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Strive to Protect Nursing Home Employees from Patients


Nursing homes are potentially one of the most dangerous workplaces in the country. Nursing assistants in long-term care facilities have the highest incidence of assaults of all American workers, with one study showing that 27 percent of all workplace violence occurs in nursing homes.

The word "violence" with a red circle around it and a line through it

Keeping Records Is Critical

Maintaining thorough records can help ensure a program's success. Among the important files that should be kept are:

  • The OSHA Log of Work-Related Injury and Illness.
  • Medical reports of work injury and supervisors' reports for each recorded assault.
  • Records of incidents of abuse, verbal attacks or aggressive behavior that may be threatening, such as pushing or shouting and acts of aggression toward other patients.
  • Information on patients with a history of past violence, drug abuse or criminal activity recorded on their charts. All staff who care for potentially aggressive, abusive or violent patients should be aware of their backgrounds and histories.
  • Records of all training programs, attendees and qualifications of trainers.

Good records help employers determine the severity of problems, evaluate hazard control methods and identify training needs. Moreover, they are crucial if an OSHA inspector arrives for an inspection of your facility.

Three-quarters of the attacks happen while performing tasks involving close contact with a resident, such as turning and repositioning patients, helping them dress, feeding and bathing. The assailants are often diagnosed with Alzheimer's or other organic brain syndromes. The violence ranges from grabbing, pinching and hair pulling, to hitting, punching and kicking.

Combined with the other safety and health hazards that come with working in residential care facilities, it's little wonder that nursing homes are on the Occupational Safety and Health Administration's (OSHA) priority hit list for safety inspections.

Residential-care facilities, including nursing homes, must have violence prevention polices in place. At the top of the list of reasons is that all employers, under the General Duty clause of the Occupational Safety and Health Act, are required to provide their employees with a workplace free from hazards that are likely to cause serious physical harm or death.

But there are other reasons: Having an effective, zero-tolerance policy against violence helps improve employee morale and productivity, while reducing workers' compensation costs, staff turnover, absenteeism and burnout.

Your facility's policy should be written and understood by everyone affected. To help ensure that your nursing home's policy is up to snuff, here are the main elements of an effective safety program.

Training: This is critical and all employees and management should be involved. Employees should be taught how to prevent or diffuse volatile situations and resolve conflicts. Staff members should also be taught self-defense measures and learn how to recognize and nonviolently deal with agitated and aggressive patients. Also, consider offering courses in stress management and relaxation techniques.

Control: Assess all units in the facility during different shifts with an eye toward problem areas. Talk with employees about the hazards they face and encourage them to report all incidents. Many nursing home employees don't report violence, particularly when no serious injuries result.

Once you assess the hazards, take steps to minimize them. There are many ways to control violence, generally falling under two categories:

1. Engineering/Design

In general, all work areas should be secure and well-lighted. Depending on the nature of the facility, here are some other physical control mechanisms:

In addition, rooms can be made safer for employees by taking these steps:

High standards of maintenance are integral to safety policies. It is crucial that burned out lights and broken windows or locks are promptly repaired or replaced. As well, room temperatures should be kept comfortable.

2. Administration/Management

More information about containing violence in nursing homes is available on OSHA's website.

(In a future article, we'll discuss ways to protect staff from other health and safety hazards.)

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