Violence in the healthcare workplace

Although the term workplace violence evokes dramatic shootings carried out by disgruntled former employees, many instances of such violence never make the news. What’s worse, many occur in healthcare workplaces. The federal government defines workplace violence as “verbal threats and physical assaults occurring to workers while on duty.” According to the Occupational Health and Safety Administration (OSHA), healthcare workers are the victims of nearly half of all nonfatal injuries caused by workplace violence.

Four types of workplace violence exist; any type may occur in a healthcare workplace:

• Type 1—violence with criminal intent, as in robbery or intent to murder
• Type 2—assault by a client, patient, or student served by the facility
• Type 3—violence between coworkers
• Type 4—domestic violence incidents at work.

Type 2 violence is most common in healthcare settings. Especially vulnerable are workers in mental health and acute psychiatric settings, emergency departments, geriatric and geropsychiatric units, and intensive care areas. Home visiting and community-based healthcare work carry unique risks, especially when conducted in dangerous communities or with high-risk clients. Certain environmental factors can increase the risk of violence.

In any setting, any patient or visitor with a history of violent behavior should be considered at high risk for becoming violent. Violence is most likely to be committed by patients with acute psychiatric emergencies, developmentally disabled patients, and previously violent persons who are frustrated, in pain, or otherwise stressed.

OSHA doesn’t regulate workplace violence, and in most healthcare settings no specific laws exist to help prevent it. California, Washington, and a few other states have laws addressing violence in healthcare settings. OSHA offers detailed federal guidelines in its “Guidelines for Preventing Workplace Violence in Healthcare and Social Service Workers” (available at www.osha.gov/Publications/osha3148.pdf).

Developing a workplace violence prevention program

Developing an effective workplace violence prevention program takes multidisciplinary cooperation and hard work. Unit-level nurses can begin this process by finding out about their facility’s violence policy and programs. Get answers to the following questions:

• How does your facility define workplace violence?
• Does the facility have detailed procedures and offer training on how to handle an agitated or violent patient or visitor?
• Is upper-level management committed to preventing violence, such as by signing off on the violence policy or forming committees on violence?
• How does the facility track violent incidents, including verbal violence, threats, and property damage? Is there evidence that changes are made in response to such incidents?
• What types of hazard controls are in place to prevent violence? Is there sufficient staffing on all shifts? Does the facility have alarm buttons, video cameras, or security guards?
• Does the facility offer violence prevention training? Are the instructors qualified and competent?
• Is there an opportunity to review policies and strategies?

This short column can’t answer all your questions about workplace violence. However, every healthcare facility should have a policy that does answer them.

If not, several sources offer information to help facilities begin a workplace violence prevention program. For instance, most states have a workplace safety agency that provides free consultation to employers. Also, the American Nurses Association offers information on its website (www.nursingworld.org/dlwa/osh/violence.htm), including a brochure titled “Preventing workplace violence.” Other professional associations and many nurses’ unions can give practical information to help nurses who want to make their workplaces safer.
Don’t let anyone tell you workplace violence is part of a nurse’s job. It’s a recognized occupational safety hazard that can be controlled and prevented with an “all-hands” approach and committed management.

Kathleen M. McPhaul, PhD, MPH, RN, is an Assistant Professor at the Work and Health Research Center of the University of Maryland School of Nursing in Baltimore. Jane A. Lipscomb, PhD, RN, FAAN, is a Professor, also at the Work and Health Research Center.

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