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Workplace Violence: A National Perspective

Paul Dusenbery, Curriculum Director, DART 10/28/2022

As defined by OSHA, workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It can range from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. However it manifests itself, workplace violence is a growing concern for employers and employees nationwide (AIHA, 2022).

Some 2 million American workers are victims of workplace violence each year. Workplace violence can occur anywhere; no workplace is immune. Some workers, however, are at increased risk. Among them are:

Workplace violence continues to affect all industries, especially healthcare. The Bureau of Labor Statistics reported that injuries to healthcare workers by another person more than doubled from 4,010 in 2011 to 8,590 in 2020. Intentional injuries to all types of workers also increased over that period, but by a less extreme 29%.

The COVID pandemic has led to even more reported incidents of violence because of the heightened levels of stress felt by patients, family members and visitors. Pre-pandemic surveys found about 70% of emergency room nurses and just under 50% of emergency physicians had been hit or kicked on the job. About 50% of nurses surveyed by National Nurses United, reported that violent incidents had increased since 2020.

A Fact Sheet published by the American Hospital Association (AHA) reported that “44% of nurses had experienced physical violence and 68% reported experiencing verbal abuse during the COVID-19 pandemic. Workplace violence has severe consequences for the entire health care system. Not only does violence cause physical and psychological injury to health care workers, workplace violence and intimidation make it more difficult for nurses, doctors, and other clinical staff to provide quality patient care. Nurses and physicians cannot provide attentive care when they are afraid for their personal safety, distracted by disruptive patients or family members, or traumatized from prior violent interactions.” 

Hospitals, health systems and their employees have expressed a strong interest in enacting a federal law that would protect health care workers from violence and intimidation, just as current federal law protects airline and airport workers (AHA, 2022).

Against this backdrop, what can healthcare workers and other workers in high-risk industries do to create a safer workplace environment? In a word, training, especially in de-escalation and situational awareness skills. The Defense Awareness Response Training (DART) organization offers highly effective courses in violence prevention and violence management for workplace situations.

Managing violent behavior cannot be the sole responsibility of staff! It must be managed at all levels of an organization, including top management. That is why DART recommends that human service organizations adopt an effective Workplace Safety System (WSS) that is aligned with OHSA guidelines. This interdependent system includes the following components:

  1. Management Support
  2. Workplace Safety Analysis
  3. Training and Education, and
  4. Post-incident Reponse.

1. Management Support

The implementation of an effective safety and security program requires the public commitment of management. Such a commitment provides a context for decisions and planning that includes: 1) A policy which places employee safety and security on the same level of importance as client/patient safety, 2) Employer refusal to tolerate violence in the institution, and 3) Employer commitment to provide adequate authority and budgetary resources.

2. Workplace Safety Analysis

Workplace analysis involves a step-by-step, commonsense look at the workplace to find existing or potential hazards for workplace violence. This entails reviewing specific procedures or operations that contribute to hazards and specific locales where hazards may develop (e.g., reception areas, parking lots).

3. Training & Education

Training and education are major program elements in an effective safety and security program. They ensure that employees know about potential security hazards and know the measures they should take to protect themselves and their co-workers. Responding to a violent attack requires knowledge, confidence, and the ability to take decisive action. All three are cornerstones of an effective training and education program.

4. Post-incident Response

All violent incidents should be reported to the proper authorities so that the organization can evaluate and develop more effective strategies to respond to them. All workplace violence programs should make provisions for employees who have been assaulted. Abuse against staff can have physical and psychological effects not only on the staff immediately impacted by the assault but their co-workers as well (e.g., fear of returning to work, a change in relationships with co-workers and family members). Medical treatment and support systems should all be part of the post-incident response that also includes an effective evaluation system.

DART’s Resource Section has many valuable resources that can help organizations develop violence prevention strategies that incorporate components of the Workplace Safety System described above. If your organization is interested in DART’s Verbal De-escalation Training, click here.