CONCORD - During the first six months of this year, at least 10 nurses and mental health workers at New Hampshire Hospital were hurt badly enough by patients that they had to miss at least one day of work, nearly double the number of such serious injuries at the hospital in all of 2017, according to Executive Council records.
Employee safety at Department of Health and Human Services' facilities has been a serious concern for council members and legislators since last summer, when there was a noticeable uptick in the number of workers' compensation claims filed.
The claims offer a glimpse at how hazardous it can be for staff in psychiatric facilities. Nurses and other workers in residential care settings have the highest rate of nonfatal workplace injuries and illnesses of any job, according to the Bureau of Labor Statistics, and studies suggest the rate for those in the psychiatric field is even higher than the rest of the group.
New Hampshire Hospital's new CEO said the facility has taken several steps to address the number of injured staff members since last fall, when a group composed of legislators, union officials, hospital administrators and other stakeholders convened to address the issue. It just doesn't have the data yet to prove the steps are working.
"I do not feel, speculation-wise, that the acuity or level of assaults are higher now than they were a year ago," said Lori Shibinette, who took over the hospital in October.
The Executive Council records only detail the number of patient-on-staff assaults that lead to workers' compensation claims. They do not include incidents in which employees are attacked but do not suffer an injury serious enough to keep them out of work.
Historically, the hospital has maintained records of all such incidents in paper reports, not in a format that's usable for the purpose of identifying patterns and potential solutions, Shibinette said. That will soon be changing. The hospital is looking for a vendor to build a digital monitoring system that could help administrators be proactive about preventing injuries - by indicating that more assaults happen during a particular shift, for example, or on a patient's third day of admission.
"This is unfortunately a regular occurrence in those institutions, and it has been for a long time," said Brian Hawkins, government relations coordinator for SEIU Local 1984, the union that represents much of the staff at New Hampshire Hospital and the Sununu Youth Services Center, another state-run psychiatric facility. "They're not going to be completely preventable, especially in a situation like SYSC or New Hampshire Hospital, but let's get some data that can inform a plan going forward."
There were eight workers compensation claims for SYSC employees in 2017, compared to two in the first half of 2018. A change in state law limited the number and type of youth that could be sent to the center in 2018.
The DHHS, which operates SYSC and New Hampshire Hospital, is also working with the University of New Hampshire, Dartmouth-Hitchcock, and other organizations on a pilot program to track employee injuries in a variety of different health care settings.
Private employers must report information about workplace injuries to the federal Occupational Safety and Health Administration.
But OSHA does not have jurisdiction over New Hampshire Hospital or the SYSC, a spokesman said, because they are state-run. The New Hampshire Department of Labor doesn't conduct investigations into workplace injuries at the facilities either.
"It's an area that's not clearly defined in the law: How much authority does this department have over sister agencies?" said Ken Merrifield, commissioner of the Department of Labor.
The only publicly available information about how frequently employees at the two facilities are injured therefore comes from the workers compensation reports submitted to the Executive Council.
Shibinette said she couldn't speak to the safety practices at the hospital before she took over, but since October she has implemented several changes.
That includes holding a "safety huddle" each morning where administrators and supervisors from each unit discuss any issues that came up during the past 24 hours and any that may present themselves in the day ahead, such as a patient who has been exhibiting violent behavior.
The hospital also conducted a review of its physical security and is in the process of installing security cameras to cover several blind spots.
All staff had to be re-certified in crisis and de-escalation training, and the trainings will be required annually going forward, Shibinette said.
By the beginning of next year she expects to have a better idea of where the hospital stands.
"We don't know what we don't know if we're not tracking the data," she said. "I would say at the beginning of the calendar year I'll be able to say, 'This is where we started, this is the progress we've made, and this is where we're going.'?"