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CMS Warns Hospitals Must Do More to Protect Staff


The Centers for Medicaid/Medicare Services (CMS) recently sent a memo to hospitals reminding them of their duty to protect patients and staff from on-site violence. The warning comes amid growing threats of violence against nurses. According to the American Hospital Association, 44% of nurses saw an increase in physical violence since the pandemic and 68% reported an increase in verbal abuse.

Healthcare facilities that receive CMS funding have a “regulatory obligation to care for patients in a safe setting,” which includes protections for both physical and emotional health. The agency added that “healthcare workers have a right to provide care in a safe setting” and warned it “will continue to enforce the regulatory expectations” through these protections.

“CMS health and safety requirements do not preclude healthcare workers from taking appropriate action to protect themselves from workplace violence,” the memo reads. “However, it is incumbent on the leadership at these healthcare facilities to ensure they provide adequate training, sufficient staffing levels, and ongoing assessment of patients and residents for aggressive behavior and indicators to adapt their care interventions and environment appropriately.”

The memo states that hospitals must have procedures in place to identify patients who could pose a danger to themselves or others. Facilities must also be able to demonstrate the steps they are taking to minimize incidents of violence.

“All hospitals are expected to implement a patient risk assessment strategy, but it is up to the hospital to implement the appropriate strategies,” CMS wrote. “For example, a patient risk assessment strategy in a postpartum unit would most likely not be the same risk assessment strategy utilized in the emergency department.”

CMS underscored the urgency of its message by pointing to three recent cases in which hospitals were cited for failing to provide a safe working environment. One was a case where a nurse was sexually assaulted by a behavioral health patient in a unit with inadequate staffing. In another, a patient died when staff and law enforcement performed a takedown that cut off their breathing. And finally, an instance where an insufficient assessment and de-escalation led off-duty police officers to shoot a patient who was acting out.

“Exposure to workplace violence hazards come at a high cost; however, with appropriate controls in place, it can be addressed,” the agency added.

Healthcare workers accounted for 73% of all non-fatal workplace injuries and illnesses due to violence in 2018, according to the Bureau of Labor Statistics.

Industry leaders are also calling on the president and members of Congress to address the issue of workplace violence in the healthcare industry. The American College of Emergency Physicians and 30 other healthcare associations recently asked Washington to create legislation that would prevent the number of overcrowded hospital emergency rooms. 

The leaders wrote that “[ER] boarding has become its own public health emergency.” This practice makes it harder for nurses to supervise their patients while limiting the amount of space available for patients who need emergency attention. Patients with substance abuse issues and behavioral disorders may also have to spend more time in the ER if there is nowhere else for them to go.

There is currently no federal legislation addressing workplace violence among nurses, but the ACEP is urging Congress to pass a bill that would require hospitals to develop comprehensive workplace violence prevention plans mandated through the Occupational Safety and Health Administration.

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