Workplace Violence in Healthcare

Workplace violence should never have to characterize anyone’s job experience. Sadly, nurses experience workplace violence to a greater degree than in other fields. According to a 2018 Bureau of Labor Statistics fact sheet on healthcare workplace violence, healthcare workers and social service industries are five times as likely to experience workplace violence than other workers. 

The COVID-19 pandemic has only amplified this issue for nurses. National Nurses United surveyed 15,000 registered nurses across the country and found that 20% of RN respondents reported increased violence during the pandemic. Fortunately, there have recently been measures to reduce the number of violent incidents.

In this post, we will explore the following:

• How does workplace violence manifest itself in the healthcare community?
• What are some of the causes of workplace violence?
• What’s being done to combat workplace violence?
• What are healthcare institutions doing?
• What can nurses do to combat workplace violence?

How does workplace violence manifest itself in the healthcare community?

According to a report on violence against healthcare workers by The American Journal of Managed Care, nurses experience workplace violence more than other healthcare workers. The report indicated that 82% of U.S. nurses had been assaulted at one point during their careers. Of that number, 73% believed that the assault was just part of the job. 

In a study by the National Institute of Health, the four main types of abuse faced by nurses on the job are:

• Shouting or yelling (60% by patients, 35.8% by visitors)
• Swearing (53.5% by patients, 24.9% by visitors)
• Grabbing (37.8% by patients, 1.1% by visitors)
• Scratching or kicking (27.4% by patients, 0.8% by visitors)

Workplace violence happens between co-workers as well. Earlier this year, there was an incident where a nursing assistant in Philadelphia shot and killed another nursing assistant. 

In many ways, there’s an epidemic of violence within the healthcare community that’s only increasing. According to the American College of Emergency Physicians, nearly 7 out of 10 emergency physicians believe that emergency department violence is rising. 

BACK TO TOP

What are some of the causes of workplace violence?

Workplace violence stems from a variety of factors. One of the primary reasons why workplace violence happens in the first place comes down to the setting. Hospitals are filled with sickness, pain, and death, which can trigger intense emotions. They may not usually be aggressive, but hospitals become a conduit for their rage. 

Given the added stressors of COVID-19, it’s easy to imagine why workplace violence has only risen in recent years.

Another factor for workplace violence occurs when patients are under the influence of drugs or alcohol. This can disorient the patient and make them behave in dangerous ways they otherwise might not. 

Many patients with dementia can also become violent due to confusion. These aren’t all the causes of workplace violence but are some of the more prevalent causes. 

BACK TO TOP

What’s being done to combat workplace violence?

With the surge of workplace violence, it’s imperative for new policies to be introduced and passed in order to curb these incidents. Efforts have been made with federal and state legislation along with healthcare facilities and nurses. 

What kind of federal legislation has been enacted?

With the passing of HR 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, there’s hope for healthcare workers. The bill would employ the federal Occupational Safety and Health Administration (OSHA) to create a national standard for healthcare and social service employers to develop and incorporate a workplace violence prevention plan. 

The law will mandate minimum requirements for the workplace prevention plan. Some of these plans include staffing for patient care and security, violence incident logs, and protection for employees to report workplace violence to their employer and law enforcement. 

This bill, which was introduced with bipartisan support, waits in the U.S. Senate for approval. 

What kind of state legislation has been enacted?

There are a few states that have attempted to address the epidemic of workplace violence in nursing head-on. For example, Washington, Oregon, California, and Illinois have required public sector employers to design workplace violence prevention programs. Additionally, in Arizona, Ohio, North Carolina, and Florida, there are steep penalties for individuals who assault healthcare workers. 

The American Nurses Association’s Workplace Violence webpage has a list that explains what different states have done to protect healthcare workers. For example, some states allow healthcare workers to only use first names on identification badges. 

BACK TO TOP

What are healthcare institutions doing?

Many hospitals have taken steps to reduce workplace violence. However, there is a lot that needs to happen for effective change. The American Association of Critical-Care Nurses has issued a statement outlining what hospitals should do to address the issue. 

The statement reads as follows: 

• Educate staff on how to recognize the potential for violence, employ de-escalation techniques, and seek assistance to prevent or respond to violence.

• Establish a clear and consistent reporting structure for workplace violence, with specific policies and procedures on reporting violent incidents to law enforcement.

• Encourage employees to press charges against persons who assault healthcare workers and support staff who do. Many states have established laws with enhanced penalties for these offenses.

• Provide resources and support programs for employees to help them cope with violent incidents.

• Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.

• Ensure the presence of sufficient security systems, including alarms, emergency response, and available security personnel.

BACK TO TOP

What can nurses do to combat workplace violence?

The primary way that nurses can deter workplace violence is by reporting. There’s a lot of underreporting that takes place within the field, which leads to more violence. Healthcare workers need to speak up so that violence doesn’t affect other workers. Additionally, nurses can alert their nurse leaders and administration to the following risk factors identified by the Occupational Safety and Health Administration:

• A lack of training on workplace violence
• Understaffing
• Providing notice for patients with a history of violence
• Inadequate security and mental health personnel 
• Poorly lit corridors, parking lots, rooms, and other areas
• Working alone in a facility or patient’s home
• Lack of means of emergency communication

Altogether, nurses should not have to worry about workplace violence when they come to work. The perception that violence is commonplace and is “part of the job description” needs to change. Though much progress has been made, there’s a long way to go in order to help nurses feel safe at work. 

BACK TO TOP