Violence in the workplace has become a hot-button issue, and healthcare facilities aren’t an exemption. Patients who become hostile can take out their anger on nurses and hospital staff members.

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.” Not only are hospitals having to care for patients in hospitals, they might have to help their own caregivers recover after an incidence of workplace violence in healthcare. The National Safety Council reports that in 2017, 18,400 injuries and 458 fatalities occurred due to violence in the workplace.

There is a growing recognition that healthcare workers are routinely at risk of workplace violence, especially when compared with other industries. OSHA suggests that workplace violence toward healthcare workers results in as many injuries as all other industries combined.

In fact, hospitals are seen as a hotbed for workplace violence to occur. OSHA reports that from 2002 to 2013, incidents of serious workplace violence were four times more likely to occur in healthcare settings than in private sector workplaces.

To better understand why a place committed to health and safety has such high rates of workplace violence, it is important to understand both the root causes and the residual effects of these incidents.

Causes and Effects of Workplace Violence in Healthcare Settings

Causes of Violence Toward Hospital Staff

It’s important to understand the numerous causes when patients lash out at hospital staff members. One study published in 2015 concluded that three themes are catalysts to why violence in hospitals occur:

  • patient behavior
  • patient care
  • situational events

Patient Behavior

Patient behavior can change wildly in cases where they demand to leave but cannot, or when cognitive impairment has occurred.

Patient Care

When patients experience pain or discomfort, they can lash out at healthcare workers.

Violence can also occur during care-based events such as physical transfers, or when nurses are administering care using needles.

Situational Events

Situational factors, such as restraining a patient or intervening to protect a patient or staff member, can also lead to workplace violence in healthcare.

The CDC, in partnership with NIOSH, provides resources for workplace violence prevention, including common reasons for client-on-worker and worker-on-worker violence, how hospitals and nurses can help prevent violence, and how to safely intervene.

Effects of Workplace Violence Toward Hospital Staff

The effects of workplace violence, particularly in the healthcare sector, are broad and far-reaching. A study on workplace violence toward hospital staff published in 2014 cites seven different categories of these consequences:

  1. Physical
  2. Psychological
  3. Emotional
  4. Work Functioning
  5. Relationship with Patients / Quality of Care
  6. Social / General
  7. Financial

This same study reported some alarming findings:

  • As many as 65% of victims sustained physical injuries; 4.4% were life-threatening
  • Up to 32% of victims suffer from PTSD; over 95% experienced flashbacks
  • Other effects included burnout, anxiety, and low self-esteem
  • Workers exposed to violence took sick leave, reported reduced productivity, experienced duty changes, and even quit their jobs in the aftermath

OSHA reports additional consequences, including direct costs associated with treatment and lost wages, caregiver fatigue leading to mistakes and injuries, and reduced patient satisfaction scores.

Recommendations for Reducing Workplace Violence in Hospitals

1. Eliminate the “Normalization” of Workplace Violence Against Healthcare Workers

The first step to reducing Violence Against Healthcare Workers is to affirm that it should never be allowed or ignored.

Healthcare staff often view verbal or physical violence as “part of the job.”Healthcare staff can often fall into the trap of accepting a patient’s behavior because they associate it with the patient’s disease or mental health. OSHA recommends that leaders in all work environments continually encourage and train employees to report all threats and incidents of violence in the workplace.

Healthcare organizations must educate their staff and break down these notions that violence is expected or acceptable.

2. Implement Education and Training Programs

Education and training should reinforce the idea that these types of behaviors are unacceptable under any circumstances. Leaders must emphasize this message and provide adequate support for staff who encounter violent behaviors. Training is essential — OSHA says “It helps healthcare workers learn to recognize potential hazards and learn how to protect themselves… Education also reinforces that violence is not an acceptable part of healthcare work.”

According to OSHA and ECRI, some of the issues that workplace violence prevention and training programs should consider include:

  • Organizational policies and procedures
  • Recognition of risk factors
  • Warning signs for violent behavior
  • De-escalation techniques
  • How to deal with aggressive individuals
  • How to locate and use safe rooms
  • Self-defense procedures when appropriate
  • Documentation, record keeping, and post-incident follow-up
  • Onboarding and ongoing education
  • Utilization of technology

3. Institute Reporting Policies and Procedures

Reporting policies and procedures assist in tracking and following up on instances of workplace violence.

Recommendations for reporting practices are driven by various agencies, including the Joint Commission, OSHA, and even state requirements.

Quality reporting helps healthcare organizations to:

  • Determine the state of workplace violence in the organization
  • Examine trends within the organization
  • Evaluate the effectiveness of education and training programs
  • Identify ongoing training needs
  • Adjust training, equipment, and policies that help prevent violence

Organizations can also identify and track the impact that workplace violence has on individual units and the organization as a whole by looking at employee days away from work, work restriction, or staff turnover in relation to workplace violence.

4. Utilize Technology

Technology to help prevent, deter, and report on violent events in healthcare settings goes beyond traditional physical security and access control solutions, and even beyond modern applications of data management such as EHR and EMR systems. Virtual patient observation (VPO) solutions such as NOVA can help promote staff safety by allowing virtual observation technicians to monitor multiple patient rooms while not needing to be physically present.

This innovative technology allows technicians to seamlessly document in real-time events that happen in patient rooms, including when violence occurs.

There is no single solution to prevent workplace violence in healthcare. But these four recommendations are a step in the right direction to reduce violence against healthcare workers, and to help staff to feel safe at their jobs knowing that their organization is genuinely invested in their safety.