Debra K. Kirby

Much has been written on the effects of the pandemic on healthcare workers and workplace violence is a growing concern too

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While much has been written on the psychological consequences of the pandemic on healthcare workers, the effects of workplace violence in healthcare are a growing concern as well. Within Emergency Departments, Emergency Room Nurses are particularly vulnerable. For HR professionals in the healthcare space, responding to and protecting staff has a particular need given the increase in violence against nurses and emergency staff. Nearly 70% have reported being hit or kicked at work. Workplace violence results in injury, lost workdays, burnout and turnover – and loss of morale at a time of increasing demand for healthcare services.

Though workplace violence is an ongoing issue across the nation, healthcare facilities and their staff experience this violence at alarming rates compared to others. A 2021 Workplace Health & Safety survey of registered nurses report that 44% experienced physical violence at least once during the pandemic from patients, family members or visitors, with over two-thirds encountering verbal abuse at least once.

Researchers at the University of California at San Diego recently found that nurses have higher rates of suicide than the remainder of the population, the latest and one of the most tragic effects of workplace violence in healthcare. The Journal of the American Medical Association – Psychiatry an April 2021 study, found female nurse suicide rates were twice that of the general population, while the incidents among physicians were not statistically different from that of the general population.

These healthcare workplace violence statistics identify a need for administrators to fund and supply essential resources, including workplace violence prevention programs and employee assistance programs, to improve workplace safety, working conditions for healthcare professionals, and to support employees in delivering optimal healthcare services.

The Extended Impact of Workplace Violence in Healthcare Facilities

Consistent, pervasive exposure to violence in the workplace or the risk of it not only degrades morale but can also have a detrimental effect on an individual’s mental wellbeing. Healthcare workers are five times more likely to be victimized on the job than other workers overall, according to the U.S. Bureau of Labor Statistics (BLS). The BLS found that healthcare workers accounted for 73% of all nonfatal workplace injuries and illness due to violence in 2018. Nurse labor leaders say the pandemic has made matters worse Another growing concern is the high rate of suicide among healthcare workers. Long hours and inherently stressful environments. While it is true that the suicide rate in the U.S. has risen nationally over the last decade, the level of violence in healthcare facilities cannot be discounted as a contributing factor in the heightened risk of suicide among nurses. Although there aren’t any research studies that directly link workplace violence to suicide rates, previous studies have shown that high-stress occupations and occupations that involve exposure to violent or traumatic events can lead to increased suicide risk.

The Occupational Safety and Health Administration (OSHA) has statutory authority over unsafe working conditions and has introduced several guidelines for preventing workplace violence in the healthcare field. However, no federal law specifically prohibits assault on nurses and other healthcare staff. There is legislation pending that seeks to change this. H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act. As drafted, it requires the Department of Labor to address workplace violence in healthcare, social service, and other sectors. Specifically, it will require that DOL issue interim occupational safety and health standards that require certain employers to take actions to protect workers and other personnel from workplace violence. The standard applies to employers in the health care sector, in the social service sector, and in sectors that conduct activities similar to those in the health care and social service sectors. Implicit in this legislation is that workplace violence prevention programs help keep people safe.

What Can a Program for Workplace Violence Prevention in Healthcare Do?

The primary goal of a workplace violence prevention program is to promote safety and, ultimately, save lives by precluding a violent incident. The research and experience of many employers and our clients have identified that workplace violence prevention programs can save lives. But an often-overlooked outcome of putting an effective program in place is the cultural shift it creates within the organization.

At the center of this culture shift is the need for a consistent approach to incident reporting procedures as identification of unacceptable behaviors is the first step to prevention of workplace violence in healthcare. This is especially important for nurses and healthcare staff who sometimes normalize violence as part of their working environment. However, the American Nurses Association (ANA) notes that nurses face many barriers to reporting, ranging from a culture that considers violence part of the job to a lack of managerial support. In its 2019 issues brief on the subject, the ANA identified a range of reporting barriers for nurses including:

  • A healthcare culture that considers workplace violence part of the job.
  • A perception that violent incidents are routine.
  • A lack of agreement on definitions of violence; e.g., does it include verbal harassment?
  • Fear of being accused of inadequate performance or of being blamed for the incident, and fear of retaliation by the offender and or employer.
  • Lack of awareness of the reporting system.
  • A belief that reporting will not change the current systems or decrease the potential for future incidents of violence.
  • Lack of manager and employer support.
  • Lack of worker training related to reporting and managing workplace violence in healthcare.
  • Fear of reporting supervisory workplace violence.

HR professionals play a crucial role in helping to develop a culture of safety and in addressing these issues. A properly established workplace violence prevention program further assists in developing a safety culture and should emphasize developing lines of communication, clear definitions of workplace violence and open reporting processes that encourage reporting without repercussions. Strong policies and practices then should be supported by ongoing workplace violence training for workers and managers to develop the understanding, perspective and knowledge of how to respond to incidents of workplace violence.

This type of program could also serve as an impetus for improved overall security. In a 2018 American College of Emergency Physicians (ACEP) survey, one half of emergency physicians said hospitals could improve safety and security by adding physical security, cameras, metal detectors and improved visitor screening to more fully protect staff and visitors to medical facilities.

Making Your Case in a Budget-Restricted Environment

Human Resources (HR) personnel in any industry often face budgetary challenges in securing programs that will effectively mitigate and, hopefully, prevent adverse incidents in the workplace and reduce the effects of workplace violence. It is often difficult to consider a comprehensive workplace violence prevention program when coping with limited security budgets, which are unfortunately extremely common in hospitals and other healthcare facilities. However, given the increase in workplace violence in healthcare and the rise in nurse suicides, such investments would return greater safety and security for staff and visitors. In the same ACEP survey, seven of 10 emergency physicians said violence is increasing – and the time to act is now. Understanding the challenge of workplace violence in healthcare – and the cost in human capital and in assets and reputation – should serve as a catalyst for leadership to realize that without changes, employees and services will suffer. With a properly managed program, centered on prevention, these effects of workplace violence in hospitals can be avoided to the benefit of any healthcare organization.

Workplace Violence is a risk for any organization, but is one that Jensen Hughes’, Workplace Threat + Violence Assessment Management & Training ( can help manage. Jensen Hughes, a leader in the industry, specializes in behavioral case management services and threat assessments for companies across all industries as well as U.S. federal agencies, other government employers and non-profit organizations.

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About the author

Debra K. Kirby
Debra Kirby serves as the Operations Leader, Midwest for Jensen Hughes.

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