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The Activity Director's Office
By Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
Music: "Peg of My Heart" furnished by Heart and Soul Music "Providing Quality Music for Nursing Homes"
Violence in the Workplace

One out of every four Americans workers will be attacked, threatened or harassed at work in their lifetime
by another human being. That is a staggering number!

I remember all to vividly the horror of watching my Dietary Supervisor being wheeled out on a stretcher.
She had been attacked (this tiny 5-foot woman) by our (over 6-foot tall) cook, during a disciplinary meeting
with the HR director. The cook was placed in a chair next to a wall. They were in a tiny office. The HR
director was sitting in front of the cook with a desk between the HR director and the Cook. Sitting next to
the cook was the Supervisor. Weather they realized it or not, they had completely blocked the cook in the
office. Not only did they place the cook in a confrontational situation, they had placed themselves in
harms way. Once the disciplinary meeting began, the cook jumped on the Dietary Supervisor, pinned her
to the ground and began pummeling her. The tiny office door was closed and blocked by her body, which
was now on the floor. The HR Director also could not escape the blocked doorway. It was a tragic event.
But with every tragic event, it gave us an opportunity to learn, the managers an opportunity to explore what
went wrong in the disciplinary meeting and take steps to insure that this never happened again.

OSHA requires that all healthcare facilities have a Violence Program in place. They state, “all hospitals
and nursing homes must have security and safety plans in place, find and correct things that lead to
violence, do things to prevent violence and give training on safety, security and ways to prevent violence
and give training on safety, security and ways to keep ourselves / patients safe”. Many facilities do have
Safety / Risk Management Programs or Committees. If, you do not have a program, they offer for free the
entire training program that can be downloaded. It is already in overhead format and is easy to follow and
use as a training tool. Additionally, OSHA states, “that their training program is not copy righted and they
want the long-term care industry to use the training materials.”

Work place violence is any physical assault, threatening behavior or verbal abuse occurring in the work
setting to employees or clients. This can be the building, surrounding perimeter, parking lots, client’s
homes and traveling to and from assignments. This includes assault, criminal mischief, disorderly
conduct, harassment, larceny, menacing reckless endangerment, robbery, and sex offense. These
offenses can range from beatings, stabbings, robbery, rapes, intimidation, verbal threats, bodily harm
and territories activity. There are many new catch phases that we hear, “Desk Rage, Terrorist Activity and
one of them is “going postal” which Sienfield coined.

Violence can be by strangers, customers, clients, and co-workers and by personal relationships, such as
an estranged boyfriend. Social workers and nurse’s aides are assaulted more often and in greater
numbers. OSHA requires employers to maintain a safe work place. Your facility / employee is at risk if you
have one or more of these factors:
Working alone at night and during early morning hours
Performing public safety functions in the community
Working with patients, clients known or suspected of having a history of violence.
Employees with a history of assaults who have exhibited belligerent, intimidating or threatening behavior
to him/her or staff.
You are an authority figure

Additionally, you need to look to see if you have a “toxic work place culture.” The Nursing Assistants Web
site list some common sense things to look for:
  • High turnover and absenteeism
  • High amount of agency staff use
  • Uptight staff
  • Gossip Groups
  • No Team Work
  • Hostilities between shifts

If your work place is toxic, what is the management doing to address these issues? Because it cannot be
allowed to fester, knowing full well that it is a bomb waiting to go off in your building. It is a myth that
“people suddenly snap.” He may have just snapped but if you look back there were warning signs. All the
staff saw the signs but maybe the culture of the building is not to report things. It is another myth that
situations will resolve themselves and just have a cooling off period will resolve it and the problem will go
away. If there is a situation, address it head on.
If you wish to begin a violence prevention program there are many components that should be included
and these are:
  • Clear policies about violence and prevention. The policy needs to be clearly spelled out to your
    employees, visitors and residents. The policy should clearly state that you have a “zero tolerance
    for violence.”
  • Ensure that employees who report incidents that they do not experience reprisals.
  • Clear Documentation Forms that not only has space to document incidents, assess risks but
    also can measure progress.
  • Develop a liaison with law enforcement and others who can identify ways to prevent violence.
  • Provide resources to carry out training.
  • Affirm management commitment to a worker supportive environment that places the importance
    on a safe work environment.
  • Let your staff know that you are starting this program and what it will involve, which includes
    preserving employee safety, supporting those employees that have experienced violence and

Finally, the 5 components of a violence prevention program are:
  1. Management Commitment and Employees Involvement
  2. Work Site Analysis
  3. Hazard Prevention and control/ responding
  4. Health and Safety Training
  5. Record Keeping.

As a final note, all management teams should receive extensive training in hiring, firing and disciplining.
There are many signs to look for in a violent employee and these are traits that the supervisors should be
trained to recognize and handle. If you are a non-profit facility, please visit the OSHA web site where they
provide grants for safety and health training.

Obviously this is a huge topic but we hope we have touched upon some key elements that should be
addressed in your violence protection programs.


Sandra Stimson has experience as a
corporate consultant, Corporate
Trainer and National Speaker. Her
experience is in long term care, as
Activity Director, Director of
Alzheimer's Units and Assistant
Administrator of a 550 bed long term
care county home.  She is
Co-founder of Pet Express Pet
Therapy Club, is a Life Replay
Specialist.  Sandra implements
dementia units nationwide.  Sandra
has written several books, Volunteer
Management Essentials for Long
Term Care and Pet Express Pet
Therapy Program. Sandra has been a
facilitator for Alzheimer's support
groups and is the Awards Chair for the
NJ Association of Activity
Professionals.  Sandra is the
Executive Director of
Council of Certified Dementia

Alternative Solutions in Long Term
Care offers resources for health care
professionals in many areas of
dementia care, care plans,
Snoezelen products, dementia
activity calendars, adult day care
calendars, sensory calendars,
reminisce videos for dementia,
activity books, and dates to
remember, party supplies,
resources and links.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

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