"Employers need to have a policy and encourage people to report so they get an accurate picture," she says. "If [incidents are] not being reported, employers may not realize they have the problem that they have."

But in some cases, reporting is pretty much impossible. MNA reported that many health care settings don't even have a reporting process - a 2005 BLS survey found 9 percent of private industry establishments had no policy. Processes that do exist tend to be extremely time-consuming. And even those employees who go through the timely process of reporting an adverse event, research has found nothing changes anyway, according to MNA. Ninety percent of establishments did nothing to change the work environment or protect workers from violence.


"We need to develop very clear procedures for reporting violent incidents," says ENA's Gurney. "Nurses can't be made to feel intimidated or ridiculed by other staff because we report it."

According McPhaul, there is a multitude of factors that prevent hospitals from implementing or changing policies, largely related to regulation issues.

"I think another reason [for underreporting] is when you do get a health care worker who reports an incident, nothing is done. You pretty much get the sense that nothing is going to be done. It's a vicious cycle," she explains.

"Sometimes hospitals don't have great systems for reporting incidents," McPhaul says. "Hospitals traditionally lump all of these kinds of events [together in an incident report]. Risk management folks who review the report tend to be more concerned with patient safety rather than employee safety...Patients can sue, workers can't."

Arizona nurse Anderson attributes the lack of reporting and the oversight of this problem to the fact that nurses are not given the respect they deserve.

"It's often that a patient will yell and scream and carry on, but when the physician walks in, everything is fine," she says. "They feel that nurses can be yelled at, can be pushed."

Despite the fact that hospitals are highly regulated facilities, workplace violence is not anything that hospitals "absolutely" have to focus on when it comes to regulation and enforcement, explains McPhaul.

Hospitals are asked to comply with the Occupational Safety and Health Administration (OSHA) guidelines, but that compliance is not enforced at all.

"In the last 15 years, OSHA hasn't regulated much of anything," she says. "What's probably a higher priority to OSHA and to workers who work in the health care industry is safe lifting and safe patient-handling standards...Violence continues to be one of those hazards that even OSHA tends to think maybe is a criminal justice [issue]."

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