Given an increase in violence in the hospital setting and continued attention on hospital security programs, there is a need to examine current hospital safety and security practices. Funded by the International Healthcare Security and Safety Foundation (IHSSF) and investigated by Duke University Medical Center, a recent survey evaluated how violence, security and their relationship can prevent and mitigate events of hospital violence, including the use of weapons by security personnel.

According to the Occupational Safety and Health Administration (OSHA), workplace violence (WPV) is a recognized hazard in the healthcare industry. WPV is any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site. It can affect and involve workers, clients, customers and visitors. WPV ranges from threats and verbal abuse to physical assaults and even homicide. In 2010, the Bureau of Labor Statistics (BLS) data reported healthcare and social assistance workers were the victims of approximately 11,370 assaults by persons; a greater than 13% increase over the number of such assaults reported in 2009. Almost 19% (i.e., 2,130) of these assaults occurred in nursing and residential care facilities alone. Unfortunately, many more incidents probably go unreported.

The purpose of this study was to examine the carrying and use of weapons among security personnel working in the hospital setting, including the assessment of how weapons used in hospital violent events may vary by hospital characteristics. In addition, the study aimed to assess the incidence of violence in the hospital setting in the prior 12 months, including the association between violence and weapons use among security personnel.

Principal Investigator Ashley Schoenfisch, Ph.D, Assistant Professor/Division of Occupational and Environmental Medicine, collected data through a questionnaire provided to members of the International Association of Healthcare Security and Safety (IAHSS) working in hospital settings in the US.  During the six weeks the questionnaire was open, there were 299 respondents. Most participants (94%) were senior IAHSS members, and over half (62%) worked in healthcare security for at least 10 years.

Several primary outcomes of interest were examined in this study: weapons availability, workplace violence (any type of event), and workplace violence (physical assaults).

Sample of Results

Hospital Security Policies - Participants were asked whether the hospital’s security policy included each of the following components: employee involvement, management commitment, incident reporting and record keeping, training of security staff, hazard prevention and control, and worksite analysis. Nearly all hospital policies (99%) had at least one component. About half of hospitals (55%) had all of these components included in their security policy.

Hospital security personnel and non-security personnel training - 87% percent of hospitals required all hospital security personnel to receive training specific to workplace violence. Most hospitals (98%) offered some type of workplace violence training to their security staff. In terms of non-security staff - direct patient care staff (64%), housekeeping (28%), food service workers (27%), and facilities’ workers (4%) - many hospitals required workplace violence training. 14% of hospitals required all staff to be trained in workplace violence prevention.

Despite a high percentage of training among hospital security personnel, participants highlighted the need for continued efforts to enhance training availability, content, and reach. Participants when asked to provide recommendations to enhance hospitals security and prevent workplace violence most commonly mentioned training. Further, a lack of education/training was a commonly mentioned source of difficulty between security and non-security personnel.

Metal detectors - Metal detectors were used in one-third (33%) of hospitals. At these hospitals, metal detectors were most commonly placed in the emergency department’s main entrance (40%). Metal detectors were more likely to be used in larger hospitals compared to smaller hospitals. Thus, metal detectors were rarely placed at the main hospital entrance, perhaps a reflection of the desire to create an open, inviting environment of care despite participants’ acknowledgment of the need to enhance visitor control.

Weapons Availability - Hand cuffs were the most common type of weapon available to be carried and used by hospital security staff (96%), followed by batons (56%), OC products (52%), hand guns (52%), TASERS® (47%) and K9 units (12%). Among hospitals with a particular type of weapon, documented training in weapons use was required in approximately 90% of the hospitals for nearly all types of weapons. The most striking find with respect to TASERS®  was the 41% lower risk of physical assault among hospitals with TASERS®  available for security personnel to carry and use compared to those without TASERS® .

Events of violence in the hospital setting - The perpetrators of violence most commonly included patients (75%), followed by visitors (9%) or outside individuals (6%). Threats and verbal assaults were most common (41%). 29% of events included a physical assault. Among the events where injury occurred, the injured commonly included security personnel (57%) or other hospital workers (38%).

In the previous 12 months, 89% of hospitals had at least one event of workplace violence. The number of events per hospital in the previous 12 months ranged from 0 to 3,000, with an average of 123 events per hospital.

The study highlights the importance of the relationship between security and clinical staff. In order to assure a safe and secure environment for patients, visitors and staff, security officers need to be integrated as part of the patient care team as well as in the planning of violence prevention and management approaches including in the hospital architectural design stage.

While the debate continues about whether the availability and utilization of weapons by security personnel in the hospital setting is wise, especially the use of TASERS®, this study shows a lower risk of physical assaults in hospitals in which TASERS® (or similar devices) were available to security personnel, which suggests these devices may be useful tools for de-escalating and controlling potentially violent (or already violent) situations.

IHSSFoundation President Steve Nibbelink concludes, “It is the goal of the Foundation to continually research the needs of healthcare security and safety professionals so they may better protect their human, technology and property assets, all the while providing a welcoming, safe and secure environment.” This Weapons Survey and other Foundation research projects also help and support the IAHSS in their development of professional training, education, policy and procedures to address healthcare facility current and future needs.

A copy of the Weapons Survey is available HERE.