Justification for Change

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

________________________________________________________________________________________
Centers for Disease Control
and Prevention (CDC)
National Institute for Occupational
Safety and Health (NIOSH)
1095 Willowdale Road, MS1811
Morgantown, WV 26505-2888
PHONE: (304) 285-5913
FAX: (304) 285-6235

To:

Office of Management and Budget

From: Marilyn Lou Ridenour, BSN, MBA, MPH
CDC/NIOSH
1095 Willowdale Road MS 1811
Morgantown, WV 26505
[email protected]
304-285-5879
Date: 5/29/2012
Re:

Nonmaterial/non-substantive Change to OMB 0920-0914

We are requesting a nonmaterial/non-substantive change to our OMB Approved Information Collection
titled ‘Workplace Violence Prevention Programs in NJ Healthcare Facilities’ (OMB control number
0920-0914) with expiration date 1/31/2015. Our changes are as follows: (1). Nurse Survey – added
question 2 on page 1 regarding advanced degrees. We added a 3rd check box under the section Violence
Based Safety Programs …, question 2 (facility does not have a workplace violence prevention
committee), and question 5 (facility does not have policies). Under the section Experiences with
Violence, questions 1 through 4 have the added statement that begins “For patient perpetrators, this is
regardless of their state of being…” We added Perpetrator is a Patient or Family Member to column two
on page 3, and added Perpetrator is a Coworker or Administrator to column three on page 3. We added
Physical Assault and Electronic Aggression to work-related violence events on page 4. We added the six
types of workplace violence to questions 2 and 3 on page 4. (2). Sample Size - Increased sample size
from 2000 to 4000.
Justification of changes for the nurse survey: allow a more comprehensive data on types of workplace
violence and on the perpetrator of workplace violence towards registered nurses (RNs) and licensed
practical nurses (LPNs). These changes came after our focus groups with nurses. The nurse survey does
not change in length at four pages.
Justification of change of sample size: to get a more precise workplace violence assault estimate for
LPNs since there are substantially less LPNs compared to RNs in the healthcare workforce. This is an
insignificant change for the RNs and LPNs since the time to complete the nurse survey does not change
(remains at 20 minutes).
The requested changes will not change the scope of the study. For this form, burden hours will increase
from 667 to 1,333 (regarding the increased sample size).
Attachment: Nurse Survey 5.24.2012 (clean copy)