Healthcare workers have always faced a significant risk of job-related violence. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” According to data collected by the Bureau of Labor Statistics (BLS), 27 out of the 100 fatalities in healthcare and social service settings that occurred in 2013 were due to workplace violence.

While public attention tends to center on reports of workplace homicides, the vast majority of workplace violence incidents result in non-fatal injuries. Data from the BLS reveal that workplace violence is a threat to those in healthcare and social service settings, and that most injuries from assaults at work that required days off from work occurred in the healthcare and social services settings. Another thing to take into account is that research has found that workplace violence is underreported—suggesting that the actual rates may be much higher.

Healthcare and social service workers face an increased risk of work-related assaults, primarily from violent behavior of their patients. While no specific type of patient can predict future violence, studies consistently demonstrate that inpatient and acute psychiatric services, geriatric long term care settings, high volume urban emergency departments and residential and day social services present the highest risks for workplace violence.

Patients experiencing pain, receiving devastating prognoses, unfamiliar surroundings, mind- and mood-altering medications and drugs, and disease progression can also cause agitation and violent behaviors from patients.

While the individual risk factors will vary, depending on the type and location of a healthcare or social service setting, some of the risk factors include:

Patient and Setting-Related Risk Factors

• Working directly with people who have a history of violence, abuse drugs or alcohol, and unpredictable relatives of patients or clients
• Transporting patients and clients
• Working alone in a facility or in patients’ homes
• Poor environmental design of the workplace that may block employees’ vision or interfere with their escape from a violent incident
• Poorly lit corridors, rooms, parking lots and other areas
• Lack of access to lines of communication in emergency situations
• Prevalence of firearms, knives and other weapons among patients and their families and friends
• Working in neighborhoods with high crime rates

Organizational Risk Factors

• Lack of facility policies and staff training for recognizing and managing escalating hostile and assaultive behaviors from patients, clients, visitors, or staff
• Working when understaffed—especially during mealtimes and visiting hours
• High worker turnover
• Inadequate security
• Long waits for patients or clients and overcrowded, uncomfortable waiting rooms
• Unrestricted movement of the public within clinics and hospitals

Violence Prevention Programs

Developing a Violence Prevention Program, offers an effective approach to reduce or eliminate the risk of violence in the workplace. The building blocks for developing an effective workplace violence prevention program include:

• Management commitment and employee participation
• Worksite analysis
• Hazard prevention and control
• Safety and health training
• Recordkeeping and program evaluation

This program should have clear goals and objectives, be suitable for the size and complexity of operations and be adaptable. The components are interdependent and require regular reassessment and adjustment to respond to changes occurring within an organization such as changes in staff or expanding a facility. As with any occupational safety and health program, it should be evaluated and reassessed on a regular basis. Those who are responsible for developing a workplace violence prevention program should also check for applicable state requirements.

Management Commitment and Worker Participation

Management commitment and worker participation are essential elements of an effective violence prevention program. Effective management leadership begins by recognizing that workplace violence is a safety and health hazard. Additionally, management should: articulate a policy and establish goals, allocate sufficient resources, and uphold program performance expectations.

Through involvement and feedback, workers can provide useful information to employers to design, implement and evaluate the program. Additionally, it’s important to include workers with different functions and at various organizational levels to bring a broader range of experience and skills to program design, implementation, and assessment. 

Worksite Analysis

A worksite analysis involves a mutual step-by-step assessment of the workplace to find existing or potential hazards that may lead to incidents of workplace violence. Cooperation between workers and employers in identifying and assessing hazards is key to a successful violence prevention program. The assessment should be made by a team that includes senior management, supervisors and workers. Workers have a very critical role to play in helping to identify and assess common workplace hazards, because of their knowledge and familiarity with facility operations, process activities, and potential threats.

Hazard Prevention and Control

After the systematic worksite analysis is complete, the employer should take the appropriate steps to prevent or control the hazards that were identified. To do this, the employer should:

1. Identify and evaluate control options for workplace hazards
2. Select effective and feasible controls to eliminate or reduce hazards
3. Implement these controls in the workplace
4. Follow up to confirm that these controls are being used and maintained properly
5. Evaluate the effectiveness of controls and improve, expand, or update them as needed.

Post-incident response and evaluation are important components to an effective violence prevention program. Doing so will provide a roadmap to avoiding fatalities and injuries associated with future incidents. The purpose of the investigation should be to identify the “root cause” of the incident. Root causes, if not corrected, will inevitably recreate the conditions for another incident to occur.

Safety and Health Training

Education and training are key elements of a workplace violence protection program and help ensure that all staff members are aware of potential hazards and how to protect themselves and their coworkers through established policies and procedures.

Recordkeeping and Program Evaluation

Recordkeeping and evaluation of the violence prevention program are essential to determine the overall effectiveness and identify any improvements that should be made. Accurate records of injuries, illnesses, incidents, assaults, hazards, corrective actions, patient histories and training can help employers determine the severity of the problem and identify training needs and develop solutions for an effective program.