1. Alexander, Mary BS, CRNI

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Figure. Mary Alexand... - Click to enlarge in new windowFigure.

Over the last year and a half, much has been written about workplace safety for healthcare workers. Many journals have focused on needlestick prevention or preparation for disasters like a bioterror attack. Nurses need to feel safe at work so they can concentrate on delivering the best care to their patients. But another safety issue-that of workplace violence-has been part of nursing for many years, and in July 2002 that hit close to home for INS. While on her way home from a patient visit, homecare nurse Viki Mardis, a member of INS' Puget Sound Chapter, was shot and killed in a random act of violence. In early 2001, a psychiatric nurse in Florida was killed by a patient who beat her about the head and face causing severe trauma. Although these are shocking crimes, they are, unfortunately, not unusual. Statistics from the US Bureau of Labor Statistics indicate that there were 674 workplace homicides in 2000-that's 11% of the total 5915 work-related fatalities in the United States, with nurses and aides the most likely victims of assault. 1 It is reasonable to assume that the actual number may be higher because many incidents go unreported. For infusion nurses, violence can occur anywhere-in hospitals, acute care, or outpatient clinics-but as we can see from Viki's tragedy, those who work in homecare also may be at risk.


For many years, the threat of violence in the healthcare workplace was something that nurses accepted as part of the job. The courts have upheld this stance in several cases by refusing to allow healthcare workers to sue patients who attacked them. 2 But more and more, nursing and healthcare organizations are advocating for the right to a safe and secure workplace by calling on employers to use safety procedures and change their organization's physical environment. So what exactly constitutes violence and what can we, as nurses, do about it?


Violence in the workplace can come in different forms. Offensive language, threats, physical assault, or homicide all fall under the National Institute for Occupational Safety and Health's (NIOSH) definition of workplace violence. In April of 2002, NIOSH published a guide to preventing workplace violence that included strategies that employers and workers can use to make their workplaces safer. Some of the environmental prevention strategies proposed by NIOSH include: emergency signaling, alarms, monitoring systems or metal detectors that prevent armed persons from entering a hospital or clinic; cameras, extra lighting both indoors and out, that increase visibility; security escorts for parking lots; enclosed nurses' stations; and private staff restrooms that can further impede violence. 3 Dealing with angry patients or family members in a firm but nonaggressive manner can go a long way toward diffusing a situation. And placing limits on overtime can help nurses stay alert and vigilant about dealing with potentially volatile patients.


As a start to the new year, INS would like to remind infusion nurses and all healthcare workers that safety at work begins with personal safety. Think about the ways your organization can improve safety measures and find out how they can be implemented. It's the best way to ensure your patients receive the best care.




1. Bureau of Labor Statistics. National Census of Fatal Occupational Injuries. Washington, DC: Bureau of Labor Statistics; April 2002. DHHS (NIOSH) publication no. 2002-101. [Context Link]


2. Tumolo J. All in a day's work? NPs combat workplace violence. Available at: Accessed October 17, 2002. [Context Link]


3. Connolly A. Nurses want tougher laws on workplace violence. Boston Business Journal. March 2, 2001. Available at Accessed December 4, 2002. [Context Link]