Introduction
The healthcare sector is one of the most essential in the U.S., as patients and the community at large need to be assured that they can receive timely, high-quality, and adequate medical care. Unfortunately, due to various factors, including shortcomings in policymaking, numerous problems exist in healthcare, which prevent nurses and physicians from delivering the necessary medical services and improving patient outcomes. One acute concern is that providers are at high risk of becoming victims of violent and aggressive behavior from patients and, in some cases, their families.
The major negative aspect of this concern is that there is no strong federal policy in place to regulate the matter and protect nurses and physicians. Individual hospitals and healthcare associations have their own rules and guidelines. Still, a relevant act should be introduced at the national and state levels to avoid the adverse consequences of increased workplace violence toward medical workers. The Workplace Violence Prevention Act is a federal bill that can reduce the number of patient aggression cases, but it is expected to increase providers’ responsibility and spending, so an alternative solution is needed.
Definition of the Problem
To begin with, it is essential to provide a detailed analysis of the identified issue, supporting its significance and negative impacts with relevant research. When working with patients in a psychiatric setting, medical workers are often at risk of being attacked or facing violence, harassment, and aggression from the people they care about (Dafny & Beccaria, 2020). Bellman et al. (2022) say that “according to the CDC, almost 25% of healthcare workers report feeling bullied, threatened, or harassed because of the nature of their work and ongoing professional responsibilities” (p. 342).
In 2020, 20% of 15,000 surveyed workers reported a severe growth in workplace violence cases, and in the following year, 31% of medical workers claimed an even greater increase (Bellman et al., 2022, p. 342). Numerous factors contribute to the problem, and “the mental burden imposed by difficult patients” is among them (Bellman et al., 2022, p. 342; Kafle et al., 2022). While systemic changes adopted by individual facilities should be quite effective, it is more important to address the issue at the national level.
As mentioned earlier, there is no single strong federal policy that would regulate the problem and help healthcare leaders protect their medical staff from patient-to-worker and patient-to-patient violence. However, since 2021, policymakers have strived to achieve more support for the Workplace Violence Prevention for Health Care and Social Service Workers Act (WPV) (Falcone, 2023; National Nurses United, 2022).
Introduced by Democratic Representative Joe Courtney and reintroduced recently, H.R. 1195 has garnered tremendous support from various associations, including the American Nurses Association (ANA), the American Federation of Teachers (AFT), and National Nurses United (NNU), among others (Falcone, 2023). However, the Workplace Violence Prevention Act also faces severe critique from other experts, who doubt that H.R. 1195 can improve the situation.
The act seeks to address the primary factor that contributes to the growth of reported and non-reported cases of workplace harassment. According to National Nurses United (2022), the focus will be on mandating that the Occupational Safety and Health Administration (OSHA) issue a national standard that holds employers more accountable for incidents of workplace violence. In accordance with this standard, employers will develop more comprehensive and efficient workplace aggression prevention plans, thereby contributing to the solution of this concern (National Nurses United, 2022).
Currently, OSHA provides guidance on how such cases can be prevented and addressed, but a federal approach is necessary (Falcone, 2023). Under this policy, employers must implement risk prevention and assessment plans, provide effective workplace prevention training, and investigate occurrences of workplace violence (Congress, 2021; Falcone, 2023). These factors enable many supporters of the act to assert that it will undoubtedly improve the situation and contribute to a reduction in cases of patient aggression toward nurses and physicians.
Nevertheless, severe concerns related to the identified act do not allow all experts, providers, and policymakers to support its enactment. For example, the American Hospital Association (AHA) asserts that this bill will impose high costs on U.S. hospitals, with those in underserved and rural areas likely to bear the greatest burden (Falcone, 2023). Patient care will be jeopardized, and providers who strive to offer affordable and high-quality services will face certain struggles.
Virginia Foxx, the Republican Leader of the Education and Labor Committee, supports this opposition to the act, stating that it is “the wrong solution to a serious problem” (Falcone, 2023, para. 22). The statistics also raise concerns related to the act. Public facilities and private organizations are expected to pay at least $100 million and $1.8 billion in the first two years and then $55 million and $750 million each year, respectively (Falcone, 2023). These factors do not allow all policymakers, providers, and experts to support the bill, despite their genuine understanding of the severity of the problem it addresses.
Lastly, this act can be analyzed using two approaches. Kingdon’s Policy Streams Model suggests that it is crucial to consider three critical areas, and if any of them are overlooked, the policy can become weak (Mason et al., 2021). Referring to the problem stream, H.R. 1195 addresses a specific issue and aims to hold employers more accountable and responsible for workplace violence cases. However, the policy and the political streams are unstable (Mason et al., 2021).
Firstly, not all researchers and stakeholders find the act feasible and effective, as mentioned earlier (Falcone, 2023). Secondly, the economic burden and the general levels of distress caused by the COVID-19 pandemic are barely taken into account in the identified act. Thus, in H.R. 1195, the three streams do not align completely to move through the open policy window simultaneously.
Another approach can also be used to learn whether the act is strong or weak. Mason et al. (2021) indicate that Longest’s Policy Cycle Model comprises three stages: policy formulation, implementation, and modification. Overall, one might say that the first phase was prepared perfectly by Democratic Representative Joe Courtney, who shared their personal experience related to the problem and gathered the stories of other medical professionals (National Nurses United, 2022). The act has a specific goal and background, which makes it relevant and deserving of attention.
H.R. 1195 is currently at the implementation stage, gathering support and critique from stakeholders and experts, and incorporating certain amendments to better align with the general requirements (Congress, 2021). Since it is not possible to evaluate the third phase at this time, one can only state that the act is relatively strong, based on Longest’s Model. Nevertheless, considering the drawbacks of this act and the doubts of some experts, it is essential to propose alternative options.
Policy Options to Address the Issue
First Option
Some efficient alternatives can be offered to address this concern and ensure that nurses and physicians are better protected when working in psychiatric settings. The first option to explore is related to one of the factors that contribute to the deterioration of the problem. According to Walker (2022), many criminal defendants who are found incompetent to stand trial fail to receive timely and adequate mental health treatment. To be more precise, Minnesota HF2725 is a bill that seeks to establish better regulation of the competency restoration process for such persons.
Special forensic navigators will be hired to assist defendants in accessing the necessary medical and mental health care, thereby preventing them from being left without treatment and support (Walker, 2022). This consideration might become a beneficial component of a law that oversees the reduction of workplace violence in psychiatric settings. Under HF2725, fewer cases of dangerous persons with mental diseases will be released without proper care. Therefore, these defendants will not have an opportunity to access healthcare services in other organizations and attack nurses and physicians (Wasser, 2019). Proper regulation and guidelines will help such individuals receive adequate treatment, thereby protecting medical workers from these patients.
This policy option has both advantages and disadvantages. Firstly, it does not directly address the matter, so the act itself cannot be considered an alternative to H.R. 1195 – it should be viewed as a crucial component that can help enhance the situation. Secondly, it will require increased costs, including the financial resources needed to hire competent forensic navigators, support their practice, and ensure that defendants receive adequate treatment, regardless of their competency (Walker, 2022). As for the strengths, this policy will address several issues simultaneously, enhancing patient outcomes, improving community safety, and ensuring that fewer nurses and physicians in an average medical facility can encounter a mentally unstable criminal defendant.
Second Option
Two other states’ legislation can serve as an example of effective efforts and become an alternative to the selected bill. Thus, “in 2018, the Maryland Nurses Association and Maryland Hospital Association (MHA) created a steering committee aimed at preventing violence in hospitals” (Livanos, 2023, p. 82). A major part of the general responsibility and effort lies with this association, which helps hospitals and relieves the burden they would have faced if they had to create their own policies, plans, and guidelines. The committee’s objectives are to guide individual healthcare providers on their path to reducing workplace violence (Atlas, 2019). This is done primarily by introducing early prevention protocols and implementing hospital-based SAFE plans.
Furthermore, Maryland introduced a bill aimed at improving the safety of healthcare workers, not potentially, but specifically, through a precise action. According to Livanos (2023), “the bill, House Bill 364, amended a law requiring the full first and last name of the employee to be displayed on their badge” (p. 82). Research shows that such personal information that any patient can see allows unscrupulous persons to use it against medical workers (Livanos, 2023).
If a patient wants to harm a nurse, knowing their full name increases the risk that this client will stalk the employee or use cyberbullying methods, threatening or attacking the nurse emotionally or physically (Livanos, 2023). Therefore, the states of Pennsylvania and Maryland passed similar bills, aiming to eliminate this potential risk and improve the safety and partial confidentiality of medical workers. Reviewing this option and including this bill’s objectives in the recommended policy would be rather effective.
This alternative also has some weaknesses and strengths, which prove that it is feasible and deserves attention, but needs some additional modifications or considerations. The primary advantage is that the policy offers an immediate solution that can partly address the identified concern. Having less information about medical employees means that patients cannot harm, attack, or harass them physically or emotionally in the long term, so the rates of workplace violence can be decreased to some extent (Kafle et al., 2022). In other words, this bill represents a small but significant step that effectively addresses a limited aspect of the major problem.
Moreover, it does not require many resources to have a positive impact. Unfortunately, the bill’s narrow focus may also be its weak feature, in addition to the potential for certain side effects, including reduced trust and confidence among patients. Regarding the steering committee in Maryland, it requires financial support to operate; however, its benefits outweigh the costs. Since it consists of experts dedicated to improving healthcare, it is more efficient in creating guidelines and policies than individual hospitals. However, such a committee may fail to adapt the rules and interventions to the specific needs of certain facilities.
Policy Recommendation
One might notice that the recommended policy should include all the strengths of the mentioned bills and interventions to serve the needs of the target population. To mitigate the anticipated pressure on employers if the Workplace Violence Prevention Act is enacted, the government should take a more proactive role in enhancing the safety of medical staff. First, although a single regulation cannot be efficient in all hospitals (Livanos, 2023), it should not be the task of individual providers to develop risk assessment and violence prevention policies. The authorities and some major healthcare and occupational associations should offer financial support to hospitals and help them improve the safety of nurses, physicians, and other workers.
Further, personal information should not be available to patients, so the policy should follow the example of Pennsylvania and Maryland, leaving only employees’ first names on their badges. As for education and training, hospitals should receive them with the help of the government, using developed and approved programs. Lastly, the policy should cover other aspects that contribute to the problem’s deterioration, including the inability of mentally ill criminal defendants to receive proper medical support, which results in the potential increase in the rates of patient violence.
When discussing the possible outcomes of this recommended policy, one should refer to the enhanced engagement of hospitals and better protection of medical workers. Patients will have fewer options for harming the staff, and if they do or show any indications of aggressive behavior, providers will have prevention plans to follow. Therefore, expected outcomes are likely to be achieved, allowing us to meet the primary goal of reducing workplace violence cases.
The policy will likely serve most people fairly and equitably for several reasons. For instance, it will make the authorities and impactful associations more responsible for addressing the issue, requiring them to support individual hospitals financially and offer standards and developed guidelines. Providers will be more eager to report cases of violence and harassment and protect their medical workers, knowing that this is not only their financial responsibility. As a consequence, there will be fewer instances of employers taking retaliatory actions against workers who report being verbally or physically attacked.
Political Environment
Eventually, it is essential to propose strategies to generate support for the policy among stakeholders and policymakers. Many methods and tools can be useful to promote a bill’s promised efficiency, attract co-sponsors and supporters, and reduce potential opposition. To begin with, influential associations and organizations stand for the effectiveness of the WPV. It should be highly advantageous to explain the value of another option to various organizations, such as the OSHA, ANA, AFT, NNU, AHA, American Psychiatric Nurses Association, and others. If these associations recognize the strongest sides of the proposed option, they will support it and participate in raising the awareness of the public and policymakers.
Another way to engage stakeholders and attract the community’s attention to the problem and proposed policy is also quite beneficial. According to Mason et al. (2021), nurses and other healthcare workers can become active participants in promoting legislation. Therefore, it should be effective to inform healthcare employees who faced workplace violence about the policy and ask them to share the information about it on social media or with their colleagues. They can also refer to their state representatives or local healthcare associations to seek their support. In other words, the more stakeholders become engaged in promoting the policy, the more likely it is that it will be enacted.
At the same time, specific strategies are also required to attract medical workers and secure their support or active participation. Stellefson et al. (2020) highlight the positive effects of social media. People should be able to access detailed information about the proposed legislation online, including its objectives, benefits, potential weaknesses, ways to address them, and other important details. It should be effective to share real-life stories of nurses and physicians who have experienced physical or verbal harassment from patients and include their sincere opinions about the policy. These steps will draw attention to the bill and increase public and policymakers’ support.
Conclusion
To conclude, the need for a well-thought-out and efficient federal act that addresses the identified concern is evident. Rates of workplace violence that medical employees face when working with patients are growing rapidly, but there is still no legislation to eliminate the threat at the national level. Local efforts are successful to some extent, but they cannot make a significant contribution to protecting nurses and other medical staff.
The WPV Act is a major attempt by Democrats to fill the gap; however, its key weakness is that individual hospitals, rather than the authorities, will experience financial pressure. It would be more efficient to combine this bill with two other identified alternatives, thereby preparing a new policy that is strong enough to address the problem. It will require the government and reputable healthcare associations to develop training programs and offer financial support to hospitals to implement the interventions. Factors that contribute to the issue, such as budgets with full names and the lack of care for mentally ill criminal defendants, should also be taken into consideration.
References
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Congress. (2021). H.R.1195 – Workplace violence prevention for health care and social service workers act. Congress.gov.
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Walker, T. (2022). House passes bill aiming to close ‘treatment gap’ for those found incompetent to stand trial. Minnesota Legislature.
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