On Tuesday night, a psychiatric patient under Kay’s care told her she was going to beat her because Kay couldn’t give her any more phone call privileges.
Kay, a registered nurse who withheld her last name, had some good reason to believe the patient and fear for her own safety. Not too long ago, a different patient charged at her from 30 feet away, crushing her shoulder. The injury required months of physical therapy and she was in constant pain. She had to be removed from her normal job for a time. “My livelihood was robbed,” she said on a call with media on Wednesday morning.
Even today she still has flareups of pain, numbness, or burning in the injured shoulder. The incident also left mental scars. “I find I respond differently to stressful or perceived stressful situations,” she said. Her fight or flight instinct is more easily triggered, and she struggles with anxiety.
She’s not the only one in her workplace, either. One particular patient, weighing 285 pounds, has repeatedly assaulted both nurses and patients at the facility. Kay herself had to intervene in one incident where the patient grabbed a coworker’s head, hitting it against a window several times. There were just three other people around to restrain the patient. The incident left Kay’s coworker, a woman in her early 40s, with head and neck injuries, the loss of a tooth, and permanent hearing loss.
“People may assume that getting punched, kicked, or stepped on, or threatened and verbally abused, is part of working in a psychiatric facility,” Kay said. But “it’s unacceptable and preventable.”
It may be preventable, but the violence Kay experiences on a regular basis in her workplace is widespread — and getting worse. According to a report released Wednesday by the AFL-CIO, there were officially about 3.8 million work-related injuries and illnesses reported in 2014, although because underreporting is so widespread, the real number is likely somewhere between 7.6 and 11.4 million. That’s more than 10,000 people hurt or sickened at work every day.
And women like Kay and her coworker are on the front lines of the problem. The health care and social assistance industry made up the greatest share of nonfatal work injuries and illnesses, at more than 20 percent. Nursing and residential care facilities in particular have a high rate of 12.6 workers injured for every 100.
Violence generally is a growing workplace threat. It was responsible for 26,540 injuries that resulted in lost work time in 2014 across the country and across industries. “While the overall injury and illness rate in the U.S. has gone down over the last 25 years, the workplace violence rate was decreasing in the 90s and now it’s getting worse,” said Rebecca Reindel, the AFL-CIO’s senior safety and health specialist on the call with media. It’s increased more than 100 percent, for example, in private hospitals and psychiatric hospitals. And women are bearing the brunt, suffering two-thirds of these incidents.
Those findings line up with a recent report from the Government Accountability Office. It found that health care workers experience injuries from workplace violence at “substantially higher” rates than the rest of the workforce, ranging from five to 12 times the rate of the overall workforce depending on the type of facility. For example, nursing and residential care workers had a rate of 35.2 per 10,000 workers, compared to 2.8 for the workforce as a whole. Patients are the most common perpetrators, and workers most frequently report being hit, kicked, or beaten. The GAO also found that rates are getting worse, not better. But the full extent of the problem still isn’t known because health care workers are so unlikely to report incidents.
Perhaps even worse than injury and illness are the high rates of deaths on the job. In 2014, 4,821 workers were killed at work, an increase from the year before, the AFL-CIO reports. More troubling, the rate of death inched up, from 3.3 workers killed per 100,000 in 2013 to 3.4, showing that even if raw numbers went up because more people were at work, the share being killed is also increasing. On top of that, an estimated 50,000 people died from diseases they picked up from their jobs. That all works out to 150 workers dying every day from dangerous work conditions.
Violence is again a big problem when it comes to fatalities, accounting for 16 percent of all traumatic workplace deaths, or 765 total, in 2014. But other causes in industries beyond health care also had disturbingly high numbers. The highest was in transportation and material moving, with 1,346 deaths on the job in 2014, followed by 902 in construction and extraction. The oil and gas industry notched the highest number of fatalities it ever recorded at 144 and had a rate nearly five times the national average. And the leading cause of death at work is transportation incidents, particularly roadway crashes.
Beyond the cost of life and safety, the economic cost of injury and illness at work is also huge, estimated to be somewhere between $250 and $370 billion each year.
That cost could be alleviated by investing more in the agency meant to police workplaces to ensure workers’ safety. The Occupational Safety and Health Administration (OSHA), created in 1970, has saved more than 532,000 people since then, according to the AFL-CIO report. But it could be doing far more. There are just 1,840 inspectors tasked with monitoring the country’s 8 million workplaces under its jurisdiction, working out to one inspector for every 74,760 workers. That means a workplace will see a state OSHA inspector once every 97 years, on average, and a federal one just once every 145 years. Over the last quarter century, “the capacity of the government to oversee and enforce safety and health has gotten a lot worse,” said Peg Seminario, Director of Health and Safety at the AFL-CIO.
But even when OSHA does inspect and uncover dangerous conditions, the fines it levies are a drop in the bucket. The average penalty for a serious violation of safety regulations was $2,148 from the federal agency and $1,317 for a state one. Even killing a worker doesn’t cost much: The median penalty was $7,000 at the federal level and just $3,500 in states. “This clearly isn’t enough to deter,” Seminario said, “to cause employers to change their practices.”
Kay wants to see much more done to ensure her safety at work. “I love my job and I love the work that I do,” she said. “I want to continue to help patients who are suffering.” But to do that without fearing for her health, she thinks it’ll take increased security measures, better policies, more training for staff, and better reporting of incidents.
And she wants to see OSHA do something about it. There is no federal standard when it comes to workplace violence. “We need a standard,” she said.