| 3.23.22

Should the Federal Gov’t Set & Enforce a Workplace Violence Safety Standard for Healthcare Settings? (H.R. 1195)

Do you support or oppose this bill?

What is H.R. 1195?

(Updated February 27, 2022)

This bill would direct the Occupational Safety and Health Administration (OSHA) to issue a federal workplace violence prevention standard requiring healthcare and social service employers to write and implement a workplace violence prevention plan to prevent and protect employees from violent incidents in the workplace. Compliance with the new standard would be required for hospitals and skilled nursing facilities as a condition of their Medicare provider agreements.

This bill would also set minimum requirements for a workplace safety standard and for employers’ workplace violence prevention plans. Those requirements would include: unit-specific assessments and implementation of prevention measures, including physical changes to the environment; staffing for patient care and security; employee involvement in all steps of the plan; hands-on training; robust recordkeeping requirements, including a violent incident log; and protections for employees who report workplace violence to their employer and law enforcement.

An amendment made to this bill during its committee markup made two major changes to it:

For facilities with multiple employers operating in them, it would require procedures for determining which employer (or employers) is/are responsible for implementing and complying with this bill’s provisions.
To create flexibility in the provision of annual training (after initial training), the amendment would allow employers to use live video-conference in cases when in-person training is not practicable, and recognizes that many employees covered by this bill — especially social services workers — don’t routinely visit a centralized workplace.

This legislation would cover a wide variety of workplaces, including: hospitals, residential treatment facilities, non-residential treatment settings, medical treatment or social service settings in correctional or detention facilities, psychiatric treatment facilities, substance use disorder treatment centers, community care settings such as group homes and mental health clinics, and federal healthcare facilities such as those operated by the Veterans Administration (VA) and the Indian Health Service (IHS). It would also cover field work settings, such as home care and home-based hospice, and emergency services and transport services.

For the purposes of this bill, “workplace violence” means the threat or use of physical force against an employee, regardless of whether an injury is sustained.

Argument in favor

Workplace violence is a growing problem in the healthcare and social service industries that puts workers, healthcare outcomes, and healthcare facility security at risk. OSHA had previously agreed to rulemaking to address this problem, but progress on this issue has stalled even as workplace violence against healthcare workers has increased during the pandemic. In the absence of rulemaking momentum at OSHA, Congress needs to step in to legislate on this issue.

Argument opposed

While no one denies that workplace violence against healthcare and social service workers is a problem, the process by which this bill has been drafted is flawed. The opposition of the American Hospital Association (AHA), which represents hospitals and healthcare networks and notes that hospitals already have stringent safety precautions in place, should give lawmakers pause as the AHA’s members are key stakeholders in this issue.

Impact

Workplace violence; workplace safety; workers; healthcare and social services workers; healthcare facilities; OSHA; VA; IHS; and federal standard-setting with regard to workplace violence and employers’ responsibility to keep workers safe.

Cost of H.R. 1195

The CBO estimates that this bill would cost $35 million over the 2020-2024 period, and $60 million over the 2020-2029 period.

Additional Info

In-Depth: Sponsoring Rep. Joe Courtney (D-CT) reintroduced this bill from the 115th and 116th Congresses to address rising rates of workplace violence against healthcare and social service employees such as nurses, physicians, emergency responders, medical assistants, and social workers:

“Health care and social workers have been waiting for years, long before COVID, to have their safety taken seriously while they’re working hard to ensure everyone else’s,” said Congressman Courtney. “This workforce faces more on-the-job violence than any other sector in the American economy and the rates have been on the rise for years, even during the COVID-19 crisis. These incidents are predictable and preventable, and it’s time we ensure workplaces take the steps we know work to avoid them. This is an extremely flexible and bipartisan proposal, and it’s driven by the very workers who are most at risk. I’m grateful for the support of our bipartisan coalition, and especially for the support of nurses, doctors, EMTs, social service workers, and others who have helped us drive this bill farther and farther ahead.”

House Committee on Education and Labor Chairman Bobby Scott (D-VA) adds:

“Health care and social service workers are routinely subjected to threats, assaults, and injury from foreseeable and preventable acts of workplace violence at rates that significantly exceed all other professions. This bill strengthens protections for these frontline workers by requiring that the Occupational Safety and Health Administration issue an enforceable standard within 42 months of enactment that ensures employers adopt plans to address preventable acts of workplace violence.”

In the 116th Congress, original cosponsor Rep. Alma Adams (D-NC) added that thousands of workers are killed or injured on the job each year:

“Every year, more than 850 workers are killed on the job and another 28,000 suffer serious injury. The Workplace Violence Prevention and Social Services Workers Act sends the message that ‘enough is enough’ — setting a national standard that forces employers to take seriously the health and safety of American workers. I am proud to stand with Rep. Courtney and Chairman Scott in support of this effort, and look forward to its consideration by the House.”

During this bill’s committee hearing in the 116th Congress, Reps. Phil Roe (R-TN) and Virginia Foxx (R-NC) raised concerns about circumventing OSHA’s normal rulemaking process. Rep. Roe shared an American Hospital Association (AHA) statement opposing this bill. In its statement, the AHA cited concerns about this bill potentially creating duplicate anti-workplace violence measures for health care facilities that already have such measures in place and allowing only limited opportunity for the public and stakeholders to review and comment on this bill. In a June 10, 2019 letter, AHA Executive Vice President Thomas P. Nickels wrote:

“America’s hospitals and health systems are committed to a culture of safety for every worker, patient and family member who enters our facilities. However, because hospitals have already implemented specifically tailored policies and programs to address workplace violence, we do not believe that the OSHA standards required by H.R. 1309 are warranted, nor do we support an expedited approach that would deny the public the opportunity to review and comment on proposed regulations.”

For himself, Rep. Roe said:

“No one is more interested in having a safe workplace more than the hospitals. What’s the hurry? Why don’t we do this in a bipartisan way? We could have the American Hospital Association in to testify and see what their issues are. That’s what I would recommend.”

Rep. Foxx added that this bill is a “rush to judgment”:

“Health care workers are familiar with the Hippocratic Oath: ‘First do no harm.’ In its rush to judgment, H.R. 1309 does great harm by short-circuiting the public input process and prescribing a specific end result from the beginning.”

Numerous labor and professional organizations representing workers in the healthcare and social services industries support this legislation. They include the American Federation of Teachers (AFT), AFSCME, AFL-CIO, American Federation of Government Employees, National Nurses United, American Nurses Association, American Psychiatric Nurses Association, and others.

This legislation has 145 House cosponsors, including 139 Democrats and six Republicans, in the 117th Congress.

In the previous session of Congress, this legislation passed the House on a bipartisan 251-158 vote with the support of 228 bipartisan House cosponsors, including 220 Democrats and eight Republicans, but was not voted on by the Senate. Its Senate companion, sponsored by Sen. Tammy Baldwin (D-WI), had 31 Senate cosponsors, including 30 Democrats and one Republican, and did not receive a committee vote.

In the 115th Congress, this legislation had 23 Democratic House cosponsors and didn’t receive a committee vote. It didn’t have a Senate companion in the 115th Congress.

Of Note: Bureau of Labor Statistics data shows that up to 30% of hospital workers have been assaulted at work. Employees in psychiatric hospitals have a dramatically higher rate of assault: nearly 50% of emergency room physicians have been physically assaulted at work, and 80% report that this violence has a negative impact on patient care.

According to a 2016 Government Accountability Office (GAO) report, rates of violence against healthcare workers are up to 12 times higher than rates of violence against workers overall. Additionally, in 2016, 70% of nonfatal workplace assaults were against workers in the health care and social assistance sectors. In 2016, a comprehensive review published in the New England Journal of Medicine, “Workplace Violence Against Health Care Workers in the United States,” found that although healthcare and social service sector workers account for only 12.2% of the workforce, they account for nearly 75% of workplace assaults.

The COVID-19 pandemic has exacerbated workplace violence issues in healthcare settings. In November 2020, National Nurses United’s nationwide survey of over 15,000 registered nurses found over 20% of nurses reporting increased workplace on the violence. The nurses attributed the increased violence to decreasing staffing levels, changes in the patient population, and visitor restrictions. Even prior to the pandemic, there was an almost 60% increase in violent incidents in health care and social service workplaces that led to employees being away from work.

Bureau of Labor Statistics (BLS) data also showed an increase in serious injuries due to workplace violence among healthcare workers over the period 2016-2017. In 2016, 13.3 out of every 10,000 health care and social assistance workers work due to nonfatal occupational injuries and illnesses that required them to take time off work; in 2017, that figure rose to 13.7 out of 10,000 full-time workers in the industry. Both the 2016 and 2017 figures for the healthcare and social assistance industry were much higher than the rates for all industries (2.8 days away from work per 10,000 full-time workers in 2016 and 2.7 days away from work per 10,000 full-time workers in 2017).

According to the U.S. Bureau of Labor Statistics Census of Fatal Occupational Injuries, at least 58 hospital workers died due to workplace violence over the period 2011-2016. Workplace violence is the fourth leading cause of workplace deaths overall, according to the National Safety Council.

In its 2016 report, the GAO observed that because relatively few studies on workplace violence prevention programs’ effectiveness have been conducted, it’s hard to know how effective they are. However, in a literature review of five studies, the GAO found that four of the five studies suggested that workplace violence prevention programs can contribute to reduced rates of assault.

OSHA — the federal agency responsible for protecting workers’ health and safety — currently doesn’t require employers to implement workplace violence prevention programs. However, it does provide voluntary guidelines, and can cite employers for failing to provide a workplace free from recognized serious harms. In recent years, OSHA has agreed to undergo rulemaking on healthcare workplace violence. However, action on this stalled under the Trump administration.

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