Workplace Violence Prevention Guide for Healthcare

Introduction

When an incident of workplace violence occurs, the effects are pervasive and devastating. For workers, it can result in physical harm like grievous injury or death, or psychological damage that can last anywhere from several years to the rest of their lives.

Organizations, on the other hand, not only bear a duty of care for their workers, but must also potentially contend with issues of trauma, loss of morale, loss of productivity, and property damage, as well as increased costs for security, personnel, workers’ compensation, and so on. They must also deal with media reports about the incident, and the public’s response to those reports.

But perhaps the most unfortunate and frustrating fact about workplace violence is that there’s no way to completely stop it from happening. The root causes of workplace violence are the same as those of any incident of violence. Despite everything we know about human behavior, something unforeseeable has caused a person to either threaten violence or carry it out; there is simply no guaranteed cure or surefire method of prevention.

While workplace violence does occur, organizations like yours still have the power and responsibility to mitigate the risk of such incidents by learning more about the scope of the problem, the risk landscape, and your compliance obligations, then taking steps to address them. This way, you can bolster the health and safety of your employees, reduce the likelihood of incidents at your work sites, and avoid penalties by ensuring that you follow all relevant workplace safety regulations.

A major factor of your company’s risk landscape is the industry in which you work — and available data suggests that work sites in the healthcare sector tend to be more at risk for incidents of workplace violence than almost any other. This means that for healthcare employers like you, workplace violence is a serious and predictable hazard. And as a result, you have a unique responsibility to be even more aware of and prepared to contend with this issue than organizations in other industries.

Before we recommend actions your company can take to reduce the risk of workplace violence at your work sites, some context is needed. We’ll cover what constitutes workplace violence, the magnitude of the issue and industry-specific risk factors for healthcare employers, and your legal responsibilities as an employer.

What is workplace violence?

Workplace violence is any act or threat of violence that takes place at a work site, including physical abuse, harassment, intimidation, or other threatening behavior. Anyone at a work site has the potential to commit or become victimized by an act of workplace violence — not just employees or managers, but also vendors, partners, patients, or visitors.

Every incident of workplace violence can have life-altering or fatal consequences. Even if a person is not directly involved in an act of workplace violence, it can have deep and lasting effects on anyone at that work site, their families, and the larger community.

How prevalent is workplace violence for healthcare employers?

But how widespread is the issue of workplace violence?

According to a joint US study released in 2022 by the Bureau of Justice Statistics (BJS), the Bureau of Labor Statistics (BLS), and the National Institute for Occupational Safety and Health (NIOSH), 1.3 million people on average per year from 2015 to 2019 were the victims of nonfatal incidents of workplace violence. BLS also reported in a separate 2022 study that in 2020, 37,060 nonfatal workplace injuries were the result of “intentional injury by another person.”

Unfortunately, the effects of workplace violence don’t stop with simple victimization or injury. This is true whether or not the incident is reported — which, in many cases, doesn’t happen.

In its 2023 Census of Fatal Occupational Injuries (CFOI), BLS reported that even though there were 5,283 fatal workplace injuries that year, 740 of them were the result of violent acts. The CFOI also found that homicides represented 61.9% of all violent acts at the workplace. And according to the 2022 joint US study referenced above, 18,000 people were killed between 1992 and 2019 while actively working, on duty, or by an act of work-related violence.

Workplace violence is also not uniquely an American issue. According to the Australian Bureau of Statistics (ABS) Personal Safety Survey (PSS) for the 2021–2022 financial year, Australians over 15 years of age experienced over one million incidents of work-related violence during the survey’s reference period.

Additionally, between 2017 and 2022, the ABS PSS reported a 56% increase in the number of “serious” workers’ compensation claims — those involving at least one week away from work — for assault and exposure to workplace violence.

The magnitude of this issue is clearly staggering, even jarring. But how do healthcare employers compare to employers in other industries in terms of risk?

According to the National Safety Council (NSC) Injury Facts^® website — which draws on data gathered by BLS — 28,970 nonfatal work-related injuries caused by assaults and resulting in Days Away From Work (DAFW) in 2021-2022, or 70.2% of all such incidents, occurred in a healthcare or social assistance setting. This rose from 15,210 in 2020, or 75.9% of the total that year. In both years, the healthcare sector reported far more cases than every other industry.

Safe Work Australia estimated that in 2024, around 95% of Australian healthcare workers had experienced physical or verbal violence.

And according to the Australian Workers’ Union and Head First Mental Health Issues in the Workplace Report from October 2023, nearly 40% of survey respondents — workers in health and community services — reported exposure to violent or traumatic events at work, including exposure to harm, abuse or assault, receiving threats, or being in view of a traumatic event or death. This seems high, especially when compared to 15% of respondents in construction, 7.6% in manufacturing, and 2.6% in mining.

Who’s at risk of workplace violence in the healthcare sector?

While every person present at a healthcare work site has the capacity to be directly involved or indirectly affected by an incident of workplace violence, certain types of employees — or types of healthcare employers — have a higher risk than others. Knowing this helps you to structure more effective policies and prevention plans specific to your work sites.

A number of factors can influence the level of risk for workplace violence an employee experiences as a result of their profession. According to NIOSH, common risk factors for violence in a hospital setting include:

• working directly with volatile individuals, especially if they are under the influence of drugs or alcohol, have a history of violence, or suffer certain psychotic diagnoses
• working while a facility is understaffed, especially during meal times and visiting hours
• transporting patients
• long waits for service
• overcrowded or uncomfortable waiting areas
• working alone
• poor environmental design
• inadequate surveillance, security apparatuses or security personnel
• lack of staff training for preventing and managing incidents

Based on these factors, the workers most at risk for workplace violence in hospitals are nurses and aides who directly interface with patients, as they spend the most time in close contact with those receiving service. A secondary risk group includes emergency response personnel, hospital safety officers, and all other health care providers, including doctors, surgeons, and technicians.

These factors also impact which areas within a hospital setting are the most prone to incidents of workplace violence — namely, psychiatric wards, emergency rooms, waiting areas, and geriatric units.

Of course, not all health care is delivered in a hospital setting. Nursing facilities, intermediate care facilities, and hospice facilities share a number of factors in common with the higher-risk areas within both acute care and specialty hospitals. Home health and personal care aides also find themselves at risk for workplace violence, especially as many assignments often have them working one-on-one in an in-home setting, delivering care to patients with a wide array of needs and conditions.

At any healthcare work site, the tipping point often occurs when someone receiving care, or closely related to a person receiving care, crosses a threshold due to agitation, vulnerability, or a perceived lack of control. And as healthcare potentially deals in matters of life and death, the stakes of every decision or delay can feel incredibly high for patients and their family members.

The effects of workplace violence in healthcare settings

The direct effects of workplace violence on its victims, as mentioned earlier, can be physical or psychological, and detrimental for both the individual and their surrounding community. These can include minor or more serious physical injuries, including temporary or permanent disability, psychological trauma, or in the most severe cases, death.

Additionally, workplace violence can carry downstream organizational effects that ripple and reverberate throughout teams, across departments, or even your entire organization, depending on the scope of the incident. These include trauma, anxiety, low morale, and low productivity — leading to an overall lower quality of care delivered — as well as increased stress levels, which can then drive feelings of burnout and instigate a higher rate of employee turnover.

For example, studies produced after the first year of the COVID pandemic revealed that the heightened conditions within which healthcare workers operated, as well as the demands of patients during such a high-stress period, led to increased levels of burnout and other adverse psychological outcomes. When run against trending data for workplace violence during the same period, it’s clear that while it was not the only factor at the time, violence in healthcare settings was indeed a strong driver for both occupational exhaustion and turnover intention.

Compliance risk for employers

To remain legally compliant, employers must abide by any and all laws that dictate safety standards for work sites to keep their employees safe. One of the most well-known regulations to set such standards is the US Occupational Health and Safety Act of 1970, a legislative response to the rising public outcry for greater environmental safety standards to protect both the public and employees who were tasked with handling hazardous chemicals for work.

Within the OSH Act is a clause colloquially known as the General Duty Clause, which set a basic standard for a duty of care for all employers to meet for their employees, regardless of industry. The General Duty Clause specifies that “each employer… shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees…”

Other countries, such as the UK, Australia, and New Zealand, have passed laws containing language similar to the General Duty Clause, outlining their own recognition of a duty of care for employers to meet on behalf of their employees — though in Australia, this is implemented at the state level. For example, the Primary Duty of Care clause for New South Wales resides within Division 2 of the Work Health and Safety Act 2011 No. 10, first passed in 2011.

Given its prevalence in the healthcare industry, workplace violence is a recognized hazard for all US healthcare work sites, as interpreted by the Occupational Safety and Review Committee (OSHRC) as recently as 2019. To that effect, healthcare industry employers must comply with their obligations under the General Duty Clause to provide employees with a safe working environment and deliver reasonable protections where applicable.

Due to the overwhelming prevalence of workplace violence at healthcare work sites, additional state-level laws and regulations in the US have been either passed or adopted since 1970 that can affect whether your organization remains compliant. These include:

• Alaska: Senate Bill 49 — referred to the Alaska State Senate Finance Committee on May 9, but not yet passed — which would amend the terms of workplace violence protective orders to enable healthcare employers to petition for one on behalf of an employee and proactively protect them without requiring their direct involvement
• California: Code of Regulations, Title 8, Section 3342, which requires healthcare employers to maintain a violent incident log and improved recordkeeping systems, as well as to create and implement a workplace violence prevention plan with routine training of employees and opportunities for worker feedback
• Connecticut: Substitute Senate Bill No. 970, which requires healthcare employers to establish and maintain recordkeeping and reporting requirements for incidents of workplace violence, as well as amends the criminal code for certain class C felonies to include incidents of workplace violence perpetrated against healthcare personnel
• Illinois: The Health Care Violence Prevention Act, which requires healthcare employers to create and provide prevention and de-escalation training, physical signage in key areas of healthcare facilities, and whistleblower protections to encourage employees to speak up without fear of retaliatory actions from their workplaces
• Indiana: Senate Bill 419 — referred to the Indiana General Assembly Committee on Courts and Criminal Code on March 3, but not yet passed — which seeks to deter acts of workplace violence in healthcare settings by defining battery against a healthcare provider as either a Level 5 or Level 6 Felony, depending on the nature of the offense
• Massachusetts: Senate Bill 2655 — for which joint legislative hearings were held in April, but has not yet passed — which requires healthcare employers to perform annual risk assessments and develop violence prevention plans, as well as allow health care providers who have been the victim of assault or assault and battery at a work site, and who may need time to address key legal issues, to take paid leave from work
• New York: Assembly Bill A203 — introduced in January, but not yet passed — which requires healthcare employers to create and implement a workplace violence prevention program and adds requirements for the retention of security personnel on premises
• Ohio: House Bill 452 — signed into law on January 8, and took effect on April 9 — which requires hospitals to establish security plans for preventing workplace violence which must include a risk assessment, annual reviews, reporting protections, posted notices, and de-escalation training for employees
• Washington: House Bill 1162 and its counterpart legislation, Senate Bill 5162 — both of which, as of publication, are awaiting signature by the governor — which mandates that each facility in a healthcare setting to develop and implement a workplace violence prevention plan, establish a safety or workplace violence committee if one does not already exist, address extant issues of physical access, physical security, and staffing, and conduct comprehensive annual reviews, among other requirements

Like any regulation, organizations bear the burden of becoming familiar with all applicable laws surrounding workplace violence prevention and taking steps to ensure compliance. This way, your organization not only avoids potential liabilities tied to noncompliance, but more importantly, an act of workplace violence is less likely to occur at one of your work sites.

Steps to mitigate and respond to workplace violence

While there is no cure for workplace violence, there are concrete steps that healthcare employers can take to both ensure they’re meeting their general duty of care obligation and working to mitigate the risk of an incident of workplace violence at their work sites:

Identify your facilities’ risk factors for violence

Before you can create a workplace violence prevention plan or other policy for deterrence, you’ll need to perform a thorough threat assessment of the physical spaces in which you operate. Institute regular reviews and track the causes of incidents to keep your assessment up-to-date.

Establish anti-violence, anti-harassment, and anti-bullying policies

Your workplace violence prevention plan and other policies should be zero-tolerance and clearly define unacceptable behaviors for work sites. This shows employees your organization’s commitment to creating and maintaining a culture of respect and building an environment that minimizes negative feelings like isolation, resentment, and hostility.

Communicate policies to all employees, managers, and supervisors

Every employee must be made aware of workplace violence prevention policies and held to the same standard throughout your organization. Include policies in any employee handbook or other documentation designed to outline both employee and employer obligations and expectations.

Hold regular employee trainings

Trainings should include the content of your policies, signs of potential violent behavior, workplace violence de-escalation techniques, and how to react should an incident occur. Establish relations with local police, social service and mental health providers, and involve them in trainings where applicable to help your workforce develop a stronger relationship with them.

Outline and evangelize reporting procedures

Make your adverse event logging and reporting process clear and accessible to all employees, with a defined chain of command. Make sure every report is looked into, and that feedback is provided to the submitter in a timely fashion, so they are aware of both the investigation and the outcome. Above all, take every report seriously.

Encourage feedback from employees on all parts of your program

Reach out to your employees for opinions and suggestions about your workplace violence prevention policies, including possible risks and suggested preventative measures. Incorporate employee suggestions where possible to show your program is an ongoing dialogue.

Improve the environmental design of all work sites

Changes you can make at physical work sites include creating a more accommodating waiting area for patients and visitors experiencing delays and enclosing nurses’ stations, possibly with reinforced glass. Security improvements include additional security personnel, lighting, surveillance or monitoring, security enhancements for entry points (e.g. keycard access), or those that address any other gaps.

Revise staffing policies

Make sure your facilities have enough personnel on-site during busy hours to avoid understaffing; and minimize hours where personnel may be working alone. If possible, amend your hours of operation to less dangerous times of day.

Perform regular risk assessment at all work sites

No prevention plan is foolproof, and work site environments change over time. Regular risk assessments will help your organization to identify any new security gaps and make appropriate adjustments before they leave an opening for an incident to occur. Keep your employees involved in the review process to gain key insights that only on-the-ground workers can supply.

Comply with all workplace violence prevention regulations

Make sure that you meet all standards for duty of care and mandatory workplace violence prevention programs as outlined in federal, state, or local laws, paying special attention to those that apply to healthcare employers or healthcare facility operators. Applicable regulations may differ by the size or location of your company, but the burden of compliance is yours to meet.

The role of security management software in preventing and responding to incidents of workplace violence in a healthcare setting

No matter how uncertain the world may seem at times, your healthcare workers deserve to feel safe and protected at their places of employment, and organizations like yours must operate work sites in a manner that delivers on that obligation. As such, it is incumbent on your organization to take advantage of up-to-date digital tools that can help you fulfill your security obligations and more effectively prevent incidents of workplace violence at work sites.

One such digital tool that can help your organization to efficiently administer your healthcare violence prevention protocol is security management software. Security management software helps your organization gain valuable threat intelligence, enhance situational awareness, and streamline incident reporting to strengthen your overall resiliency. Should an incident occur, security management software helps you restore normal operations quickly.

When evaluating security management software, look for a tool that enables your team to:

• Ensure security teams stay informed on the status of your operations with more efficient data gathering through public forms accessed via QR codes, SMS, or mobile app
• Consolidate info across multiple sources using customizable dashboards with elements like scrolling banners, live maps, and news feeds, and streams with up-to-the-minute weather, social media, traffic, and natural disaster data
• Stay on top of potential threats and risks to people, assets, work sites, and reputation with real-time, AI-driven threat intelligence that streamlines escalation and supports effective incident response
• Keep interested parties informed and support better decision-making with easily distributable notices to ensure teams have the latest intelligence about persons, organizations, assets, or other entities of interest
• Manage incident response efficiently with automated notifications via customizable workflows, assigned response actions to expedite recovery, and shareable updates
• Prevent reoccurrence and enhance preparation with thoroughly conducted incident investigations, including easy capture of case notes and dossiers for persons of interest
• Gain greater visibility of your business continuity posture and uncover valuable insights with flexible dashboards and analytics capabilities, including custom reporting options

No healthcare worker should be unreasonably exposed to the risk of workplace violence, especially considering its prevalence in the industry and the gravity of its effects. But security management software like Noggin makes it easier than ever to develop and maintain a thorough violence prevention program to help your healthcare facilities, your larger organization, and most importantly, your employees at all types of work sites to continue to deliver quality health care to patients and safely avoid grievous harm.

To see how you can take good care of everyone, request a demo of Noggin today and find out for yourself.