The document discusses various challenges faced by nurses in the workplace including workplace violence, staffing shortages, long working hours, and a lack of recognition. It also provides solutions to address these issues such as implementing positive work environments, improving teamwork, balancing workloads, and recruiting and retaining more staff. The document also outlines Indian laws related to occupational health and safety for nurses, including the National Policy on Safety, Health and Environment at Workplace from 2009 and various labor acts.

1. WORKPLACE VIOLENCE &
STAFFING CHALLENGES
Hanuman Ram Bishnoi
Faculty, All India Institute of
Medical sciences Jodhpur

5. WORKPLACE VIOLENCE
18,000 weekly workplace assaults
 employees to lose 3.5 days of work per incident
annually, with a loss of $55 million in wages
18% of all crimes committed in the workplace;
costs employers $3 to $5 billion annually;
Indirect costs -lost productivity, insurance, loss of
public image
Jury cost

6. WHAT IS WORKPLACE VIOLENCE?
1. Physical Assault
2. Threatening Behavior
3. Verbal Abuse
4. Harassment

7. CATEGORIES OF
WORKPLACE VIOLENCE
1. Violence by Strangers Committing
Robbery
2. Violence by Customers, Clients, or
Patients
3. Violence by Employees and Supervisors
4. Violence by Domestic Partners or
Relatives of Employees

8. RISK FACTOR
What Are Some
Examples of Risk
Factors on Your
Job?

9. EXTERNAL RISK FACTORS :
1. Working alone or in small numbers
2. Working late night/early morning
3. Working with money
4. Delivering passengers, goods or services
5. Having a mobile workplace like a taxicab or
police car
6. Working in high crime areas
7. Guarding property or possessions
8. Contact with the public

10. INTERNAL RISK FACTORS:
1. Highly competitive sectors with intense workloads
2. Restructuring of an organization, e.g. impending layoffs
3. Ignoring warning signs from certain individuals who have
a gripe with co-workers or management
4. Allowing an ongoing feud between co-workers to go
unaddressed by management
5. Chronic verbal abuse by a supervisor towards workers
6. Denial on the part of management regarding employee
tension or favoritism towards one party
7. Old school mentality by management that tolerates and
enables supervisor abuse

11. How Can Violence Be
Prevented on the Job?

12. Prevention Strategies
(External Risk)
1. Don’t work alone late at night or early morning
2. Call for a security escort if working late
3. Carry a cellular phone
4. Redesign workspace to prevent entrapment
5. Train staff in ways to diffuse violence.
6. Place curved mirrors at hallway intersections
7. Maintain good lighting indoors and outdoors
8. Prepare plan for consumers who “act out”
9. Control access to employee work areas.

13. Prevention Strategies
(Internal Risk)
1. Risk Assessment: Confidential survey of all
employees designed to uncover internal risk
factors, coupled with analysis of external risk
factors
2. Presentation of overall risk analysis to top
management, along with supporting facts
3. Sensitivity training for high-risk employees as
necessary

14. Responding to a Violent
Incident
1. Isolate/secure the work area
2. Call 100 if an emergency
3. Seek medical attention for victims
4. Report the incident to your supervisor
5. File an incident report

15. Five Warning Signs of
Escalating Behavior
1. Confusion
2. Frustration
3. Blame
4. Anger
5. Hostility

16. Warning Signs of Confusion
• The person appears
bewildered or
distracted.
• They are unsure or
uncertain of the next
course of action.

17. Responses to Confusion
1. Listen
Attentively to
the person
2. Ask clarifying
questions
3. Give factual
Information

18. Warning Signs of Frustration
1. The person is
impatient and
reactive
2. The person resists
information you are
giving them
3. The person may try
to bait you

19. Responses to Frustration
1. Move the person
to a quiet location
2. Reassure them,
talk to them in a
calm voice
3. Attempt to clarify
their concerns

20. Warning Signs of Blame
1. The person places
responsibility on
everyone else
2. They may accuse
you or hold you
responsible
3. They may find fault
with others
4. They may place
blame on you

21. Responses to Blame
1. Disengage with the
person and bring a
second party into the
discussion
2. Use a teamwork
approach
3. Draw the person
back to the facts
4. Show respect and
concern
5. Focus on areas of
agreement to help
resolve the situation

22. Warning Signs of Anger
1. The person may show
a visible change in
body posture
2. Actions may include
pounding fists,
pointing fingers,
shouting or screaming
3. This signals VERY
RISKY BEHAVIOR!

23. Responses to Anger
1. Don’t argue with the
person
2. Don’t offer solutions
3. Prepare to evacuate
the area or isolate
the person
4. Contact your
supervisor and
security personnel

24. Warning Signs of Hostility
1. Physical actions or
threats appear
imminent
2. There is immediate
danger of physical
harm or property
damage
3. Out-of-control
behavior signals
the person has
crossed the line

25. Responses to Hostility
1. Disengage with the
person and
evacuate the area
2. Attempt to isolate
the person if it can
be done safely
3. Alert your supervisor
and contact security
immediately

26. Violence in the HealthcareViolence in the Healthcare
WorkplaceWorkplace
–Hospital workers are assaulted at rates 4
times the average for other private-sector
industries

27. Activities Related to Violence
Activities:
– Meal times
– Visiting hours
– Patient transportation
May occur when:
– Denied service
– Involuntary admission
– Limiting the patient

28. Case Reports
Examples:
– An elderly patient verbally abused a nurse
– An agitated psychotic patient attacked a nurse
– A disturbed family member walked into the
emergency department and fired a small-
caliber handgun

29. Who Is At Risk?Who Is At Risk?
Who?
– Anyone working in a healthcare setting
– Nurses and aides
– Emergency response personnel
– Safety officers
– Healthcare providers

30. Where May Violence Occur?
Where?
– Psychiatric wards
– Emergency rooms
– Waiting rooms
– Geriatric units

31. Risk Factors for ViolenceRisk Factors for Violence
– Working directly with volatile people
– Working when understaffed
– Transporting patients
– Long waits for service

32. Risk FactorsRisk Factors
– Overcrowded, uncomfortable waiting rooms
– Working alone
– Poor environmental design
– Inadequate security

33. More Risk FactorsMore Risk Factors
– Drug and alcohol abuse
– Access to firearms
– Unrestricted movement of the public
– Poorly lit areas

34. Prevention StrategiesPrevention Strategies

35. Environmental DesignsEnvironmental Designs
– Emergency signaling, alarms, and monitoring
systems
– Security devices
– Cameras
– Provide security escorts
– Design waiting areas
– Design public areas

36. Administrative ControlsAdministrative Controls
– Designing staffing patterns
– Restricting the movement of the public by
card-controlled access
– Developing a system for alerting security
personnel when
violence is threatened

37. Behavior ModificationsBehavior Modifications
– Recognizing and managing assaults
– Resolving conflicts
– Maintaining hazard awareness

38. Safety Tips for HealthcareSafety Tips for Healthcare
WorkersWorkers
– Watch for signs of violence
– Maintain behavior that helps defuse anger
– Stay alert
– Have an escape plan

39. INDIAN LAW ON SEXUALINDIAN LAW ON SEXUAL
HARASSMENTHARASSMENT

40. Indian Law on SexualIndian Law on Sexual
HarassmentHarassmentThe
Constitution
of India
1997:
Vishaka vs.
State of
Rajasthan
The Sexual
Harassment of
Women at
Workplace
(Prevention,
Prohibition and
Redressal) Act,
2013
The Indian
Penal
Code,
1860

41. The Vishaka Judgment - 1997The Vishaka Judgment - 1997
Supreme Court acknowledged that:
Sexual harassment is a human rights violation
Sexual harassment is a violation of the constitutionally
guaranteed fundamental rights:
 Articles 14 and 15: Right to equality
 Article 21: Right to life - to live with dignity
 Article 19(1)(g) - Right to practice any
profession/trade/occupation/business, i.e., a right to a
safe environment free from harassment
There is a need for guidelines to fill the legislative vacuum

42. The Vishaka Judgment - GuidelinesThe Vishaka Judgment - Guidelines
 Employer’s duty to
 Prevent and prohibit acts of sexual
harassment Article 21: Right to life - to live
with dignity
 Redress and resolve grievances pertaining
to sexual harassment
 The Guidelines = Law, until such time a
legislative frame work on the subject is enacted

43. The Sexual Harassment of Women at
Workplace(Prevention, Prohibition and Redressal)
Act, 2013
What about
me??

44. ““Sexual Harassment” underSexual Harassment” under
the new lawthe new law
A demand or
request for sexual
favors
Sexual
Harassment
Showing
pornography
Unwelcome physical,
verbal or non-verbal
conduct of sexual nature
Making sexually
colored remarks
Physical contact
and advances

45. Circumstances Considered asCircumstances Considered as
Sexual HarassmentSexual Harassment
 Implied/explicit promise of preferential treatment in employment
 Implied/explicit threat of detrimental treatment in employment
 Implied/explicit threat about present or future employment status
 Interference with work or creating an intimidating/hostile
environment
 Humiliating treatment, likely to affect health or safety

46. Internal Complaints Committee
 Mandatory for establishments employing 10 or
more employees
 ICC to be appointed by an order in writing
 At least ½ of the membership of the ICC to be
women
 ICC to prepare and submit an annual report to the
employer and the District Officer

47. Local Complaints Committee
 To be set up in every district
 LCC is the grievance redressal body with
respect to:
 organisations having less than 10
employees
 organisations that have not set up an
ICC

48. Grievance Redressal ProcessGrievance Redressal Process
Incident of Sexual
Harassment
Complaint made
to ICC/LCC
Settlement
Not monetary;
ICC to record
settlement and
forward to LCC
and parties
No further
inquiry
INQUIRY
Reasons for delay to
be recorded in writing
Beyond 3 months
3 months
Employee
requests for a
settlement
No
settlement
Employee does
not request for
settlement
Beyond 3
months

49. The Indian Penal Code Provision
Section 509 - Word, gesture or act intended to insult the
modesty of a woman
Offence:
utterance of any word,
making any sound or gesture
exhibiting any object
With an intention to intrude upon the privacy of such

50. Nursing Problems and solutions

51. Challenges Faced by Nurses at
Workplace
Workplace mental violence
•Huge amount of workload
•threats, verbal abuse, hostility and
harassment, psychological trauma and
stress.

52. Shortage of staffShortage of staff
• Deficient Manpower
• 0.8 NURSE for 1000 people
• Upto 1:40 nurse patient ratio

53. Workplace health hazards
• Nurses confront a high risk of developing
occupational health hazards

54. Long working hours
• Short staffing pattern -results in long
working hours and double shifts of staff
nurses.
• It is evidently affecting the health of the
nurses.

55. Lack of Synchronicity
• Disharmony and lack of teamwork

56. Lack of recognition
• There is no support system for nurses and
hence their performances are usually not
projected well.

57. Non-nursing rolesNon-nursing roles
• non-nursing-related work, for e.g., billing,
record keeping, inventory, laundry, diet,
physiotherapy, absconding of patient, etc.,
thereby diminishing time for patient care.
• If at any instance, there is any fault in
these roles, the nurses have to bear the
brunt of that in the form of cancellation of
leaves, salary deductions etc.,

58. Solutions to Curb the
Challenges
• All the listed challenges are somehow
interlinked and interdependent. It is
necessary for us to look deep within these
problems and to reach to the core of these
challenges in order to find resolutions for
the same.

59. Positive practice
environment
• Work environment: There needs to be
employer friendly work environment.
Safety and security of the nurses should
be given importance.

60. Equipment/materialsEquipment/materials::
• The availability and adequacy of samples
of equipment and consumable supplies is
often a matter of concern.

61. Positive team workPositive team work
• A team needs to be taught about
importance of team work and a good team
can always conquer the goal of effective
and quality patient care. It can also
accelerate the focus on curative care of
the patients.

62. Recruitment/retention
policy
• A proper and well planned policy for
recruitment and retention has to be
included in an organization in order to
enhance the manpower for better support
and care.

63. Closing education-service
gap
• Every heath care organization should be
focusing on eradicating the difference
between what is taught to the nurses
during their study period and what is being
done practically by them in hospitals.

64. Workload balance
(Quality/Quantity)
• Workload often leads to unwanted hassles
and loss of mental peace which ultimately
leads to less efficient care. An
organization should try to balance the
workload by distributing it equally

65. Evidence based practice
• Nurses should also deviate a part of their
focus towards evidence based practice.
Various practices have related researches
which can be read by the nurses to see if
that practice is actually effective or not

66. National Policy on Safety, Health andNational Policy on Safety, Health and
Environment at Workplace (NPSHEW)Environment at Workplace (NPSHEW)
20092009
• On the basis of Directive Principles as well
as international instruments the
Government of India, Ministry of Labour &
Employment, had declared the National
Policy on Safety, Health and Environment
at Workplace

67. Legislation on occupational
health and safety
• ILO, which estimates that around 4,03,000 people in India die every year due to work‐
related problems, that is, about 46 every hour6 .
• The Factories Act, 1948 has been amended in 1954, 1990, 1976 and 1987.
• Explosives Act, 1884;
• Petroleum Act; 1934;
• Insecticide Act, 1968;
• Dangerous Machines (Regulations) Act, 1923;
• Indian Atomic Energy Act, 1962;
• Radiological Protection Rules; 1971;
• Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989;
• Electricity Act, 2002.
• The Directorate General of Factory Advice Service and Labour Institutes in the
Ministry of Labour provide inputs for national policies on occupational safety

68. Reference
• Medical Chivalry and Team Work (1927) American
Journal of Nursing 27(5): 367.
• Ramsay, D James (2005) A New Look at Nursing Safety:
The Development and Use of JHAs in the Emergency
Department. The Journal of Sh & e Research 2(2): 1-18.
• https://www.osha.gov/Publications/OSHA3826.pdf
• http://www.truthaboutnursing.org/faq/short-staffed.html
• http://www.nursingworld.org/workenvironment
• http://www.nursingworld. o rg/MainMenuCategories/
WorkplaceSafety/Healthy-Work-Environment