Managing Workplace Violence in Healthcare

• It is important to understand the intensity of violence in healthcare and to examine real-life situations that have been reported.  
• An organization must have effective procedures in place to protect employees working in healthcare from violence.   
• One must fully understand the effects of violence among employees and the impact it can have on those who experience it.   

Violence against healthcare providers is spiraling out of control, and it should be a concern for all of us.   

According to the National Institute for Occupational Safety and Health healthcare workers are at increased risk of violence compared to other professions, and the consequences range from minor physical injuries, increased stress levels, and possibly even death.   

In my personal nursing career, I witnessed violence at least once a week during the three years in which I worked in a psychiatric emergency department.  In most of the incidents, substance abuse was a factor – but not an excuse.   

Although procedures were already in place to protect staff, vigilance was still necessary.  One of the facility’s responses to violence was to place signs throughout the hospital announcing that violence is not tolerated.   

Sadly, we cannot always rely on leadership to be proactive rather than reactive.  After all, most individuals have never walked into a medical facility that has metal detectors at the entrance.  Workplace violence is a serious issue and must be dealt with and handled in a professional and constructive manner.   

Examples of Workplace Violence in Healthcare

It is important to be aware and mindful of the multiple occurrences of violence among healthcare workers.  In 2022 alone, the following incidents have been reported: 

• A psychiatric nurse practitioner was stabbed to death at a halfway house/detox center in Durham, North Carolina and her patient has been charged with murder. 
• In Palm Beach County, Florida, a mental health therapist treating a patient in his home was kidnapped, bound with duct tape, beaten, and raped before being rescued by deputies.  The client faces multiple charges. 
• A man wearing an ankle monitor while visiting his girlfriend at a Dallas, Texas hospital is accused of fatally shooting a social worker and a nurse.  Before the attack, he accused his girlfriend of cheating on him.  He has been charged with capital murder. 
•  In a rampage at a Tulsa, Oklahoma medical facility, a gunman killed two physicians, one employee, and one patient.  The gunman also died in the rampage. 
• A man was charged with three counts of attempted murder in the stabbings of a doctor and two nurses at an Encino, California hospital. 

Procedures to Protect Against Workplace Violence in Healthcare

To protect employees, one should do the following in addition to abiding by facility procedures: 

• Recognize signs of aggression.  These include yelling, staring, clenching fists, and voicing threats.  Typically, all of these behaviors commonly precede a violent episode.  When these signs are apparent and tension is mounting, it is time to flee.  However, one should announce to the patient that he/she is leaving in order for any sudden movements such as standing, walking, or running to not be interpreted as an attack. 
• Wear clothing that fits.  Scrubs that are too tight will restrict movement.  Scrubs that are too loose can get caught on something and restrict movement.  Also, it is much easier to run in shoes that are comfortable. 
• When patients are unruly, do not administer care alone.  Trust one’s instinct and ask another nurse or security guard to be present.   
• Carry a panic device. Choose a wearable device that is appropriate for each individual.  Some devices are simple noise makers while others can send alerts and one’s actual GPS location.  One can search for “wearable panic devices” on Google or Amazon for more information. 
  
• Learn self-defense tactics and verbal de-escalation techniques. Most facilities offer classes on the management of assaultive and disruptive behavior, but in addition to these classes, consider studying martial arts.  The problem with most facility classes is that they do not mimic real-life situations.  For example, the “violent patient” always cooperates when accosted.  In a life-or-death situation, don’t expect the violent patient to always cooperate.  Be prepared to do whatever it takes to protect oneself. 
  

Effects of Workplace Violence in Healthcare

Many human resource departments do not seem to mitigate workplace violence, although the prevalence of violence against nurses and physicians seems to be increasing.  However, since all cases have likely not been reported, the prevalence can be much higher.   

The ones who are subjected to violence – physical and nonphysical – are more likely to struggle with symptoms of anxiety, depression, or post-traumatic-stress disorder.  These adverse effects on one’s mental health can erode confidence and interfere with patient care.   

Additionally, fear of stigma or being perceived as weak may prevent those affected from acknowledging any psychological distress; therefore, facility leadership must support their staff and do more to counter workplace violence.  Strengthening policies, promoting self-care, and lending an ear when someone says, “I need help,” are good starting points.

The Bottom Line

Workplace violence among healthcare workers can take a huge toll on staff and organizations and can create effects that can interfere with the performance of employees.  Violence in the workplace has become an issue that cannot be overlooked or ignored.  It is imperative to examine and implement programs that are designed to prevent, mitigate, and stop violence in order to promote positive effects.    

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