By Jamie Ridenhour

Workplace violence in the healthcare industry is more common than most people realize.  Violence against healthcare workers is indeed so prevalent that those workers often cite it as simply part of the job.  Education and training becomes vitally important, not only for prevention, but also to promote accurate reporting.

As we discussed in Healthcare Security, nearly 75% of workplace violence incidents occur in the healthcare industry.  Up to 70% of emergency room nurses have been assaulted on the job.  Even more concerning is the fact that many assaults go unreported.  Healthcare workers often view violent confrontations as part of their duty in dealing with injured patients and distraught relatives.

The hospital environment can be stressful for patients, their family and friends, and employees of the facility.  The fear and stress of injury or illness coupled with long wait times and daunting financial implications can bring out the worst in people.  Unlike many other industries, violence in the healthcare setting is often not criminal in nature, but comes from the very people nurses and doctors are trying to help.

Particularly in the U.S., the healthcare system itself engenders this type of stress.  As the American Journal of Managed Care (AJMC) puts it, “Healthcare is not focused on wellness.  The system creates a situation where there is so much stress, where people can’t get preventative care, where they’re worried about whether or not they’re going to have to file bankruptcy.  This type of stress is leading to violence, and it all comes together in that hospital room.”

The fact that patients are so often involved makes preventing and dealing with healthcare violence a lot more complex than in other industries.  Simply preventing access to suspicious individuals or criminalizing patients who become violent is at odds with the stated mission of healthcare facilities.  Moreover, the use of force is contrary to the principle of “do no harm” that medical professionals adhere to.

Training, system-wide reporting initiatives, and thorough analysis of incidents are some of the best strategies for overcoming the increase in violence in the hospital setting.  Most importantly all of these require the input and consistent support from everyone in the organization, from management to front line staff.

OSHA382, Preventing Workplace Violence: A Road Map for Healthcare Facilities lays out the following objectives and topics that should be covered in training.

  • A review of the facility’s workplace violence prevention policies and procedures.
  • Policies and procedures for obtaining a patient’s risk profile before admission, when feasible.
  • Risk factors that cause or contribute to assaults.
  • Policies and procedures for assessing and documenting patients’ or clients’ change in behavior.
  • Location, operation, and coverage of safety devices such as alarm systems, along with the required maintenance schedules and procedures.
  • Recognition of escalating behavior, warning signs, or situations that may lead to assaults.
  • De-escalation techniques to prevent or defuse volatile situations or aggressive behavior.
  • Approaches to deal with aggressive behavior in people other than patients and clients, such as relatives, visitors, or intruders.
  • Proper use of safe rooms or areas where staff can find shelter from a violent incident.
  • A standard response action plan for violent situations, typically referred to as “codes,” including the availability of assistance, response to alarm systems, and communication procedures.
  • More generally, what to do in case of a workplace violence incident—i.e., responsibilities of others who are not directly responding to the event.
  • Self-defense procedures where appropriate.
  • Progressive behavior control methods, including when and how to use medications or physical restraints properly and safely when necessary.
  • Ways to protect oneself and coworkers, including working in teams when necessary.
  • Importance of getting early assistance.
  • Policies and procedures for reporting and recordkeeping.
  • Policies and procedures for obtaining medical care, counseling, workers’ compensation, or legal assistance after a violent episode or injury.

The training outlined above should be a regular occurrence and should involve all hospital management and staff.  Ideally, a committee made up of members from all hospital units should be planning and directing the training.  The committee should also be tasked with reviewing the effectiveness of the training on the number of reported incidents and incorporating any useful feedback.  Plans should be re-evaluated and updated at least quarterly.

Which brings us to perhaps the most important change that must occur to decrease workplace violence in healthcare – transparency.  Staff must develop the attitude that violence is unacceptable and is not part of the job description.  They must also be confident that they can report incidents of violence with no repercussions and that their concerns are being heard and acted upon.

Retaliation against reporting individuals is much too common and has an adverse effect on both the individual and the process as a whole.  When staff members are deterred from reporting, the number of violent interactions cannot be accurately calculated.  Statistics on violence are meaningless if staff are afraid to report incidents.

The past couple years of the pandemic response have highlighted the critical contribution that healthcare workers make to society.  Unfortunately, challenges such as inadequate staff numbers and low wages have also become apparent.  Violence should not be yet another concern.  As hospitals and other healthcare providers grapple with how to attract and retain workers, strategies for decreasing workplace violence must be part of the discussion.