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The Occupational Safety and Health Administration (OSHA) has identified violence in healthcare settings as a significant occupational risk, and a new workplace violence standard for the healthcare industry could be on the horizon.

According to data from the U.S. Bureau of Labor Statistics, incidents of violence against healthcare workers increased more than 60 percent from 2011 to 2018, and healthcare and social service workers were five times more likely to experience workplace violence than other workers. The reasons for such violence varies, but factors leading to violence in the healthcare setting may include patients’ or their families’ anger or confusion over medical diagnoses, frustration with staffing shortages, mental health issues, and general outrage over social or political issues.

Studies suggest the COVID-19 pandemic has exacerbated the problem with healthcare workers reporting an increase in threats, harassment, and other aggressive acts against them since the start of the pandemic, including while on duty, on the way to and from work, and on social media. This aggression appears fueled by the fears over the spread of and dangers involved in contracting the virus, and by doctors, nurses, and other healthcare workers being placed at the center of debates about safety restrictions and vaccinations.

OSHA’s Role

Although OSHA has no specific standard on workplace violence, OSHA has made protecting doctors, nurses, and other healthcare workers with direct patient interaction from violence a priority under the General Duty Clause in Section 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970. The General Duty Clause imposes an obligation on employers to provide each worker with “employment and a place of employment … free from recognized hazards that are causing or are likely to cause death or serious physical harm.”

In 2017, OSHA published an updated compliance directive providing OSHA compliance officers with guidance on responding to complaints of workplace violence in the healthcare setting. The guidance recognized workplace violence in healthcare settings as a known risk, specifically at hospitals, residential treatment settings, nonresidential treatment services, home health agencies, community care, and field work.

In 2019, the Occupational Safety and Health Review Commission (OSHRC) upheld a citation issued to a healthcare employer after an employee was fatally stabbed by a mentally ill patient. OSHRC held that incidents of workplace violence fall within an employer’s obligation under the General Duty Clause.

Beyond OSHA, several states have laws or regulations relating to workplace violence in the healthcare setting. For example, among others, California, Connecticut, Illinois, Maine, Maryland, Minnesota, New Jersey, New York, Oregon, and Washington require healthcare employers to implement workplace violence prevention programs. Further, multiple states have increased criminal penalties for assaults on nurses.

Workplace Violence Standard for Healthcare Settings

Given OSHA’s focus on the issue, a new federal workplace violence standard for healthcare settings could be on the horizon. In January 2023, the U.S. Department of Labor (DOL) released its Fall 2022 Statement of Regulatory Priorities, indicating that OSHA will move toward rulemaking on a workplace violence standard for the healthcare industry. Specifically, the DOL said, “OSHA will initiate small business consultations as its first step in developing a Prevention of Workplace Violence rulemaking” with the purpose of providing “protections for healthcare and other care economy workers.”

The announcement comes after OSHA in 2016 published its “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” outlining OSHA’s focus on the “serious hazards” of “job-related violence” against healthcare and social service workers. OSHA later published a request for information (RFI) seeking input on a new standard for the prevention of workplace violence in healthcare and social assistance settings.

The RFI sought feedback from healthcare employers, workers, and other subject matter experts to better understand the scope of problems in healthcare and social assistance settings, interventions and controls currently working in the field, and the feasibility and cost of different options. The agency also considered engineering and administrative controls to reduce violent incidents including eliminating or reducing security hazards, maintaining alarm systems and procedures, limiting access to doors and automobiles, installing bright lighting, hiring trained security officers, maintaining adequate staffing, quickly investigating and responding to complaints, and properly training employees.

OSHA’s new proposed standard would likely require healthcare employers to develop a workplace violence prevention plan that covers workers, patients, clients, visitors, contractors, and others who may come into contact with the healthcare setting. The standard would also likely require employers to provide mandatory training and retain records of incidents within the workplace. Additionally, the standard would likely apply broadly to healthcare facilities, hospitals, drug treatment centers, emergency medical services (EMS), in-home and outpatient care providers, and other healthcare settings.

Key Takeaways

Workplace violence in healthcare settings appears to be a growing issue. Potential rulemaking from OSHA could provide additional guidance for healthcare employers on how to address workplace violence, but will likely also create additional compliance requirements for healthcare employers. In the meantime, healthcare employers may want to review their workplace safety policies and protection plans with respect to how they address potential workplace violence threats.

Ogletree Deakins will continue to monitor and report on developments with respect to a proposed workplace violence prevention standard and will post updates on the firm’s Workplace Safety and Health and Healthcare blogs. Important information for employers is also available via the firm’s webinar and podcast programs.


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