"Six Die In Workplace Shooting In Mississippi", "Seven Killed in Boston Area Office Shooting", "Gunman kills 1, wounds 3 in Seattle shipyard shooting", "Gunman kills 7 in Honolulu office", "Gunman in Atlanta rampage kills himself; 12 dead, 12 injured"(Reh, 2009) More and more we see this on our television screens and read this in our newspapers. What is triggering this kind of behavior in the workplace? What are the signs? Who commits these acts of violence? The Bureau for Labor and Statistics (BLS) breaks down work place violence into 4 groups: * Criminal - when the perpetrator has no legitimate relationship to the business or its employees and is usually committing a crime in conjunction with the violence (e.g. robbery, shoplifting, or trespassing); * Customer or Client - when the perpetrator has a legitimate relationship with the business and becomes violent while being served by the business (e.g. customers, clients, patients, students, inmates, or any other group to which the business provides services); * Co-Worker - when the perpetrator is an employee, past employee of the business, or contractor who works as a temporary employee of the business and who attacks or threatens another employee; and * Domestic Violence - when the perpetrator, who has no legitimate relationship to the business, but has a personal relationship with the intended victim, threatens or assaults the intended victim at the workplace (e.g. family member, boyfriend, or girlfriend).(BLS 2009) So how do we address these acts of workplace violence in healthcare facilities? The first is to understand that the myths of “It can’t happen here” and “It could not be prevented” are not true. The second is healthcare and social service workers face an increased risk of work-related assaults stemming from several factors. These include:
The commonness of handguns and other weapons among patients, their families or friends; * The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals; * The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care (these patients have the right to refuse medicine and can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others); * The availability of drugs or money at hospitals, clinics and pharmacies, making them likely robbery targets; * Factors such as the unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly; * The increasing presence of gang members, drug or alcohol abusers, trauma patients or distraught family members; * Low staffing levels during times of increased activity such as mealtimes, visiting times and when staff are transporting patients; * Isolated work with clients during examinations or treatment; * Solo work, often in remote locations with no backup or way to get assistance, such as communication devices or alarm systems (this is particularly true in high-crime settings); * Lack of staff training in recognizing and managing escalating hostile and assaultive behavior; and poorly lit parking areas. Healthcare facilities must take greater precautions to ensure the safety of their employees and the best way to make certain that employees are safe is to implement a Workplace Violence Prevention program. The Occupational Safety and Health Act of 1970 (OSH Act)(1) mandates that, in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. OSHA will rely on Section 5(a) (1) of the OSH Act, the "General Duty Clause,"(2) for enforcement authority. Failure to put into practice these guidelines is not in itself a violation of the General Duty Clause. However, employers can be cited for violating the General Duty Clause if there is a known hazard of workplace violence in their establishments and they do nothing to prevent or abate it. (OSHA, 2007) The Crisis Prevention Institute (CPI), along with Paul D. Kim, M.D. and John N. Sabourin authors of VIOLENCE IN THE HEALTHCARE INDUSTRY:"Is your facility ready?" gives us steps managers should take to prevent violence in the workplace:

1. Assess Your Work Environment How many entrances and exits do you have in case of an emergency? They should be known to all employees and visitors alike. A display should be placed in common areas detailing where they (employee or visitor) are and how they can exit from the building. Does your workplace have security? Can you contact them easily? Knowing you have access to security is not the same as utilizing them. If you are uncomfortable about walking to your car, or if you feel threaten by someone you should immediately inform your supervisor and security. If your company does not have a security team you should know how to contact the authorities to acquire assistance.
2. Pay Attention to the Warning Signs * Sudden personality changes. * Job performance suddenly becomes more erratic. * Employee makes open comments about being treated badly, wanting to strike back. * Behavior that suddenly becomes more aggressive, such as bullying and/or intimidating behavior toward supervisors or fellow workers. * Showing off, commenting about use of, or actually brandishing a weapon * Aggressive words spoken aloud that indicates physical retaliation for not having been promoted, transferred, etc. * Obsessions, such as nursing a grudge against a co-worker or supervisor, or from frustrated romantic interests. * Employee is involved in frequent verbal/physical disputes with co-workers or supervisor. For the most part those that commit violence at work have given off the warning signs well in advanced by communicating their unhappiness or dissatisfaction with the supervisor, manager or administration. All threats should be documented and reported.
3. Promote Respect Having a sense of the worth or excellence of a person, a personal quality or ability, or something considered as a manifestation of a personal quality or ability is respect. Communicating this to your co-workers, colleagues, vendors, and all you encounter within the workday can help to ensure an environment free of violence.
4. Eliminate Potential Weapons
Assess your work area are there objects that could be turned into weapons? If so secure them. Do away with those objects that could be used as a weapon. If it is an essential work tool for day- to-day business make sure this is secured after each use.
5. Know Your Violence Response Procedures
Does your company have Violence Response Procedures? Do you know them? The formations of these procedures are intended to reduce even eliminate injury and or death during a violent occurrence at the Workplace. Janice Corbin and Janet May authors of “Strategies for Preventing Workplace Violence” give us these suggestions to use as a base for a workplace violence policy: * A statement that employees are not to engage in any threatening and/or intimidating behavior and/or acts of violence in the workplace or on the employer's premises; * A description of the behavior/conduct that may be viewed as threatening or violent (this list would not be all inclusive); * A statement that an employee may be removed from the workplace temporarily and placed on administrative reassignment while the allegations that the employee violated the workplace violence policy are investigated; * A provision that states that while on administrative reassignment the employee is to check in each day with the employer (phone), and remain accessible to the employer (unless vacation/sick leave had been approved prior to placing the employee on administrative leave); * A statement that the employee, while on administrative leave, is not permitted to be in the workplace or on the employer's premises; * An acknowledgement that the employee may be required to participate in a Fit-For-Duty assessment before returning to duty; * A requirement that all employees are to report any incidents of violence. * A requirement that all employees are to report to management if they are the subject of a restraining order, or have acted to secure a restraining order. * These procedures should consist of a way to alert police. * A safe zone to secure those out of the path of violence. * Policy should also have a quick response team to help with those that may have been injured due to the violence. * Utilize your Employee Assistance Program (EAP) to help obtain assistant for your employees needing help
Using a guide like this one can help in prevention, but can only be useful if team leaders and managers now the policy.
6. Trust Your Instincts Most of us if not all have what we like to call intuition, or gut feelings. If something feels wrong it probably is. Don’t discount your instincts, use your good judgment to head off the confrontational situation, act in response to the circumstances being presented.
7. Use a Team Approach The “Buddy System”, is the best way to keep track of those in the harm’s way and helps reduce injury and casualties in a violent attack at the workplace.
By using these steps or similar ones can help to ensure hospitals and healthcare facilities preparedness in times of disaster and violence in the workplace is a disaster (Kim & Sanbourin 2008). All hospitals have some type of emergency disaster preparedness policy a violence in the workplace policy should be just as important.