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.

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

Nurse Elise Wilson was in critical but stable condition after being stabbed by a patient at Harrington Hospital in Southbridge last month. Nurses aren't "expecting to encounter violence but they do, every single day of the week," said Elise's husband, Clifton. "They are cursed, spit upon, bitten, punched, kicked, and yes, stabbed."

The Boston Globe said, Elise was treating Connor Oregan, 24, of Southbridge, in the emergency room around 10:15 a.m. when Oregan slashed at her multiple times with a knife before fleeing the hospital.

The nurse was stabilized in the emergency room before being flown to UMass Memorial Medical Center for further treatment. She underwent eight and a half hours of surgery and remained in critical but stable condition, the district attorney’s office said.

Clifton Wilson, and colleagues will testify Wednesday before a committee at the State House in support of legislation proposed by the association “that requires health care employers to develop and implement individualized workplace violence prevention plans,” according to a release. The association has dubbed the legislation “Elise’s Law.”

“The attack against Elise was vicious and left her fighting for her life,” said RN Tracy DiGregorio, who was working in the ER at the time of the assault. “Unfortunately, I cannot say violence against nurses is rare. Nurses and other health care professionals are assaulted every single day at hospitals throughout Massachusetts. We should pass ‘Elise’s Law’ right away to help stop the violence.”

Massachusetts Nurses Association talked about the photo and said, "This is a tough photo to look at. But RN Elise Wilson and her loved ones want the public to see the violence nurses and other health care professionals are experiencing. And they want it to stop. Elise is only smiling because she is grateful her ventilator and feeding tube have been removed." 

The young man allegedly sat in the parking lot sharpening his knife for 20 minutes before entering the emergency room, Clifton Wilson told lawmakers. Conor O'Regan, 24, is accused of the attack. Clifton also said, "She bled out three times and almost died."

Since the attack, Harrington Hospital has beefed up security, and now has a metal detector, he said. They've also hired a Southbridge police officer.

Have you experienced violence from a patient or witnessed it at your place of work? Please share with us in the comments section below.