Updated 10/24.

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

Regulators within the California Division of Occupational Safety and Health (Cal/OSHA) approved a new rule that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process.

Two unions, the California Nurses Association and the Service Employees International Union (SEIU), have been pushing for more comprehensive protections because of what they see as an “alarming” rate of health care workplace assaults, including the 2010 strangling death of a nurse at a state-run psychiatric hospital in Napa.

“Unfortunately, [violence] is sort of a daily occurrence,” said Kathy Hughes, a registered nurse and spokesperson for the SEIU Nurse Alliance of California. She said her union formed a campaign and talked to hundreds of health care professionals, many of whom had accepted the idea that assaults happen at work. But “violence shouldn’t be part of the job,” said Hughes.

The California Nurses Association sponsored the 2014 bill that required the board to adopt the violence prevention rules this year.

National research shows that health care workers are at a “substantially higher” risk of workplace violence than the average worker. In 2013, for example, private-sector hospital workers were five times more likely to take time off of work because of an injury caused by violence than a typical private sector worker.

Workplace safety standards already exist in California, but the new Cal/OSHA rules are specifically designed to prevent violence. Health care employees would help assess workplace risks, and the resulting injury prevention plans will address their concerns, union sources say.

“It can’t be a cookie-cutter approach,” said Hughes, adding that emergency departments and pediatric care units pose different dangers to workers, so safety protocols can’t simply be a “canned plan” found on the internet.

Both health care worker unions say they hope the new California standards will become a national model.

Testimony at hearings leading up to this week’s approved violence prevention rules suggest that worker assaults vary in severity.

As a student nurse at a San Francisco hospital, Amy Erb remembered being kicked in the head by an agitated, confused patient with a traumatic brain injury.

Other health care workers told stories about patients throwing lamps, lifting caregivers up by their necks or stuffing dirt into the mouths of their colleagues.

Under the new rules, California employers would not be liable for every act of violence against a worker, such as a mass shooting, but they could be cited by Cal/OSHA for not following protocols, Hughes said.

Hospitals and physicians were at the table when regulators hammered out the workplace rules. The California Hospital Association did not provide comment for this article, but it had been opposed to creating new standards when lawmakers looked at the issue in 2014. Hospitals also wanted “workplace violence” to be better defined.

The hospital trade association said several recent trends may contribute to violence at health care facilities. Cuts to mental health care services lead to more psychiatric patients in hospitals. The aging patient population may include more Alzheimer’s patients with aggressive tendencies. And hospitals caring for current or recently released prisoners face a higher risk of violence.

The newly approved standard now will be reviewed by the Office of Administrative Law before taking effect, which may not happen until January 2017.