Brandy Welch, RN, a pediatric nurse in Long Beach, never thought she would experience workplace violence. She cared for children. All that changed when a distraught, autistic boy threw a 20-pound chair straight at her. She managed to catch the chair with her right hand, saving both her and the boy’s mother from being hit. But her arm was damaged in the process, and she now struggles with even basic tasks, from walking her dog to hanging IV bags.

As registered nurses, we are all Brandy Welch. We are all Cynthia Palomata, RN, who was killed by a patient in 2010. With our very lives, RNs embody the fact that healthcare workers experience higher levels of workplace violence than all other occupations. And to protect our patients, registered nurses have long known that we must ensure a safe working environment in which to provide high quality care.

That’s why it was such a groundbreaking victory last week when the California Occupational Safety and Health Standards Board voted unanimously to approve nation-leading regulations to prevent workplace violence in hospitals and healthcare settings.

The regulations—the most comprehensive in America—are the culmination of two years’ worth of public testimony, lobbying, and direct action by nurses to implement SB 1299, state workplace violence prevention legislation that California Nurses Association/National Nurses United (CNA/NNU) sponsored. The law passed in 2014 – after nurses stood up to a healthcare industry that challenged us every step of the way.

Nearly 100 CNA/NNU nurses gathered again last week to encourage the Board to approve the regulations—many of the nurses, like Welch, personally testifying to the regulations’ importance.

“I no longer feel safe at work, and I know this injury will chase me through my life and career. Workplace violence should not be part of the job,” said Welch, noting that if common workplace violence prevention practices—such as bolting heavy furniture to the ground—had been in place, she would not have been hurt. 

CNA co-president Deborah Burger, RN, advised the Board, “All the nurses in this room either know someone or have themselves experienced physical violence, threats, and assault while on the job. They all experience the fear and frustration of knowing that the procedures their employers have in place are not enough to prevent violent acts from occurring, or to respond adequately and supportively when they do.”   

And that’s just it: the procedures under which healthcare employers have been operating have not been enough. Violence in healthcare settings has been pervasive despite known ways of reducing risk, such as appropriately staffing units, and engineering the physical environment to protect staff and patients. But it was not until passage of the CNA/NNU-sponsored legislation and resulting approval of the regulations—that risk reduction measures will move toward being mandated.

Nurses know that two key aspects of the workplace violence regulations are critical to their strength:

Planning. The new standards specifically require hospitals to include nurses and healthcare workers in developing comprehensive plans to prevent workplace violence.  The standards also require hospitals to implement these plans, provide all the training needed, and conduct an annual review to correct any problems.  

Prevention. Because increasing punishment for perpetrators after the fact does nothing to protect workers, nurses laud these regulations for their emphasis on prevention over criminalization. The regulations—protecting against both threats and acts of physical violence—require employers to identify and evaluate environmental risk factors for each individual facility, unit, service, or operation. Employers will also be required to use engineering and work practice controls to mitigate or eliminate hazards, by removing sight barriers, installing alarm and surveillance systems, and securing objects that can be used as weapons.

No other state, nor the federal government, has established these kinds of sensible and effective workplace violence prevention regulations for healthcare workers.  Registered nurses hope that this victory will become a model for other healthcare facilities throughout the country, as well as other industries.

Caring for others should not be a life-threatening endeavor, and nurses will keep advocating until workers, patients and members of the public—across America—are protected from workplace violence.