As of April 1, 2018, California is the first state to require all healthcare facilities to have comprehensive workplace violence prevention plans.

The mandate, which applies to all acute-care hospitals and skilled-nursing facilities in California, is part of a 2014 law. The order was created by the state’s Division of Occupational Safety and Health (OSHA) with input from nurses, reports Modern Healthcare.

The California Nurses Association strongly pushed for the mandate as approximately 20 percent of nurses and nursing students in the U.S. say they have been physically assaulted on the job, averaging to around 650,000 injuries each year.

Under the mandate, those in charge of hospital safety must assess and identify areas in which employees are vulnerable to violence while at work. Some areas include a review of staffing and staffing patterns and the effectiveness of security systems.

Areas of high-security risk such as entry and exit points for employees during late-night and early-morning shifts and employee parking lot safety must also be monitored under the mandate, according to Health Employment and Labor.

All employees must undergo annual education and safety training, which must include how to recognize potential violence, strategies to avoid physical harm and reporting violent incidents to the employer.

Employees must also have access to resources for coping with violence, such as critical stress debriefing or employee assistance programs.

Another part of the 2014 law’s mandate, which has been in effect since April 2017, requires healthcare facilities to maintain a log of each incident of workplace violence. A 2015 survey from PubMed.gov found only 19 percent of violent incidents against hospital employees are reported.

Hospital Organizations Voice Opinions on Mandate

Bonnie Castillo, executive director of National Nurses United, applauded the mandate’s focus on protecting nurses.

“We as nurses take this seriously, and we will engage in an aggressive enforcement campaign to make sure hospitals comply [with the regulations]”, Castillo said during a news conference a few days after the mandate passed.

As for the California Hospital Association, vice president Gail Blanchard-Saiger says while the group supports the law, it has concerns regarding some of its aspects. For instance, part of the new regulations require hospitals to assess patients and visitors for potentially violent behavior and Blanchard-Saiger says there is little guidance from Cal OSHA on how to effectively do so.

“Hospitals are committed to providing a safe work environment and complying with regulations, but there are challenges,” she said. “There are a lot of different moving parts and ambiguity.”

It is recommended that California healthcare facilities consult with counsel for assistance with the development of a legally-compliant plan and annual training materials.

The mandate will be enforced by Cal OSHA and providers may be fined if they are in violation, which the division would be notified of through complaints.