Colorado hospitals, nursing homes and other health care facilities would be required to come up with plans to reduce violence against their staffs under a bill in the state legislature.
The legislation also would require those facilities to treat any assaults as aberrations that require study and a response.
Violence affects not only health care workers themselves, but anyone who needs care, since nurses are leaving the field in response, said Rep. Eliza Hamrick, a Centennial Democrat who is one of the bill’s sponsors.
“We need to give health care workers a voice and take care of them so they can take care of us,” she said.
Nationwide, the number of violent incidents recorded against health care workers doubled from 4,010 in 2011 to 8,590 in 2020, according to the U.S. Bureau of Labor Statistics. Even before the pandemic, the health sector shouldered a disproportionate burden from violent workplace acts that were severe enough to force the victim to take time off work.
A survey by National Nurses United in early 2022 found about half of workers in that field thought violence was up in their workplaces.
Information about workplace violence isn’t typically available at the state level. But Colorado nurses and others in the health care sector have reported witnessing or experiencing frequent assaults, even as the facilities where they work are taking steps to keep patients under control.
House Bill 24-1066 would require facilities to set up violence prevention committees that include frontline staff members, offer safety training to all employees, review assaults quarterly and update their prevention plans based on those reviews.
The requirements would apply to hospitals, free-standing emergency departments, nursing homes, assisted living facilities with at least 20 beds, behavioral health facilities and federally qualified health centers.
The bill defines workplace violence broadly, also including threats, harassment and bullying in addition to physical force. But it specifies that threatening to file a lawsuit in court, or a complaint with a state agency, doesn’t qualify as an act of aggression.
It also would require facilities to offer mental health support to employees who have been victims of workplace violence.
The bill doesn’t specify what health care facilities need to include in their violence prevention plans — or what constitutes an acceptable response to an act of violence.
That’s by design, said Colleen Casper, executive director of the Colorado Nurses Association, who is working with Hamrick. The text includes best practices from other states while allowing facility leaders the flexibility to adapt, she said.
“It needs to have a few essential elements,” she said of the plan, “but how you get there is up to you.”
The bill was assigned to the House Health and Human Services Committee, but a hearing had not been set as of Tuesday.
Jeff Tieman, the president and CEO of the Colorado Hospital Association, said the group had not yet decided whether to support the bill as written.
Reducing violence is vitally important, he said, but some provisions of the bill appear to duplicate requirements from other agencies and are focused on reporting incidents, which may not result in meaningful change.
Hospitals would like to see the state offer funding for de-escalation training and for security measures, such as cameras, room alarms and guards, Tieman said. While many facilities already invest in those measures, some smaller ones don’t have the resources to do so, he said.
“Hospitals already do so much and are deeply committed to making sure we get this right,” he said.
Passing the bill would help reduce violence by reframing its occurrence as a sign that something has failed — rather than treating it as just part of the job, Casper said.
But the state and employers need to do more, she said, including opening more beds for patients in crisis and increasing hospital staffing, which would reduce frustration with long waits for care.
One thing the bill doesn’t include is additional penalties for violence against health care workers.
In Colorado, assaulting someone working in an emergency room is a felony, comparable to assaulting a police officer. But hitting someone working in a different health setting remains a misdemeanor, unless the assailant causes serious injury.
Other states have increased the criminal penalties, but that lands more patients who are in crisis in jail — and doesn’t appear to actually reduce the frequency of incidents, Casper said.
“Everyone tries this punishment approach first, but it doesn’t work,” she said.
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