Is Talk Cheap? The Value of Verbal De-Escalation in Workplace Violence

• Recommended protocols, including verbal de-escalation, must be in place to mediate workplace violence. 
• Understanding the importance of early signs of escalation is paramount when dealing with workplace violence. 
• Effective communication skills are critical when handling workplace violence.

Workplace violence (WPV) is a growing concern in healthcare. Prevention of WPV can be challenging, to say the least. Aggression from patients and family members has become a growing concern over the past several years.  

It has been suggested that fear and anxiety from the COVID-19 pandemic, as well as limited visitation during the pandemic, greatly impacted WPV in healthcare. Yet, according to 2021 U.S. Bureau of Labor Statistics data, the incidence of violence–related healthcare worker injuries has steadily increased for at least a decade.

Is our society just becoming more violent? Has respect for healthcare professionals declined? Have we lost the ability to effectively intervene when someone is upset? Is the inability to mediate escalating situations a result of overworked, understaffed healthcare facilities? Or a result of a generation that has learned to communicate via text and ‘snap’ methods rather than face to face? A combination of these issues is most likely the answer. 

Whatever the reason, whatever the cause, the relevant question is how we can mediate the risks associated with WPV in healthcare. What can we, as healthcare professionals, do to prevent workplace violence? 

Protocols for Workplace Violence

There are many recommendations and protocols to mediate workplace violence, including no-tolerance policies and behavioral response teams. These are important and impactful interventions, but is there something more grassroots that can be done?

The first step in mediating violence is to recognize a situation that may potentially escalate. If escalation can be recognized and appropriate interventions applied, the elevation to violence might be avoided. When we, as busy healthcare professionals, experience an escalating situation, do we have the knowledge, skills, and mindset to recognize a risk and de-escalate a situation before a violent event occurs? Can we potentially avoid the need for physical intervention that puts both the patient and professional at risk? 

Recognizing Early Signs of Escalation

The Joint Commission (TJC) reported in 2019 that physical restraint is a leading cause of staff injury. The same report found that skilled verbal de-escalation can prevent the need for physical restraint.

What is needed to become effective in verbal de-escalation? Is this an attainable goal?

Staff need training to recognize early signs of escalation and the wherewithal to implement de-escalation skills prior to physical intervention.

We have all experienced a team of healthcare workers arriving in full force to respond to an escalating situation. This often results in the perpetrator of violence responding like a cornered cat in full attack mode. We have also experienced skilled, smooth-talking staff who control a situation, calm an environment, and develop an effective therapeutic relationship.

Effective Communication Skills 

How do we learn to turn the frightened hiss to a purr?

Communication skills are often underdeveloped and not the primary focus in healthcare education. Developing knowledge and skill for assessment, diagnosis, intervention and treatment is fundamental in providing care for those in need.

So where does the development of interpersonal skills occur? These skills are not effectively developed without intentionality, and the issue is more compounded in the digital age. De-escalation will remain evasive until individuals can actively listen in an empathetic manner, preserve autonomy, effectively set boundaries and communicate humanely.  

Some skills with effective communication can come with life experience and maturity, but much can — and — should be taught. Effective training in verbal de-escalation is vital. This training must be immersive and experiential. 

No one has ever learned to de-escalate a multiple-choice question. Training in “case scenarios” and role playing is needed to enhance verbal de-escalation skills. This skill cannot be learned without experiential practice.

Granted, there are some with specific disease processes or impairment that may not respond appropriately with verbal intervention. Yet, the attempt to verbally de-escalate prior to physical intervention should always be made. It may be effective with intentional skilled intervention by those trained in verbal de-escalation.

If that’s the case, it preserves the therapeutic relationship, patient autonomy, and safety for both the patient and caregiver.

A 2018 report on workplace violence from the Joint Commission found that healthcare and social service employees have an increased risk of violence in the workplace — five times more than other industries

As of January 2022, TJC-accredited hospitals are required to implement and analyze workplace violence prevention programs annually. In addition to physical intervention techniques, health care facilities are required to provide de-escalation training and non-physical intervention skill development.  

As violence in our world increases and communication skills remain underdeveloped, training in verbal de-escalation is vital and requires more than what is currently in place. It must be hands on and immersive. Verbal de-escalation must be practiced, practiced, and practiced again until it becomes a natural reaction to an escalating situation. Just as most hospitals practice ‘mock codes’, the implementation of ‘behavioral mock codes’ should be seriously considered in healthcare settings.

According to the National Safety Council, health care workers and educators were the fourth most ill or injured professions in 2021. In addition, the average cost of a medical consultation for a work-related injury was $42,000 in 2021. Clearly, all these illnesses and injuries were not a result of WPV, yet in 2020 the Centers for Disease Control and Prevention reported WPV increases job stress, resulting in absenteeism and staff turnover. These figures do not include the cost of extended hospitalization that occurs with physical or chemical restraint or the cost of the intervention itself.  

The Bottom Line

Is talk cheap? The answer is no. The potential value of skilled verbal de-escalation can save thousands, if not tens of thousands, of dollars, preserve the patient-client relationship, retain employees, and potentially reduce the incidence of workplace violence.

Due to its prevalence and importance in the workplace, protocols and effective means of communication must be followed to decrease this ever-present issue.  

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