O T H E R F E AT U R E S National Violence Prevention Training Standards for Hospital Security Officers Are Overdue Denise Martindell, RN, JD News accounts about violence in hospital emergency departments (EDs) help explain Senior Patient Safety Analyst why a survey by the Emergency Nurses Association found that 27.2% of ED nurses Pennsylvania Patient Safety Authority have considered leaving the ED.1 ED staff have been severely injured by violent acts in the ED and, although patients and visitors were not injured in the following inci- dents—which are summarized from recent news articles—they could have been. A young nurse staffing the ED reached out, as she was trained to do, and asked a seem- ingly extremely anxious man in the ED what was troubling him. The man beat the nurse so severely she was out of work for six months and permanently traumatized.2 A patient smashed his fist into the jaw of an emergency room nurse, fracturing the nurse’s jaw. The nurse, who had worked in the emergency room for 32 years, decided he could no longer tolerate patients hitting, yelling, cursing, or spitting at him.3 A drunk, naked patient covered in blood burst out of his emergency room cubicle bran- dishing scissors. He lunged at two nurses and began chasing them. It took two police officers and three zaps from a Taser to subdue him.4 Events reported to the Pennsylvania Patient Safety Authority indicate that patients are sometimes injured by violent acts in the ED. The patient was in the ED waiting room when he was assaulted [hit] by another patient in the ED waiting room without provocation. A patient in the ED being transported to radiology was hit in the head by a boot thrown by another ED patient. A patient was in the waiting area when another patient approached the patient and punched the patient’s head several times. Prior to being assaulted, the patient had gone to the registration window to alert staff that another patient was verbally assaulting others in the waiting room area. Security was called to the ED three times. Security officers are the first line of defense for patients and staff, underscoring the need for a well-trained security force.1 On January 12, 2012, AlliedBarton Security Services, in conjunction with HR Plus, the International Association for Healthcare Security and Safety (IAHSS), the National Capital Healthcare Executives, and the ASIS International Maryland Chapter sponsored a Workplace Violence in Healthcare Communities seminar. One focus of the seminar was the issue of violence in the ED. The lack of national training standards for security officers was raised as an ongoing concern of the hospital and contracted security communities, and understandably so, if one considers the current state of violence prevention training in hospitals.5 An Authority survey of ED violence prevention practices showed that only 36% of respondents reported mandatory training for ED staff in violence protection practices.6 Not only is mandatory training of ED staff not widespread, mandatory training of hospital security officers may be similarly limited. According to the Authority survey, of the hospital respondents that employ security officers, 70% require that security officers complete a national training program. Although the survey indicates that the majority of respondents report mandatory training of hospital security officers, argu- ably the percentage should be closer to 100% in light of the pervasiveness of violence in the ED. Even if training were mandatory, the lack of national training standards, as previously noted, raises the issue of the sufficiency and consistency of training. More- over, mandatory training requirements in the absence of national training standards serves to put the cart before the horse. Currently, there are no federal guidelines governing mandatory training or training stan- dards for security guards. Consequently, each state determines licensing requirements, Vol. 9, No. 2—June 2012 Pennsylvania Patient Safety Advisory Page 65 ©2012 Pennsylvania Patient Safety Authority O T H E R F E AT U R E S background checks, and training for which requires a lethal weapons training as demonstrated by Peek-Asa et al. in a security companies and guards providing program allowing a security officer to study of 50 hospital security programs in contracted security. In Pennsylvania, a legally carry a sidearm while on duty.9 New Jersey. Diversity in security training private security guard requires a state- This requirement may help explain why programs was evidenced by training mate- issued license to engage in the private only 4% of respondents in the Authority rials from many different sources, varied detective business, defined in the Private ED survey reported that security officers training formats, variations in orientation Detective Act as the business of private in their ED carried firearms.3 and retraining, and training delivered detectives; investigators; or watch, guard, At the hospital level, employee security by different individuals. Peek-Asa et al. or patrol agencies.7 The Private Detec- officer training requirements in Pennsyl- recommend systematic evaluations of tive Act also governs independent or vania are left to individual hospital policy. the various training programs studied to proprietary commercial organizations The Joint Commission’s Sentinel Event identify the most effective and efficient whose activities include safeguarding the Alert 45 recommends guidelines for the methods to deliver workplace violence employing party’s assets. The licensing reduction of violence in the workplace training, including training content, process is different from most other states as outlined within its requirements for a length, and modality, as well as trainer and involves submitting information to safe and secure healthcare environment, fidelity.11 Budget constraints and perceived the county clerk of courts and petition- but the alert falls short of mandating lack of the need or value of security train- ing for a license to the court. Training a standardized violence reduction pro- ing by hospital administration have also requirements are imposed by the court gram.10 A number of organizations, such been cited as barriers to effective violence and vary by county but generally involve as IAHSS, ASIS International, and the prevention training in hospitals.1 a 40-hour training course to be taken at Crisis Intervention Institute, provide Violence in hospitals is a growing and a state-certified training center. Nonsecu- certification and training programs for complex issue. Current workplace vio- rity organizations that employ their own security officers; however, these programs lence prevention guidelines are a good security services, such as hospitals, are not are not standardized or mandatory. start. However, the ongoing risk to regulated under the Pennsylvania act. The Occupational Safety and Health patients and hospital staff is a compel- A recent query of a job search website Administration, ASIS International, and ling reason for a change in the current for hospital security officer positions in IAHSS have independently developed assortment of regulations, guidelines, and Pennsylvania showed that the required and published guidelines on workplace training programs for hospital security qualifications generally included being age violence; however, adoption of these officers. Development and adoption of 18 or older and possessing a valid driver’s guidelines is voluntary. Lack of standard- minimum national criteria for the selec- license.8 Armed security guards in Penn- ization may contribute to the diversity of tion and training of all hospital security sylvania must become Act 235-certified, training programs at the hospital level, officers is long overdue. NOTES 1. Emergency Nurses Association. Emer- hospitals to protect patients and staff. Pa 10. Joint Commission. Preventing violence in gency department violence surveillance Patient Saf Advis [online] 2011 Dec [cited the health care setting [online]. Sentinel study [online]. 2011 Nov [cited 2012 Apr 2012 Apr 26]. Available from Internet: Event Alert 2010 Jun 3 [cited 2011 Nov 10]. Available from Internet: http://www. http://patientsafetyauthority.org/ 10]. Available from Internet: http:// ena.org/IENR/Documents/ ADVISORIES/AdvisoryLibrary/2011/ www.jointcommission.org/assets/1/18/ ENAEDVSReportNovember2011.pdf. dec8(4)/Pages/126.aspx. SEA_45.PDF. 2. Hammel P, Stoddard M. Tougher 7. Private Detective Act of 1953. P.L. 1273, 11. Peek-Asa C, Valiante D, Blando J, et al. penalties for assaulting nurses. Omaha No. 361, Cl. 22. Also available: http:// Workplace violence prevention and World-Herald 2012 Mar 2;Sect. B:1. www.legis.state.pa.us/WU01/LI/LI/US/ training programs in New Jersey hospital 3. Violence is not part of anybody’s job. PDF/1953/0/0361..PDF. emergency departments. Summary report Hosp Employee Health 2011 Nov 1. 8. Indeed [job search website; search term: on 50 New Jersey hospitals participating 4. Garrison J, Hennessy-Fiske M. Violence hospital security in Pennsylvania]. [cited in the evaluation of California initiatives afflicts ER workers. Los Angeles Times 2011 2012 Feb 20]. Stamford (CT): Indeed. to reduce violence against healthcare Jul 31;Part A:1. Available from Internet: http://www. workers study [online]. [cited 21 Feb indeed.com. 2012]. Available from Internet: http:// 5. Sheets RL. Remarks at: Workplace Violence nj.gov/health/surv/documents/ Seminar; 2012 Jan 11; Silver Spring (MD). 9. Lethal Weapons Training Act. 22 P. S. § § 41-50. Also available: http://www.pacode. njhospsec_rpt.pdf. 6. Martindell D. Survey of emergency department practices in Pennsylvania com/secure/data/037/chapter21/ chap21toc.html. Page 66 Pennsylvania Patient Safety Advisory Vol. 9, No. 2—June 2012 ©2012 Pennsylvania Patient Safety Authority PENNSYLVANIA PATIENT SAFETY ADVISORY This article is reprinted from the Pennsylvania Patient Safety Advisory, Vol. 9, No. 2—June 2012. The Advisory is a publication of the Pennsylvania Patient Safety Authority, produced by ECRI Institute and ISMP under contract to the Authority. Copyright 2012 by the Pennsylvania Patient Safety Authority. This publication may be reprinted and distributed without restriction, provided it is printed or distributed in its entirety and without alteration. 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