As the demand for home healthcare grows, so does the risk of workplace violence for home health nurses. U.S. Bureau of Labor Statistics reports that home healthcare is one of America's fastest-growing industries, with a projected compound annual growth rate of 5% for 2014-2024, which equals approximately 760,400 new jobs. With patients' continued preference to remain at home and advances in telemedicine, home health nurses will continue to be a major area of growth within the healthcare industry. Workplace violence has long been a challenge in health care, with healthcare workers accounting for 73% of all nonfatal workplace injuries and illnesses due to violence in the U.S. prior to 2019. Unfortunately, studies continue to show that workplace violence incident rates increased during the COVID-19 pandemic. And although certain clinical settings, such as emergency departments or psychiatric/behavioral health units, have high rates of workplace violence incidents, home healthcare workers are often placed in situations that make them particularly likely to encounter workplace violence.
Home health risk factors
Home health nurses are often the only caregivers present while delivering home healthcare. This can result in an unprotected environment, depending on the patient's behavior. Other people in the home, such as a friend or family member may also be responsible for causing workplace violence. Verbal abuse from the patient, family members, or others in the care setting is considered a form of workplace violence, along with physical abuse, stalking, or threats of abuse. Cara Lunsford, RN, Founder and CEO of HOLLIBLU and Vice President of Community at Relias, has long understood the physical and mental implications of providing home health nursing care. "Home health and hospice can be challenging, and at times, come with some major safety concerns," Lunsford explained.
"Nurses are expected to go into private homes, sometimes in the middle of the night, without any prior knowledge of the family dynamics that exist within that household. Sometimes patients or family members are struggling with mental illness which can put the home health nurse in a very vulnerable situation if the environment proves to be unsafe," she added.
Impacts of workplace violence
The nursing profession is challenging on its own, but workplace violence incidents can bring added stress and difficulties to the role. One study involving home care nurses found that exposure to workplace violence was associated with greater stress, depression, sleep problems, and burnout. Of the participants, 50% reported incidents of verbal aggression, 26% noted workplace aggression, 23% experienced workplace violence, and 25% encountered sexual harassment -- just from the previous year. The study noted that confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes. This factor is key to taking steps to reducing workplace violence incidents and their effects on the nursing workforce. Increasing nurses' support of reporting workplace violence can help to better identify where, when, and what types of workplace violence are present to better address the issue.
Addressing workplace violence in home healthcare
An article from The Joint Commission Journal on Quality and Patient Safety discussed a study evaluating recent data from peer support programs from adverse clinical events to workplace violence. Leveraging databases from the forYOU Team at University of Missouri Health Care (MU Health Care) and the RISE Team (Resilience in Stressful Events) at Johns Hopkins Hospital (JHH), researchers found that nurses are the most frequent victims seeking peer support. And, unsurprisingly, the study noted a recent significant increase of violent episodes against healthcare staff and a parallel rise in number of calls for peer support associated with workplace violence. While ensuring adequate support and resources for nurses who experience workplace violence is necessary, further action to prevent workplace violence is an effort that nurses need now more than ever.
The CDC and National Institute for Occupational Safety and Health (NIOSH) outlined steps both organizations and home healthcare workers can take to prevent violence on the job. Best practices for home health agencies include adopting a zero-tolerance policy for all incidents of violence and working with police to identify potentially dangerous neighborhoods where special precautions need to be taken and provide that information to employees.
"It's important that proper assessment is done prior to sending anyone into the home. If a nurse requests that they be paired with another nurse for the visit due to potential concerns, the home health agency should accommodate that request," Lunsford said. At a time when the U.S. cannot afford to lose more nurses during the ongoing nursing workforce shortage, the threat of workplace violence to nurses cannot be ignored. Throughout COVID-19, nurses have been placed in extremely difficult positions, increasing moral injury, burnout, and consideration for leaving the profession altogether. As politics and local mandates have influenced patients' frustrations with healthcare delivery, nurses have been subjected to even greater rates of workplace violence. When providing care in an unfamiliar environment with many unknown factors, home care nurses face a unique risk for workplace violence. Those called to care for others deserve to have the respect, support, and resources to first and foremost keep themselves safe. Consider these courses to learn more about addressing workplace violence and home health nursing: Preventing Violence in the Healthcare Setting (1.0 contact hours) Violence in healthcare settings reflects the chaos of a broader work environment. The National Institute for Occupational Safety and Health defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty." Experts not only agree on the extent of violence in the healthcare setting, but also concur on its best treatment: education and prevention. Nurses heighten their awareness and expertise in dealing with violence in their professional settings by learning to identify risk factors and warning signs, and by applying interventions that can shield their patients and themselves from harm. Becoming a Home Health Nurse (2.5 contact hours) According to statistics and projections from the National Bureau of Labor and the Health Resources and Services Administration, the need for nurses skilled at providing care to patients in their homes is growing. This is a good time to consider a career in home health nursing. This course provides nurses with information about home health nursing practice, so the nurse can determine if home health nursing is a good career choice for them. The rewards, challenges, required skills, regulations, and agency types of home health nursing are reviewed. For Nurses New to Home Care (1.0 contact hours) This course presents an orientation to home care for professional nurses who are new to home-based services, which include home care and home healthcare. It provides learners with introductory instruction that covers a description of home-based nursing care, qualifying criteria for patients to receive home healthcare, health and safety hazards associated with home care, and proper infection control practices in the home.
