Work-related fatalities should be reported within eight hours. Work-related injuries and illnesses that are significant or meet any of the additional criteria listed below should also be recorded. Any significant work-related injury or illness that is diagnosed by a physician or other licensed healthcare professional or that involves cancer, chronic irreversible disease, a fractured or cracked bone, or a punctured eardrum should be recorded as well [3].

The following interventions are considered medical treatment and are almost always recordable on the OSHA 300 Log[3,4]:

Workers' compensation court usually requires an initial accident report and a first injury report to be filed within ten days of the injury, even if the injury leads to no lost time. The documentation of the injury should be complete and kept at the facility. OSHA requires employee health records to be kept confidential [3].

Violence in the workplace is an issue that is increasingly receiving public attention. An estimated 2.6 million workers are injured each in the workplace, of which more than 37,000 injuries are intentionally caused by another person. While a majority of these injuries are nonfatal, the U.S. Bureau of Labor Statistics (BLS) reported that of the 5,190 fatalities in the workplace in 2021, 761 workers were fatally injured by assault and/or violent attack [6,7,8].

Workers' vehicles are often taken for granted. However, maintenance issues are important, particularly for staff who work late at night or who conduct home visits in unfamiliar neighborhoods [10]. Staff members should have their keys readily available when they walk to their cars, and they should check the back seats before getting in their vehicles. Items that place a car at risk of being vandalized, such as a supply of psychotropic medication, should be put away or not left in the vehicle.

When going on home visits, knowledge of neighborhoods is a prerequisite to safety. The following questions may be helpful in determining the risk associated with certain neighborhoods [10,15,16]:

De-escalation involves defusing potentially agitated patients and reducing maladaptive behaviors using conflict resolution methods, limit-setting, and calm and empathic verbal strategies [18,19]. Ultimately, this depends upon the clinician's ability to negotiate and use conflict resolution [18,20]. One of the goals of de-escalating potentially aggressive patients is to promote autonomy and dignity by providing options [21]. To achieve this goal, clinicians must learn to recognize the warning signs of agitation. Behavioral cues may include increased pacing, increased volume and tempo of voice, flushed face, or agitated body movements [18].

Verbal strategies to de-escalate tension in cases in which clients have weapons can also be effective. When clinicians talk to clients in a calm and rational manner, both clinicians and the clients suffer less physical injury or property damage than when clinicians opt to use verbal or physical aggression [22]. Active listening skills are helpful and involve appropriate eye contact and body language, empathizing, and paraphrasing to convey understanding [12]. Clinicians should also be aware of their tone, volume, rate, and rhythm of speech, also referred to as paraverbals. If not careful, paraverbals can convey the opposite of what is communicated verbally [23]. Empathetic listening and communication can help to de-escalate violent situations [24]. Instead of trying to suppress emotions, listening and talking through the frustration can help mitigate potentially violent anger.

The use of de-escalation techniques as early intervention results in more therapeutic gains for patients as opposed to using more restrictive management techniques to deal with aggressive behaviors [18]. Clinicians who successfully use de-escalation techniques report improved relationships with patients and increased feelings of self-efficacy, which can lead to greater job satisfaction [18]. It is vital that the environment supports patient self-management of anxiety [26]. Facilities can promote this by providing access to massages, relaxing sounds, aromatic oils, comforting blankets, guided imagery, and other soothing techniques.

Clinicians should also be attuned to their own feelings and reactions. If they sense that a client will be violent, a safety plan should be implemented immediately. Not only should clinicians be aware of their feelings, but they must be aware of how their body language and facial expressions mirror their feelings. For example, if they feel fear and anxiety, these reactions should be masked so as not to communicate the fear to their patients [12]. If patients sense fear, open communication, trust, and rapport can be negatively impacted [12].

For some practitioners who witness workplace violence, compassion fatigue, secondary traumatization, and burnout are typical consequences. Compassion fatigue is a relatively new term, coined in 1992, and is meant to convey a nonpathologic concept [30]. It is a natural consequence of the emotions that stem from either witnessing or knowing about a traumatic event or daily continual contact with those who are suffering [30]. Secondary, or vicarious, traumatization is defined as "transformation of the inner experience of the therapist that comes about as a result of empathic engagement with clients' trauma material" [31]. Vicarious traumatization can cause emotional and cognitive arousal symptoms, such as increased emotional sensitivity, lack of well-being, intrusive thoughts, and difficulty concentrating [32]. Finally, burnout has been defined as physical and emotional symptoms that are linked to the workplace experience, ranging from working with clients to environmental components of the workplace [32]. The practitioner experiencing burnout feels exhausted and, at times, emotionally detached from clients [32]. In one study, Levine, Hewitt, and Misner found that nurses withdrew from their patients after an incident of workplace violence [33].

It is important to view occupational policies regarding workplace violence in the context of the range of different types of organizational responses to incidents of workplace violence or bullying. Ferris divided organizational responses into three categories: "See no evil, hear no evil, and speak no evil" [35]. Organizations that fall into the "see no evil" category acknowledge the existence of workplace violence or bullying but normalize the behavior. When affected staff members approach the employer, they are told to toughen up and to learn how to deal with the behaviors [35]. Organizational responses identified as "hear no evil" acknowledge the problem but frame it as an interpersonal conflict. The victim is often blamed for somehow triggering the negative behaviors due to his or her personality [35]. The third and final response is classified as "speak no evil." These organizations acknowledge the problem and its deleterious effects. Consequently, they take allegations seriously, follow up with an investigation, and take action against the bullying or violent individual. Ferris noted that the "speak no evil" organizations had learned from previous encounters of workplace violence that had resulted in lawsuits [35]. Organizations may ask where their current policies would be categorized based on this system.

Mandates for the development of zero-tolerance violence policies have been set for healthcare organizations [15]. This sends a clear message to employees that all types of workplace violence, including harassment, are not tolerated [36]. Such behaviors should be followed up with the appropriate disciplinary action [37]. The main premise of zero-tolerance policies is that workplace violence is reduced by promoting open communication of acceptable behaviors [37]. However, it is crucial for organizations to remember that a zero-tolerance policy itself does not prevent workplace violence [19].

It is recommended that an interview be conducted with the victim and witness(es) as soon as possible after the event. The American Federation of State, County, and Municipal Employees recommends questions covering [39]:

OSHA has established the following recommendations for organizational policies for decreasing workplace violence and promoting the safety of employees [15,41]:

Nearly one in five adults in the United States live with a mental illness [46]. Stress can increase these and other mental health challenges and can be harmful to our health. The amount and type of stress experienced varies from person to person due to many factors, including those experienced at work. Approximately 65% of U.S. workers surveyed have characterized work as being a very significant or somewhat significant source of stress in each year from 2019 to 2021. An estimated 83% of U.S. workers suffer from work-related stress, and 54% of workers report that work stress affects their home life [46]. In addition, workplace stress has been reported to cause 120,000 deaths in the United States each year [46].

Work has always presented various stress. Workers are constantly dealing with new stressors introduced to the workplace, and in some instances, these stressors have amplified other issues at work. Workplace stressors may include [46]:

The standard requires employers to implement an exposure control plan that mandates Universal Precautions (i.e., treating all body fluids as if they are potentially infectious). The standard also stresses hand hygiene, recommends the use of Personal Protective Equipment (PPE), sets forth processes to minimize needle sticks and blood splashing, ensures appropriate packaging of specimens, and regulates waste by employing biohazardous labeling before shipping [50,51].

Annual inspections by the fire marshal, quarterly fire drills, annual fire safety in-services, and monthly fire extinguisher documentation are all elements of a successful fire safety program. Staff education and documentation of the education are integral parts of the fire safety plan.

Attorneys who investigate incidents of employee injury will expect to be able to examine available documentation, including incident reports, medical records that include treatment of the employee, and training and education records. Safety conditions that might have caused the injury, any perceived unsafe conditions that exist, the safety committee minutes that show how the facility has addressed the condition, and further actions to correct the condition may also be reviewed.