About Hospital Safety Center  
Career Center  
Contact Us
       Free Resources
Hospital Safety Insider

Mac's Safety Space  
        News & Analysis
Healthcare Safety Leader  
Environment of Care Leader  
Forms and Checklists Library  




OSHA updates workplace violence rule


June 1, 2015

OSHA updates workplace violence rule

High injury rates from workplace violence spurs recommendation for employers to take action


Editor's note: Thomas A. Smith, CHPA, CPP, president of Healthcare Security Consultants in Chapel Hill, North Carolina, and former director of hospital police and transportation at University of North Carolina Hospitals in Chapel Hill, contributed to this article.


OSHA in April released an update to its Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers, known to many in the safety field as OSHA Rule 3148.

This document was first published in 1996 and later updated in 2004. The 2015 version provides updates to the statistical information on workplace violence incidents and some additional references for deeper reading in specific subject matter such as the International Association for Healthcare Security and Safety Security Design Guidelines for Healthcare Facilities.

According to the Bureau of Labor Statistics, in 2013 more than 23,000 significant injuries were caused due to assaults at work. More than 70% of these assaults were in healthcare and social service settings. Healthcare and social service workers are almost four times more likely to be injured as a result of violence than the average private sector worker, OSHA says. Further statistics show that about 30% of the fatalities in healthcare and social service settings occurring in 2013 were due to assaults and violent acts. As a result, OSHA issued the update to OSHA 3148, encouraging healthcare workplaces to develop a workplace violence prevention plan.

"It is unacceptable that the people who dedicate their lives to caring for our loved ones often work in fear of injury or death," said Assistant Secretary of Labor David Michaels in a statement from OSHA. "This updated booklet will help employers implement effective measures to reduce or eliminate workplace violence hazards."

While the updated rule was quietly released by OSHA, healthcare safety experts say it was only a matter of time before the agency responded to the increased rate of workplace violence. According to some safety experts, The Joint Commission is giving serious consideration to incorporating the new OSHA rule into its survey recommendations, but nothing official is expected any time soon.

"I think it's safe to say hospitals are taking this seriously," says Dan Scungio, MT(ASCP), SLS, laboratory safety officer for Sentara Healthcare, a multihospital system in the Tidewater region of Virginia. "There has been much activity around workplace violence at Sentara involving raising awareness, and this is in response to news around the country of events."

Active shooter incidents and violent incidents are becoming more of an occurrence in U.S. hospitals, once largely viewed as non-violent places.

One of the most recent incidents occurred in Boston in January, when a prominent surgeon was murdered by a disgruntled patient who walked into a hospital with a gun. In that case, Stephen Pasceri, 55, of Millbury, Massachusetts, walked into the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women's Hospital and specifically asked for the doctor, Michael J. Davidson, MD. When the two stepped into an exam room to speak, colleagues reported hearing loud voices and then two shots fired. Police found that Davidson had been shot twice, and later located Pasceri's body in a separate exam room, dead from an apparently self-inflicted gunshot. Davidson died of his injuries.'''

The shooting spurred other Boston hospitals to conduct their own security assessments, and others have been considering increasing visitor pat-downs and security patrols, as well as possibly installing metal detectors.


OSHA recommendations

The updated OSHA 3148 guidelines start with recommendations for developing an effective workplace violence prevention program. These include:

  • Management commitment and employee participation
  • Work site analysis
  • Hazard prevention and control
  • Safety and health training
  • Recordkeeping and program evaluation


According to OSHA, the guidelines are meant to take into consideration variations in healthcare settings and incorporate the latest and most effective ways to reduce the risk of violence in the workplace, since hazards can vary greatly between, say, a medical clinic and a hospital. The settings covered in the guidelines are as follows:

  • Hospital settings represent large institutional medical facilities
  • Residential treatment settings include institutional facilities, such as nursing homes, and other long-term care facilities
  • Non-residential treatment/service settings include small neighborhood clinics and mental health centers
  • Community care settings include community-based residential facilities and group homes
  • Field work settings include home healthcare workers or social workers who make home visits


"Indeed, these guidelines are intended to cover a broad spectrum of workers … and other support staff who come in contact with clients with known histories of violence," according to the new OSHA guidelines booklet. "Employers should use these guidelines to develop appropriate workplace violence prevention programs, engaging workers to ensure their perspective is recognized and their needs are incorporated into the program."

The new OSHA guidelines are very specific in the types of workplace controls that employers should consider, especially when it comes to facility security and keeping track of employers. Examples include:

  • The use of silent alarms and panic buttons in hospitals and medical clinics
  • Providing safe rooms and arranging furniture to make sure there are clear exit routes for workers and patients
  • Installing permanent or handheld metal detectors to prevent visitors from bringing in weapons, and providing staff training on the use of these devices
  • Ensuring nurse stations have a clear view of all treatment areas, including the use of curved mirrors and installing glass panels in doors for better viewing, as well as closed circuit cameras to help monitor areas
  • Using GPS, cell phones, and other geolocation technology to help keep track of staff working with patients in off-site locations
  • Protecting front-end and triage staff by using facility design elements such as deep counters, secure bathrooms for staff separate from patient treatment areas, bulletproof glass, and lockable doors with keyless entry systems


In addition, the recommendations include employing administrative controls to track patients and visitors who have a history of violence, better educating workers on the dangers and signs of impending violence, and ensuring improved reporting procedures. Specifically, they call for:

  • Providing clear signage in the facility that violence will not be tolerated
  • Instituting procedures that require off-site staff to log in and log out, as well as checking in with office managers periodically
  • Keeping a behavioral history of patients, including identifying triggers and patterns
  • Establishing staggered work times and exit routes for workers who may be subjects of stalkers
  • Keeping a "restricted visitor" list for suspected violent people, such as gang members, and make sure all staff are made aware of this list


Also, OSHA recommends that employers provide updated training for employees, including:

  • Factors causing or contributing to violent incidents
  • Early recognition of escalating behavior or recognition of warning signs
  • Ways to recognize, prevent, or defuse volatile situations or aggressive behavior, manage anger, and appropriately use medications
  • Proper use of safe rooms?areas where staff can find shelter from a violent incident
  • How to apply restraints properly and safely when necessary
  • Ways to protect oneself and coworkers, including use of the "buddy system"
  • Self-defense procedures where appropriate


For more information on the guidelines, visit www.osha.gov/Publications/osha3148.pdf.

Subscribe Now!
Sign up for our free e-newsletter
About Us | Terms of Use | Privacy Statement | Contact Us
Copyright © 2020. Hospital Safety Center.