Congress has summarized this bill as follows:
This concise summary is a beautiful “tl;dr”, but if you are anything like me, you’re wondering what the other 33 pages say. Let’s break this down section by section. If, at any point, this becomes a bit much, you can always contact us to ask questions.
Let’s start at the beginning. This bill opens with the goal, “To direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan.” (Page 1 lines 1-2) In the sections that follow, background reporting of data indicating the urgent need for this legislation is reported. This begins on page 2, line 5, and continues until page 4, line 7.
There is then a description of how OSHA has worked on this standard thus far. There have been guidelines developed but these guidelines are unenforceable, therefore making them optional. To date, the only real recourse for recognized hazards has been OSHA’s General Duty Clause. Unfortunately, this lacks specificity in the context of healthcare workplace violence and is often challenged by employers as unenforceable, in spite of violence being a known, recognizable danger in the workplace in healthcare and social services.
In 2016 and 2017, OSHA stated they would develop a standard specific to prevention of violence in healthcare. To date, none of this has happened. “Therefore, legislation is necessary to ensure the timely development of a standard to protect workers in healthcare and social service settings” (p 5, 22-24).
After these introductory pages, we find ourselves in the section that defines the workplace violence prevention standard. There is to be an interim standard which is developed in the first year. Employers are to develop prevention plans in this period. It is expected that this will be based on the above mentioned guidelines previously released by OSHA. This interim standard must be enacted within 30 days of promulgation, and can present a reasonable phase-in timeline regarding engineering controls. This interim version of this legislation is enforceable, including if this is not developed within a year of promulgation.
Beginning on page 8, line 24, discussion of the final standard begins. This final standard requires OSHA to have completed development of a final standard within two years of promulgation of this act. At minimum, the standards of the interim standard must be part of the final version. By 42 months, the final standard must provide no less protection than other OSHA standards, and must be no less enforceable than other OSHA standards.
The section that follows gives a list of covered employers, facilities, and employees who are required to adhere to these guidelines. If you are a healthcare or social services worker and you do not see your workplace listed here, contact us.
Now for the most important part: what are the requirements expected in this bill?
- Develop and implement a WPV plan
- Include direct-care employees in its development
- Specific plans to each specific work area’s risk factors
- Be suitable to available size & available resources at all hours of operation
- Content must include procedures and methods
- Proper delegation of which roles each person should have
- Take into consideration current risk factors and past incidents
- Review prior incidents
- Input required by direct care employees
- Input required by the employer
- Hazard prevention, addressing engineering and administrative controls, which will include reduction of risk factors and timely responses to escalating situations
- A reporting system with an official post-incident response and investigation, including debriefing with employees and representatives
- Provision of medical care
- Emergency response plans, including to threats of violence and/or mass casualty incidents
- Communication and training covering:
- Violence hazards
- The employer’s plan
- Responding to, confronting, and reporting violence and/or threats
- Reporting incidents and/or concerns
- Employees’ rights
- Coordinated risk assessments with employers who also have staff in the facility in question (travel staffing, physician staffing, etc.)
- Annual re-evaluation of plan
- This plan must be available to staff at all times
If there is an incident of assault, this standard will require it be investigated. This investigation must be conducted as immediately as is possible. After discussing with those employees who were affected, it is required to determine whether anything in the prevention plan was effective, whether anything could have or should have been different to produce a better outcome, and document these findings. Changes should be made to reflect the outcome of the situation.
Training for management should include recognition of hazards in order to assign staff in such a way that violence is prevented, and that high-risk situations are lessened. When possible, employees should be assigned so as to increase their safety. New employees should go through training before receiving patient assignments. Training should be interactive, with ways to follow up for more information.
Record keeping must include findings of risk assessments, corrections of those risks, training procedures, violent events in a log dedicated to recording incidents, outcomes of investigations of those incidents. These records and logs should be made available on request to all staff, including photo copying. HIPAA compliance still applies.
Incident log templates will be created by the Secretary of Labor, and will include at minimum:
- The incident
- Environmental risk factors
- Date, time, location of incident
- All employees present
- Nature and extent of injuries
- Classification of assailant (patient, visitor, stranger, etc.)
- How the incident was abated
Annual evaluations will determine adjustment needs. These evaluations will be done in writing, with participation of covered employees, and be available to employees.
Among one of the most important parts of this bill is its anti-retaliation requirement. This begins on page 25 line 16. Reporting an incident or concerns is a protected act in this legislation. This is enforceable.
The remainder of this bill discusses some definitions, and clarifies it is its own standard, enforceable as any other. There are definitions of some key terms in discussing workplace violence in healthcare and social services. Overall, though, the above is the content of this bill.
I know this is a lengthy read, but I hope it takes away some of the intimidation of reading legislation in general. To be effective at advocating for legislation such as this, it helps to understand what it is saying.
What this bill does:
- Lets employees identify and reduce risk factors they see in their own workplaces
- Allows hospitals to choose for themselves how to approach and solve this crisis
- Allows floor staff to make note of things they observe every day
- Reduces risk factors, thereby doing all we can to reduce life-threatening (sometimes life-ending) assaults
What this bill does NOT do:
- Blame employers if an assault happens
- Require employers who have plans in place to reinvent the wheel
As always, if you have questions, you are welcomed to contact us anytime! We hope that you will consider joining us on July 10, 2019 as we contact congress on our National Call-In Day! For more information on that, visit our FAQ, and share our poster!