Workplace violence is a serious growing concern. Hospitals must prioritize precautions and preparedness measures to mitigate the risk of violence against staff, patients, and visitors.

According to a report  from National Nurses United, 81.6% of Nurses reported they have experienced workplace violence, with half stating they have seen instances of violence increase in the last year. 

"As a result, Nurses are subjected to multiple impacts of workplace violence, including physical and mental injury," the report summary states. "Injuries, including both physical and non-physical, can result in long-term physical and mental harm, resulting in RNs requiring medical care, taking time off work, and/or considering leaving their jobs or profession altogether." 

In total, 60% of Nurses say workplace violence has led them to change jobs, leave jobs or at least consider leaving the job or even the profession entirely, according to the report. 

Specifically, Nurses reported the following experiences to NNU: 

• Verbally threatened 67.8%
• Physically threatened 38.7%
• Pinched or scratched 37.3%
• Slapped, punched, or kicked 36.2%
• Objects thrown at you 34.6%
• Verbally harassed based on your sex or appearance 33.3%
• Spat on or exposed to other bodily fluids 29.9%
• Groped or touched inappropriate 19.8%

Around 18% noted they have not experienced workplace violence at all.

Policy Development 

Create explicit guidelines and protocols to prevent and address incidents of workplace violence. These policies should clearly state a strong stance against violence, provide mechanisms for reporting, and establish repercussions for those responsible.

Training and Education 

Ensure all staff members receive extensive training on identifying potential warning signs of violence, mastering de-escalation techniques, and effectively responding to emergency situations. It is crucial to conduct regular refresher courses to keep everyone up-to-date and well-prepared.

Risk Assessment 

Perform comprehensive risk assessments to identify areas of susceptibility within the hospital, including emergency departments, psychiatric units, and waiting rooms. Implement focused interventions in areas with higher risk levels.

Physical Security Measures 

Enhance the overall physical security of the facility by implementing advanced security measures, including installation of state-of-the-art security cameras, panic buttons, access control systems, and ensuring optimal lighting conditions. Restrict access to sensitive areas and establish robust visitor screening protocols to further fortify the security of the premises.

Staffing and Staff Support 

To prevent overwork and fatigue, which can exacerbate tense situations, it is essential to maintain adequate staffing levels. Offering support services such as counseling and employee assistance programs can greatly assist staff in managing stress and trauma effectively.

Personal Protective Equipment (PPE) 

Provide staff with the necessary personal protective equipment (PPE) to ensure their safety in potentially volatile situations. This includes equipping them with duress alarms or protective gear, allowing them to feel secure and protected.

De-escalation Techniques 

Train all staff in effective de-escalation techniques to diffuse tense situations before they have a chance to escalate into acts of violence. Encourage staff to employ the power of verbal communication and non-confrontational body language to soothe and calm individuals who may be feeling agitated.

Collaboration with Law Enforcement 

Establish partnerships with local law enforcement agencies to enhance security measures and coordinate responses to violent incidents. If you don’t have any security staff at your place of work, consider hiring your own security staff or hire them from a security firm.

Incident Reporting and Investigation 

Promote a culture of prompt incident reporting and thorough investigations to gain insight into the underlying causes of violence. Utilize incident data as a valuable resource to shape effective prevention strategies.

Emergency Preparedness 

Establish comprehensive emergency response plans that clearly outline protocols for safely evacuating both staff and patients in the event of violent incidents. Regularly conduct drills and simulations to assess the efficacy and readiness of these plans, ensuring all personnel are well-prepared to handle any potential emergency situations.

Post-Incident Support 

Extend support and provide a wide range of resources to staff, patients, and visitors who have been impacted by workplace violence. Make available professional counseling services, essential medical care, and follow-up assistance fit for their individual needs.

By implementing these precautions and preparedness measures, hospitals can begin to create safer environments for their staff, patients, and visitors while effectively managing the risk of workplace violence.

As a Nurse, you consider many factors when choosing where you want to work. Safety should be at the top of your list of considerations.

For more than 20 years, The Leapfrog Group has collected, analyzed, and published hospital data on safety and quality.

Leapfrog assigns Hospital Safety Grades to nearly 3,000 general acute-care Hospitals across the nation twice annually.

Here is the most recent list of safest States and Hospitals to work at according to Leapfrog.

1. New Hampshire 
   Dartmouth-Hitchcock Medical Center 
   
   
2. Virginia 
   Augusta Health 
   
   
3. Utah 
   Intermountain Alta View Hospital 
   
   
4. Colorado 
   Centura Health Castle Rock Adventist Hospital
   
   
5. Idaho 
   Eastern Idaho Regional Medical Center
   
   
6. New Jersey 
   Bergen New Bridge Medical Center 
   
   
7. North Carolina 
   AdventHealth Hendersonville  
   
   
8. Maine 
   Abbott Northwestern Hospital
   
   
9. Pennsylvania 
   AHN Grove City  
   
   
10. Florida 
    AdventHealth Altamonte Springs
    
    
11. Oregon 
    Asante Ashland Community Hospital
    
    
12. Washington 
    Cascade Valley Hospital
    
    
13. Massachusetts 
    Baystate Noble Hospital
    
    
14. Texas 
    Ascension Providence
    
    
15. Tennessee 
    Baptist Memorial Hospital
    
    
16. Hawaii 
    The Queen's Medical Center
    
    
17. Rhode Island 
    South County Hospital
    
    
18. Minnesota 
    Abbott Northwestern Hospital 
    
    
19. Michigan 
    Ascension St Joseph Hospital
    
    
20. Montana 
    Billings Clinic
    
    
21. South Carolina 
    Beaufort Memorial Hospital
    
    
22. Louisiana 
    Ochsner Medical Center
    
    
23. Mississippi 
    Baptist Memorial Hospital Golden Triangle  
    
    
24. Kansas 
    AdventHealth Shawnee Mission  
    
    
25. California 
    Hoag Memorial Hospital Presbyterian  
    
    
26. Ohio 
    Cleveland Clinic Avon Hospital
    
    
27. Indiana 
    Hancock Regional Hospital  
    
    
28. Illinois 
    FHN Memorial Hospital
    
    
29. Nevada 
    Desert Springs Hospital Medical Center
    
    
30. Georgia 
    AdventHealth Redmond
     
31. Arkansas 
    Baptist Health Medical Center
    
    
32. Connecticut 
    Greenwich Hospital  
    
    
33. Oklahoma 
    Mercy Hospital Ardmore
    
    
34. Missouri 
    Centerpoint Medical Center
    
    
35. Maryland 
    Anne Arundel Medical Center
    
    
36. Kentucky 
    Baptist Health
    
    
37. Alaska 
    Mat-Su Regional Medical Center
    
    
38. Delaware 
    Bayhealth Hospital Sussex Campus
    
    
39. Alabama 
    South Baldwin Regional Medical Center 
    
    
40. New York 
    Catholic Health System – Kenmore Mercy Hospital 
    
    
41. Wisconsin 
    Bellin Memorial Hospital
    
    
42. Wyoming 
    Ivinson Memorial Hospital
    
    
43. Arizona 
    Mayo Clinic Hospital
    
    
44. New Mexico 
    CHRISTUS St. Vincent Regional Medical Center
    
    
45. South Dakota 
    Sanford USD Medical Center
    
    
46. Nebraska 
    Kearney Regional Medical Center
    
    
47. West Virginia 
    Greenbrier Valley Medical Center
     
48. Iowa 
    Lakes Regional Healthcare
    
    
49. Vermont 
    Central Vermont Medical Center
    
    
50. Washignton D.C.
    George Washington University Hospital
    
    
51. North Dakota 
    Sanford Medical Center

Violence against healthcare workers is more common than most people realize. The environment of a healthcare institution can create high levels of stress for patients, their loved ones, and staff. Fear and illness are major contributors of agitation and aggression from patients.

National Institute for Occupational Safety and Health classifies work place violence (WPV) into four basic types:

• Type I: Involves “criminal intent.” In this type of workplace violence, “individuals with criminal intent have no relationship to the business or its employees.”
• Type II: Involves a customer, client, or patient. In this type, an “individual has a relationship with the business and becomes violent while receiving services.”
• Type III: Violence involves a “worker-on-worker” relationship and includes “employees who attack or threaten another employee.”
• Type IV: Violence involves personal relationships. It includes “individuals who have interpersonal relationships with the intended target but no relationship to the business”

According to the American Nurses Association, 1 out of 4 Nurses is assaulted on the job and only 20% to 60% of Nurses report the incidents. The lack of reporting is a serious barrier to effective research and regulatory or legal action.

Three of the most common reasons for not reporting violent incidents are:

• Fear of retaliation
• Lack of a clear reporting method
• Belief that nothing will be done about it

Studies show that WPV can affect the quality of care and care outcomes, contribute to the development of psychological conditions, and reduce the RN's level of job satisfaction and organizational commitment.

If an attack happens, Nurse.org recommends these suggestions:

• Try to escape - If you can’t escape, yell loud enough to get help.
• Create a barrier - Put something between that person assaulting you and yourself so you might be able to escape. 
• Defend yourself - You can defend yourself. You are allowed to meet the attacker with equal force to get them to stop. Some people don’t know that. 
• Report the incident - Notify your facility of the assault.
• Take a leave of absence - Many people will be nervous to go back to work after an incident. If you are struggling emotionally with the trauma, people need to begin to realize that trauma and anxiety are legitimate reasons to get a leave of absence. Don’t rush back to work if you aren’t ready. 
• Get support and seek help - Surround yourself with people that you trust. Consider getting trauma counseling. 

The World Health Organization (WHO) holds employers accountable for both ensuring the safety of their employees and acting to treat them after an act of violence has occurred.

Hospitals should establish a culture of safety by implementing WPV prevention programs and by showing support of incident reporting. 

The Joint Commission released new and revised requirements addressing workplace violence prevention programs which will be effective on January 1, 2022.

These requirements include hospitals providing de-escalation training, education, and resources at time of hire, annually, and whenever changes occur regarding the WPV prevention program. Also the program should be led by a designated individual and developed by a multidisciplinary team. 

The American Association of Critical-Care Nurses (AACN) urges hospitals to:

• Establish a clear and consistent reporting structure for workplace violence, with easy to understand policies and procedures on how to report violent incidents to law enforcement.
• Encourage employees to press charges against persons who assault healthcare workers, and support staff members who do.
• Provide resources and support programs for employees to help them cope with violent incidents.
• Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.
• Ensure the presence of sufficient security systems, including alarms, emergency response and available security personnel.

Many hospitals have set up personal security and safety protocols in case of an altercation or attack. 

Cox Medical Center in Branson, MO installed a panic button system. The hospital said about 300 to 400 staff will have their own personal panic buttons on their badges. If the button is pushed, it activates a personal tracing system, security is notified and an alert on hospital computers shows the employee's location.

Resources

Training:

Workplace Violence Prevention for Nurses

Podcasts:

Combating Workplace Violence in Health Care by Creating Safer Workplaces

Trauma And Trauma Informed Care

M.O.V.E. to Prevent Workplace Violence

Websites:

victimlaw.org 

Futures Without Violence: Workplace

Workplaces Respond National Resource Center

DOL Workplace Violence Program

Hotlines:

The National Domestic Violence Hotline is 1-800-799-7233, or you can text LOVEIS to 22522 if you cannot speak safely.

Workplace Harassment & Discrimination – Employee Concern Hotline Services: 800-307-5513

Fact Sheet:

Building a Safe Workplace and Community A Framework for Hospital and Health System Leadership

Guide:

End Nurse Abuse Resource Guide

The need for in-home care has grown since COVID-19 because many fear contracting the virus in hospitals and clinics, especially among the elderly population.

With no security like hospitals usually have, home visiting Nurses put themselves at risk whenever they enter a patient's home alone. 

Ha Do Byon, Assistant Professor of Nursing at the University of Virginia School of Nursing mentions in a  STAT news article, "Even before the pandemic struck, I heard Nurses’ stories of home visits — some during my time as a visiting Nurse, and others as part of a study I am conducting to understand violence faced by home visiting Nurses. They told me about patients who blared pornography, or being groped while administering care. About patients who waved handguns and hurled racial insults. About being bitten, punched, kicked, or slapped. About dealing with screaming fits, intoxicated family members, and dogs that bit them or threatened to."

According to a 2015 study by BMC Public Health, the threat of workplace violence was one of home health workers’ top concerns, ranking above transportation issues or environmental hazards.

Developing a safety program for your home care workforce is crucial in reducing health care worker stress and turnover.

The rate of patient-on-Nurse violence among home visiting Nurses is unknown.

An article in Home Care Magazine states, only one-fifth of violent incidents “are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients." Nurses have cited fear of retribution from supervisors, the complexity of the legal system and disapproval from administrators as barriers to reporting workplace violence.

Nurses and providers can take measures to prevent violent situations.

We view Nurses and healthcare workers as heroes and we should appreciate the essential work that home visiting Nurses provide by making sure they can safely do their job and feel comfortable enough to notify management when they aren't safe.

Nurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team but, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient. This means Nurses have the critical role in ensuring a patient's safety.

Nurses ensure their patient's safety by monitoring them for clinical deterioration, detecting errors, understanding care processes, and performing countless other tasks. There are many ways to help you achieve quality safety for yourself and your patients. Here are a few...

Nurse-to-patient ratios

According to Agency for Healthcare Research and Quality, assigning increasing numbers of patients eventually compromises a Nurses' ability to provide safe care. Several seminal studies have demonstrated the link between Nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and even mortality as the number of patients per Nurse increases. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum Nurse-to-patient ratios; in California, acute medical–surgical inpatient units may assign no more than five patients to each registered Nurse.

Safe and healthy workplace

OSHA, which enforces the Occupational and Safety Health Act of 1970, ensures employers are providing a safe and healthy workplace for workers and comply with OSHA’s regulations. Some of the obligations include:

• Complying with your employer’s policies and procedures based on its obligations under OSHA;

• Using personal protective equipment, including masks, when indicated;

• Informing your Nurse manager and others designated in the facility policy of workplace violence (e.g., bullying, intimidation, verbal abuse);

• Using proper body mechanics when lifting, pushing wheelchairs or otherwise working with patients;

• Reducing risks for slips, trips or falls by removing obstacles, wiping up wet walking surfaces and wearing shoes that support your feet and your walking;

• Speaking with your Nurse manager and CNO when policies and procedures governing safety are not being followed.

Overtime and long shifts

It is common for hospitals and clinics to request that their Nursing staff work overtime. While working overtime can be an effective solution to a Nursing shortage, it also can present a number of problems. Nurses risk becoming burned out, tired and/or stressed if they take on too much overtime.

 A study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The most common medication errors identified in the study due to Nurse fatigue were wrong doses, dose omission and extra doses.

Communication

Health care teams that communicate effectively and work togehter reduce the potential for error, resulting in an improved clinical performance. According to the American Hospital Association,  A key aspect in improving teamwork and communication in health care is engaging patients and families. Increasingly, research shows a correlation between increased patient and family engagement and fewer adverse events. Determining how patients and families want to be involved in their care and then engaging them in designing their plan of care increases their understanding of tests, procedures, and anticipated care outcomes, including a successful discharge.

If you have any questions about patient or staff safety, please click below to ask your question and a Nurse Leader will respond.