Staff Matters Newsletter Summer 1995
Cover Me, I'm Going To The Copy Machine:
Violence In The Workplace
By Steve O'Connor

Writing about a difficult subject requires structure and perspective. My tenth grade English teacher, Sister Catherine Paul, taught me two absolutes about writing. First of all, write about what you know, and secondly, every story has a beginning, a middle, and an ending. I have no personal experience with violence in the workplace, except for that unfortunate mishap years ago when my boss "accidentally" slugged me in the stomach. But that's another story.

Let's begin this frightening subject with a definition and its impact on the health care system. Rollo May, American psychologist and therapist, says in his book, Love and Will, "Deeds of violence in our society are performed largely by those trying to establish their self-esteem, to defend their self-image, and to demonstrate that they, too, are significant . . . Violence arises not out of superfluity of power but out of powerlessness." Violence in the workplace often arrives at the hospital doorstep. We are all familiar with the increased utilization of our emergency rooms caused by the proliferation of violence.

Leroy Schwartz, M.D., president of the Health Policy International, has written about the medicalization of social problems. He writes, "The need for extensive health care is heightened by our tendency to medicalize these problems. Medicalization is taking a behavior which society considers deviant, attaching a medical term or label to it, and treating it through the health care system." In comparing the seven main industrialized countries of the world, it is clear that the United States has significantly more homicides and serious assaults per 100,000 population than our developed neighbors.

Sister Catherine Paul would tell me to begin this story at the beginning. In the employment arena, that is at the point of hire. Screening applicants for a safer workplace is tricky business, indeed. There are those who believe that workplace violence can be solved by carefully screening job applicants and developing profiles of persons with the potential to become violent. However, employers considering this must be aware of liability issues. Because employers may be sued for discriminating against job applicants with criminal histories, screening is not a panacea. Recent interpretations of the ADA further complicate this screening process. According to the EEOC, before acting on the basis of a predicted profile employers must examine five factors to determine whether the worker poses a direct threat:

(1) a significant risk of substantial harm
(2) a risk specific to the individual
(3) a risk specific to the current circumstances
(4) a risk based on objective evidence
(5) a risk that cannot be reduced through reasonable accommodation.

Clearly, it is difficult to screen out potentially violent employees, but we must use every legal method to attempt to do so.

The middle of this discussion should be focused on preventing violence and protecting our employees. There are at least two things an employer can do to deal with workplace violence. The first is to fully utilize the employee assistance program (EAP) at the hospital or in the community. EAP providers are recognized for their employee counseling skills and are qualified to handle such situations. EAP professionals can often detect early signs of workplace aggression. The second step an employer can take is to perform a formal workplace violence "assessment of vulnerability". Violent acts can happen in any organization at any time. However, there are certain factors that increase the probability of violent actions. In order to assess the risks, some human resource professionals are turning to a standardized violence assessment questionnaire. In its publication entitled, "Deflecting Workplace Violence", HURECO, Inc. has provided an assessment tool. It consists of 20 questions which help workers rate "workplace culture" issues on a scale of one to six. The total score indicates the organization's low, moderate, or high probability of violence occurring in this workplace. Acting upon this information and publicizing the results can be a large step towards preventing violence. It can also display an overt gesture of support and sensitivity toward an anxious workforce. HURECO Inc. can be reached at (703) 359-2470. Since each case is unique, it is dangerous to promote a treatment without first diagnosing the problem. As Emerson said, "We all boil at different degrees."

Terminating an employee is the end, and a very common circumstance in which violence may erupt. Drafting dismissal guidelines can help prevent violent situations. Gavin deBecker in Federal Human Resources Weekly states, "The way a company handles a dismissal can determine whether the employee becomes violent". deBecker provides the following guidelines in dismissing an employee: (1) make the termination complete. Once the decision to fire someone is made, the termination should be clear and final. (2) Do not negotiate. The termination has only one purpose: to inform the employee of the decision, not to discuss the issues again. (3) Keep the discussion future-based. Avoid discussions of the past by talking about the future. (4) A higher-level manager than the employee's immediate supervisor should conduct the termination. Have someone present whom the employee admires. Even people about to be dismissed will be on their best behavior if they feel that they have a good reputation with someone in the room. (5) Know who should not be present. Security guards and local police should not be present because they will send the wrong message. Don't have supervisors at the meeting who were involved in the day-to-day controversies with that employee.

Inherent in a structured plan to deal with workplace violence is an open display of support and sensitivity from top management. It is absolutely critical that the chief executive and other members of the management team make a conspicuous effort to communicate to the employees that they are taking every step to protect them. This is especially important in a patient care environment. The caregivers in our hospitals must feel secure at work. They must know their employer is aware of the potential problem of violence and is doing something about it. Our mission as health care providers is to care for the victims of society's craziness. We cannot let our employees become victims themselves. I think Sister Catherine Paul would have been pleased with my story but saddened by the need to write it.