What is alopecia?

What is alopecia, anyway?

alopecia

If you look it up in a medical dictionary you will discover that it is a disease where the hair follicles attack their own hairs and the patient becomes bald.  There are several different types of alopecia–from total loss of body hair to just having small bald spots appear sporadically.  The causes of this illness are unclear and can be from excessive stress, rubbing or pulling excessively, medications, pregnancy, hereditary status or even illness.  Children have been known to loose hair due to a very high fever that lasts longer than normal.  There actually are over 30 different illnesses that can cause alopecia.

Why are we talking about alopecia now?

Although you may not be familiar with this issue, it is much more common than you think.  We all are familiar with male-pattern baldness and the reason so many men shave their heads now.  However, women also suffer with this condition and it is becoming more and more prevalent due to the rise in breast cancer and its treatment.

For a woman, her hair is very much tied up with her internal image of her femininity and the loss of her hair deals her a very heavy blow to her psyche.  Even though men also have problems with their public image when they loose hair, women begin to feel less than a woman with this loss.

What should you know about your patient with alopecia?

If you have a female patient who has just learned she has breast cancer, it isn’t really the time to hit her in the face with “and you will lose your hair, too”.  As nurses, we expect this issue to be addressed by the oncologist-but don’t count on it.  Sometimes the doctors simply state that the chemotherapy will make your hair fall out but don’t worry because it will come back again.  The patient takes a big breath but then lets it out because they feel assured that things will get back to normal after treatment.  Well, unfortunately, that is not always so and as nurses we need to be sensitive to this growing problem some women are dealing with.

If your patient suffers from any mild form of alopecia before chemotherapy, there is a very good chance that regrowth will be slow if ever or that hair will grow back only in places.  This issue needs to be addressed very carefully and if you are a patient-centered nurse you will tread softly, but you will address the issue with your patient.alopecia

When a woman loses her hair, she is embarrassed, feels afraid, is upset, feels denigrated, and can become very depressed.  Doctors fail to acknowledge the loss and pain she feels because they know that it cannot be avoided and they know that the treatment will save lives.   But if you ask your patient what it means to her to lose her hair, she will give you another side of this story.  Unfortunately, not enough nurses out in the work force ever think to ask their patients about this aspect of having breast cancer.

How can you help your patient as a nurse, then?

First, be open and honest about the potential for hair loss.  Let your patient explore her feelings about being bald.  Give her a sounding board that is a safe place.  Help her explore options for after she loses her hair.  Scarves, hats, and wigs are plentiful in today’s society.  Help her look into these various ways to dress herself so she can remain feminine and feel pretty despite the loss.

alopecia

Remember that this patient will be dealing with great loss.  Her grief will be huge and horrible and as her nurse you need to help her deal with this aspect of her illness even before it happens.  This care plan can be explored prior to any treatment for breast cancer.  Once diagnosed, you owe it to your patient to talk about this issue.  Don’t make your patients have to go home and Google it.  Don’t be that type of nurse.

 

Minoxidil is the only FDA approved medication on the market for hair loss.  It must be applied twice a day directly to the scalp and takes up to six months to show any results.  The real problem with using this drug is that if you stop using it, the hair that grew in may simply fall out again.  To me that is a pretty poor solution to a huge problem.

Next week we will talk more about this condition and its clinical manifestation.  In the meantime, why not click over to read this article and see pictures of actual patients to see how they are able to deal with this horrible blow to their psyches.  This article is about a photographer in Scotland who wanted to show this condition for what it is but he had trouble finding models willing to be photographed.  Read his motivation for the article and what he hopes can happen because of it.

 

 

 

 

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Doctors Throwing Fits

Here is a rather long article, but it is important and necessary to read and acknowledge the problem as it affects patient care and patient outcomes.  We all have to possibility of becoming a patient at sometime in our lives, so our health outcome should be a priority to us.  Doctors throwing fits creates a hostile and dangerous environment for nurses and patients alike.

Doctors throwing fits is universal to all healthcare environments but should that make it be okay?  Stress, fatigue, disappointment, and fear of loss all combine to make the attending a pressure cooker about to explode.  Nurses have historically done all they can to soothe and care-take physicians to prevent such outbursts; but in today’s workforce, such behavior has come to be seen for what it really is.  Doctors are bullies.  Somewhere in the course of their training, they have gotten the idea that they are in control and everyone else is just there to do their bidding.

This is so far from the truth that I can’t even begin to address it.  Nurses are there to attend to the patient’s needs and to protect the patient’s rights when they are unable to do so due to illness or anesthesia.  Techs are there to provide the muscle and to present the necessary equipment needed, as well as to attend to the patients.  Doctors seem to forget that they only spend a short time with each patient but the nurses are with that same patient for 24 hours a day.  Who do you think should know more about what is going on for that same patient?

I hope you take the time out of your day to read this long article. It is important to make yourself aware of all the dangers that may befall you if you find yourself in that awful position–patient.

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Doctors Throwing Fits

One of the hardest parts of being a nurse is dealing with bullying doctors.

A doctor-bully epidemic is jeopardizing both nurses and patients
Most nurses have witnessed or been the victims of doctor bullying.

Photo illustration by Slate. Photo by Thinkstock

Adoctor-bully epidemic is jeopardizing both nurses and patients. In news reports and hospital break rooms, stories abound of physicians berating nurses, hurling profanities, or even physically threatening or assaulting them. Doctors are shoving nurses in the operating room; throwing stethoscopes, scissors, pens, or surgical instruments. In Maryland, a surgeon yelled, “Are you stupid or something?” at a nurse and hurled a bloody surgical sponge at him. A surgeon threw a scalpel at a Virginia nurse, who told me, “He was angry because I didn’t have a rare piece of equipment he needed, so he endangered me and several others by throwing a tantrum.”

Many things surprised me during the reporting for my new book, The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital, which follows the stories of four nurses and is based on interviews with hundreds of other nurses across the country. But this disturbing problem was one of the more shocking discoveries when nurses pulled back the curtain. Most nurses have witnessed or been the victims of doctor bullying. A 2013 Institute for Safe Medication Practices survey found that in the year prior, 87 percent of nurses had encountered physicians who had a “reluctance or refusal to answer your questions, or return calls,” 74 percent experienced physicians’ “condescending or demeaning comments or insults,” and 26 percent of nurses had objects thrown at them by doctors. Physicians shamed, humiliated, or spread malicious rumors about 42 percent of the surveyed nurses. A New York critical care nurse told me, “Every single nurse I know has been verbally berated by a doctor. Every single one.”  (read the rest of this article here)

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I’m not a nurse

Here is an article about female doctors, not nurses.  However, this article is important in that it addresses the stereotype that all the public have of who and what a “nurse” is.  It also addresses the inequalities between male and female counterparts, no matter what their status may be.  So when this doctor says, “I’m not a nurse,” it is in no way a reflection of the status of nurses but rather a reflection of how we see women in the healthcare field.

I certainly can understand why this doctor really hates being called a nurse.  She prepared and studied and passed boards to be able to say M.D. after her name.  She does not do the same work that the nurses do and that should be obvious to patients.  In the same vein, nurses are often called “aides” and expected to do the same work as an aide, despite them being the person giving the patient medicine.

Hospitals finally got wind of the patient’s confusion about who is what in their care and some are mandating color coding for uniforms.  Great.  I love the idea!  But it only helps out if there is some type of education for the patients to discuss what each person’s colored uniform means for them and their care.

This article is worth the read.  It may help you to understand how to differentiate who is providing care for you or your loved one the next time you find yourself in a hospital.

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Thanks for the compliment, but I’m not a nurse

Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me nurse, I hate it.

i'm not a nurse

photo by: shutterstock

Here’s why:

1. I hate being called “nurse,” because I feel like it undoes the work of thousands of female physicians before me.

Recently, I was on service with one of the most accomplished female physicians at my institution. Our first patient welcomed us into his room with this: “Can I call you back? The nurses want to talk to me about something.”

One hundred and fifty-four years ago, he would have certainly been correct. However, in 1849, Elizabeth Blackwell became the first woman to receive a medical degree in the U.S. Hundreds of thousands of female medical school graduates later, women are now poised to outnumber their male colleagues by 2017. Still, I can’t say I feel secure in my place as a female physician. We are still underpaid and underpromoted compared to our male colleagues. To me, it feels like we’ve just splintered the shell of this previously male-dominated field. Being called “nurse” reminds me of the enormous gender gap I have yet to cross. Overpowering gender stereotypes will take more than outnumbering the men in our field.  (read more here)

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Unapologetically a Nurse

Here is an essay I found on the Huffington Post headed “Unapologetically a Nurse”, and I am so glad I found it and glad I read it.  Nurses everywhere need to read this.  She defines nursing in such a profound way, with unadulterated truth and honesty.  Nurses are just people.  However, they are very special people who have been called to minister to others.  I know, that sounds corny in today’s world, but corny or not, it is the truth.  You can run away and try to evade it, but if nursing is calling you, nursing will get you.

I was tearfully moved by one statement she makes in her essay, ” And yet those who are in on the secret, or at least are suspicious of it, understand that it was no miracle that saved your loved one. Rather, it was the intent and vigilant care of a critically thinking, intuitive, and fiercely devoted nurse. Our secret is that we save more lives than we are willing to admit; we catch more errors than we hope to share; and we can sense subtle nuances that prevent a turn for the worse. ”  This is so true.  I can speak as a nurse but I can also speak as a parent.

When my youngest daughter was bleeding to death in ICU after her liver/kidney transplant, it was her 7p-7a nurse that saved her life that night.  She worked tirelessly and she hung bag after bag of blood, platelets, albumin, and IV fluids to keep my daughter alive.  She took orders from the nurse practitioners on the floor that night as well as three different doctors calling orders in to her from home.  She went with my daughter off the floor, bringing all those bags of life saving fluids with her for a procedure to try to find and stop the bleed.

As far as I am concerned, that night I witnessed a miracle and was in the presence of a real Angel.  I cannot ever thank her enough for all she did and the worst part of it all is that I don’t even know her name–just Liz.  When my daughter stabilized and her shift was over, she hugged me and told me to go home and get some sleep, then she left and I never saw her again.  But believe me, she is in every prayer I utter every day.

Please read this essay.  You will be a better person for it and you will understand your nurse better for it.

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Unapologetically a Nurse

I’m No Angel
 
 

I sit here starting at a blank computer screen, filled with quiet concern. It’s simply that I have so many things to say to about the nineteen million and counting nurses across the planet, and not enough time in the world to say it. They are my team. They are my posse. They are my family — an utterly dysfunctional one, but family at that. I believe that few professions exist where colleagues can be grossly irritated by each other one moment, and cracking jokes in the next. It has been mentioned before that what we do every day makes us akin to the “Navy Seals” of the healthcare profession. That statement alone suggests that nurses work in some of the most stressful environments while enduring more intense circumstances daily than many face in a lifetime. What we do, every single day, is a labor of love. But we are all in on the real secret: nurses are not angels placed on earth to serve and lift. We are not diminutive and submissive and gentle souls that kiss boo-boos. We are not the starched white caps and perfectly polished shoes that history books portray. Nor are we fishnet stockings and naughty rendezvous in dark corners. We have been glamorized and fetishized and placed on a pedestal unlike any other profession, and yet the definition of what we are is only surpassed by the list of what we are not.

Please read the rest of this short essay here.  I promise you it is well worth your time.

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The Patient Satisfaction Survey Score

 Here is an article that addresses a common issue found in today’s healthcare setting.  The Patient Satisfaction Score, although a great idea, has become an albatross around the necks of all healthcare workers.  It is one thing to practice a patient-centered nursing, which is good; but it is another thing to turn nurses into maids and servants who are desperate to please.  Sometimes what the patient wants is not what the patient needs to improve his health and denial of his wants can be reflected in the patient satisfaction score.

There is not a nurse alive who goes to work and says, “I am going to make my patients very unhappy today by denying them all their requests.”  To think there is such a nurse is just plain stupidity.  Nurses are there to administer care while a patient is unable to do so for himself and while his condition warrants close monitoring.  All nurses want their patients to be happy and healthy, but there is also a reason why the patient is in the hospital to begin with.  Nurses have to walk that fine line between wants and needs all day long.

Please read this article and see if you agree or disagree that Patient Satisfaction Scores are becoming a real problem in the healthcare arena.

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The Problem With Satisfied Patients

A misguided attempt to improve healthcare has led some hospitals to focus on making people happy, rather than making them well.

patient satisfaction
Philippe Wojazer/Reuters
When healthcare is at its best, hospitals are four-star hotels, and nurses, personal butlers at the ready—at least, that’s how many hospitals seem to interpret a government mandate.When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.

Beginning in October 2012, the Affordable Care Act implemented a policy withholding 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and the top performers will receive bonus money from the pool.

Patient-satisfaction surveys have their place. But the potential cost of the subjective scores are leading hospitals to steer focus away from patient health, messing with the highest stakes possible: people’s lives.
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Remembrance of Days Gone By

Today is All Soul’s Day and I think it would be appropriate to reminisce about nursing in the past.  Remembrance of days gone by is always challenging because reflection brings strong emotions to bear sometimes.

I was leaving my exercise class this morning at the clinic and I spied this picture up on the wall in the entryway.  I was mesmerized by this photo.  It made me stop and think about all the nurses who went before me, all the nurses who blazed trails for the modern day nurse.  I fear that most or all of the nurses in this picture may be deceased by now, but posting the photo here is my way of saying, “Thank you very much for your service.”

It also helps me to remember that as a nurse myself, I am part of a long line of selfless, caring people who wanted to make the world a better place one patient at a time.

Let’s use this opportunity to remember nurses past.

remembrance of days gone by

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Nurses: Why Are We Letting Them Burn Out?

Burn out is real and a danger to all of us–both nurses and patients.  When your nurse is burned out, you get only part of the care that nurse is capable of.  When the nurse is burned out, the interactions on the unit become strained and difficult so communication among and between care teams is at risk.

As a nurse for 25 years, I can attest to the statistics floated in this article.  I cannot remember a single shift I worked where one of the other nurses would not complain about the state of nursing and vow to quit.  Not one shift.  That is terrible.  Nurses want to give good, competent care.  Nurses want to make patients better–improve their lives if possible.  But the truth of the matter is that they are overworked and with the advent of computerized charting must spend time away from their patients to chart.  Together these two things are driving nurses out of nursing in large numbers.

Please read this entire Huffington Post article and see if you don’t agree that there may be a significant problem on our horizon that no one seems to be interested in attending to.

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We Need Nurses More Than Ever. Why Are We Letting Them Burn Out?

The combination of an exodus of RNs and an influx of aging patients could create a health care crisis.

JOHN TLUMACKI/THE BOSTON GLOBE VIA GETTY IMAGES
Tufts Medical Center nurses picket in Boston on July 13 after being locked out after a 24-hour strike. One of the sources of stress nurses report is not being included in the decision-making process at health facilities.

About 10 years ago, Elizabeth Scala was a young RN, working on a psychiatric floor of a busy Maryland hospital. She’d been in the role for two or three years, and she’d risen to a position of authority, coordinating her colleagues’ activities as a charge nurse on the unit. From the outside, it looked like she had everything together, but inside she was so stressed out she was nearly falling apart.

“It was like Jekyll and Hyde,” Scala said.

When she got off work, she said, she would go home and pick vicious fights with her boyfriend. She wasn’t sleeping or eating well. She was constantly furious with her co-workers and supervisors. She remembers throwing a temper tantrum one night, flailing around on her bed like a 4-year-old.

Then the situation began affecting her ability to do her job.

“Eventually I just started to really resent going into work — dreaded going in — and actually didn’t want to talk much with the patients,” she said.

Scala finally left the job, shifting to a career in which she could use her nursing skills in administrative and research. She also wrote Stop Nurse Burnout, a guidebook for nurses who feel like she once did.

And that’s a lot of nurses. A survey earlier this year by travel nursing company RNnetwork found that almost half of the nurses they asked were considering leaving the profession. About a quarter said they felt overworked, 46 percent said their workloads had risen and 41 percent said they’d been harassed or bullied by managers or administrators. Making matters worse, with the aging of the baby boom generation, demand for health care is rising at the same time that large numbers of experienced nurses are retiring. That could lead to the worst nursing shortage in generations within the next decade.

Read the rest of this article here.

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Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing

This article surprised me in that it comes from Marie Claire magazine.  Although written in 2015, the article still remains pertinent and applicable to today’s nursing.  There is the nurse culture of bullying and hazing and it is one of nursing’s secrets, even today.

When you think of nurses, you probably think of calm, competent men and women who try to do whatever they can do to help a person recover from an injury or illness.  This is an accurate picture, but underlying that calm, helpful image is a bizarre negative.

Nurses can be angels sent from heaven and usually are, but they can also be hateful, deceitful, vengeful, people–usually toward other nurses.  If you ask nurses about the nurse culture of bullying and hazing, you will be met with a blank stare and a confused expression.

But if you ask “why do nurses eat their young?”, every nurse will understand what you are asking and will probably have their own personal story to illustrate this concept.  It is not that nurses intend to be mean to each other; rather it is the stress of the job, the expectations of the patients and families, and the limit of time that contributes to nurses not being as nice to each other as they could be.

Please read this article and decide what you think about this culture of bullying and hazing.

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Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing

It’s not only threatening the profession, it’s putting patients’ lives at risk.

Everett

Over the course of four years, I interviewed hundreds of nurses for a book (The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital), examining a subculture the public knows little about. The nursing profession demands a lot from its ranks: 12-to 14-hour shifts coping with traumas, managing grotesqueries, soothing distraught family members. And they do it with a calm and grace that belie just how complicated their jobs really are. The women and men I spoke with exuded the compassion and selflessness we’ve come to expect from nurses, traits that make it easy to understand why the country’s 3.5 million nurses have topped Gallup’s annual poll of Honesty and Ethical Standards in Professions for 13 straight years.

Which makes the profession’s silent secret all the more surprising: rampant hazing, bullying, and sabotage so destructive that patients can suffer and, in a few cases, have died. Nurses told me about numerous daunting behavioral patterns: colleagues withholding crucial information or help, spreading rumors, name-calling, playing favorites, and intimidating or berating nurses until they quit.

“Nurses eat their young.”

Nurse bullying is so pervasive that it has its own expression. In 1986, nursing professor Judith Meissner coined the phrase “Nurses eat their young” as a call to action for nurses to stop ripping apart inexperienced coworkers. Nearly 30 years later, the bullying seems to be getting worse, says Gary Namie, Ph.D., director of the Workplace Bullying Institute in Bellingham, Washington, which receives more calls from nurses than from workers in any other field (36 percent vs. 25 percent from educators, the next-most-frequent callers). “The profession’s on the brink of some sort of transition,” Namie says. “Nurses uniformly seem to accept nurse-on-nurse violence as just part of the job. But they’re losing nurses by the drove.”

Read the rest of this article here.

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Nurses Endure Violence On The Job

This incident was an eye-opening event for some about the shocking amount of violence nurses face on the job.  There is not a nurse anywhere who has not personally been abused at work or who has not seen abuse of nurses at work.  It is our dirty little secret.

I know that when this incident happened, I was appalled.  I absolutely could not believe my own eyes.  This nurse was following the law.  She was protecting an unconscious person in her care.  She refused to do something illegal to aid in prosecution.  And she was thrown into the back of a police vehicle and booked into jail.  WOW!

This incident was discussed on every news channel, in print, on the web, on YouTube.  My question is “What does it take to protect nurses from assault at work?”  Has anything changed?  Not that I can see.  Has anyone proposed legislation to protect nurses at the work place?  If there has been proposed legislation at the federal level, we are not privy to that information.

The end of this story has a happy ending in that she was released, got an apology from the Chief of Police and the Mayor, and now we find out that the police officer in question has been fired.  Yea, or is it?  It seems like a knee-jerk reaction to this situation with no attempt at resolving the issue.

I am sure that this nurse did not want the police officer to lose his livelyhood, but she may have wanted him chastised, maybe fined, and sent back for more intensive training in the laws of this country.  All in all, I feel that this has been a no-win situation all the way around.

Nurses everywhere continue to be assaulted, abused, and injured doing the job they love to do–helping others.  Am I the only person who sees this as a significant problem?

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Nurses Endure A Shocking Amount Of Violence On The Job

Usually, though, it’s not at the hands of police officers.

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Rules About Violence Against Health Workers

Here is an article from Kaiser Health News that addresses rules about violence against health workers and states that California’a rules may become the model for such rules around the entire country.

As a psychiatric nurse, I can definitely tell you that violence against health workers occurs pretty regularly, especially for nurses.  In my 25 years of work, I have had teeth kicked out, my face and nose broken, and I have torn my rotator cuff, as well as having my knee injured in a fall while at work.  That is just my injuries.  Many nurses can list more and more serious injuries sustained while trying to help patients heal.

ER nurses, psychiatric nurses, ICU nurses are all at extreme risk due to the population they care for; but no nurse or doctor is immune.  Violence in the workplace has taken on a whole new meaning when you are talking about healthcare.

Please read this article and see what your thoughts are about dealing with this problem.  We need to address this issue before we find ourselves with no nurses to care for patients.

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California Rules About Violence Against Health Workers Could Become A Model

violence against health workers

California rules would require site-specific assessments to identify violence risks for health care workers and plans to mitigate them.

Dana Neely/Getty Images

Workers in California’s hospitals and doctors’ offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.

Regulators within the California Division of Occupational Safety and Health approved a rule last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.

“This is a landmark day for the entire country,” said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.

There are no federal rules specifically protecting workers from violence, but some states, including California, New York, Illinois and New Jersey require public employers to take preventive measures, according to the American Nurses Association.

The Cal/OSHA rules apply to private health care facilities in the state and are more robust than existing workplace protection rules, union officials say. Site-specific assessments will be done to identify violence risks, and the resulting plans to prevent injuries will address concerns identified by workers. 

“California has now set the bar with the strongest workplace violence regulation in the nation,” wrote Castillo in a statement.

Read the rest of this article here.

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