking process is driven by research and finding the best evidence-based solutions. This means creating a new rule can take OSHA decades. The Government Accountability Office (GAO) estimates it could take OSHA at least 7 years to create a WPV prevention standard. Rep. Joe Courtney has been a champion against health care WPV. He has led the Workplace Violence Prevention for Health Care and Social Service Workers Act in the House of Representatives for many years. This bill was reintroduced in the 118th Congress on April 18, 2023 with Sen. Tammy Baldwin leading in the Senate. It requires OSHA to release an interim final standard for WPV prevention within a year of passage and a final standard within three and a half years. OSHA already has decades of research to utilize including recent evidence gathered during the SBAR. Nurses and all health care workers cannot continue to wait for this life-saving standard. Visit RNAction today to tell your legislators to cosponsor the bill that will make sure nurses get the protection they need now. 

To learn more about ANA’s surround-sound advocacy approach on WPV prevention, visit the recording of the 2023 Nurses Month Webinar. 

References

https://www.osha.gov/workplace-violence/sbrefa

https://www.nursingworld.org/~4a209f/globalassets/covid19/anf-2022-workforce-written-report-final.pdf

https://www.osha.gov/sites/default/files/publications/osha3148.pdf

https://www.osha.gov/laws-regs/oshact/completeoshact

https://www.nursingworld.org/~496f4b/globalassets/docs/ana/comment-letters/ana-wpv-sbar-comments_final-2023-04-06.pdf

https://www.osha.gov/sites/default/files/OSHA-WPV-SBAR-Panel-Report.pdf

https://courtney.house.gov/sites/evo-subsites/courtney.house.gov/files/evo-media-document/workplace_violence_prevention_for_health_care_and_social_service_workers_act_fact_sheet.pdf

The Power of Hill Day

  

Every membership group has an iteration of “Hill Day,” “Legislative Conference,” or “Fly-in” where its members come to Washington, DC, to speak directly to their members of Congress on issues of importance to the association. Hundreds of members of the American Nurses Association (ANA) will be on Capitol Hill on June 20 for our annual Hill Day. This is a powerful experience and, in many ways, the most basic form of the democratic process. These constituents have the ability to schedule a meeting with their elected representatives or their staffs to discuss issues of importance to them and the association.

Members of Congress will always feel the weight of an issue when the constituent is able to make a personal connection and being able to draw upon those stories is quite effective. For nurses, this might be an instance where you have encountered workplace violence or a lack of resources to effectively perform your job for example.

With the 116th Congress a quarter of the way into its session, it has already been bombarded with special interest groups seeking to meet with members of Congress and their office staffs. These groups have been introducing themselves to freshman members of Congress while solidifying previous relationships with the more experienced lawmakers.

It is truly an incredible experience for nurses and nurse advocates to head up to Capitol Hill for the first time – as well as for those more experienced participants. When a constituent advocates on behalf of a cause they believe in and are passionate about, it empowers them to become more engaged politically and professionally. It enables a person to tangibly connect with their history, with the policies they are fighting for, and allows them to fulfill their civic duty of participating in democracy. Advocating for a cause on Capitol Hill provides citizens the platform to provide critical feedback to a lawmaker and serves as a check on the legislative branch by those it represents.

It is an especially important time for nurses and nurse advocates to take their experience and insights to Capitol Hill. There are many pieces of legislation impacting nurses and their patients gaining momentum in Congress. The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309), the Home Health Care Planning Improvement Act of 2019 (H.R. 2150), and the Title VIII Nursing Workforce Reauthorization Act of 2019 (H.R. 728) are all being discussed by over 400 nurses making their way to Capitol Hill this week. To read more on these pieces of legislation, please visit RNAction. Nurses and nurse advocates must speak in a clear, united voice because when nurses speak, Washington listens. And regardless of the issue our members are advocating for, or whether it is called a fly-in or Hill Day, when you are advocating on behalf of your profession on an issue you care about, it is a powerful feeling. This communication makes a real impact on members and their staffs. We are excited for ANA’s upcoming Hill Day and look forward to the feedback our members will share about their experiences.