Addressing Workplace Violence in Healthcare

Workplace violence in healthcare is a pervasive issue that demands urgent attention. Its prevalence poses a significant threat not only to the safety and well-being of healthcare workers but also to the patients they care for. Beyond the physical and emotional toll on individuals, the widespread occurrence of workplace violence in healthcare settings undermines the fundamental principles of patient-centered care and erodes the trust that should exist between healthcare providers and those seeking medical assistance. A comprehensive understanding of workplace violence — and how to prevent it — is essential to create a healthcare environment where both patients and healthcare workers feel safe.

Understanding Workplace Violence in Healthcare

Workplace violence in healthcare encompasses a range of aggressive behaviors, including physical assault, verbal abuse, and threats directed at healthcare staff, social workers, patients/clients, or visitors. The Occupational Safety and Health Administration (OSHA) recognizes workplace violence as a significant hazard in healthcare, acknowledging the unique challenges explored below and the need for targeted interventions.

Workplace violence risk factors in healthcare settings can include (1) the unpredictable behaviors of patients and families, frequently experiencing emotional stress, and (2) organizational and systemic factors. Among the latter are high-stress work environments, staff shortages, absence of organizational policies and staff training, overcrowding, extended wait times, rigid visiting hours, and insufficient information.

Who is Most Affected: Highlighting the Extent of the Problem

According to the Bureau of Labor Statistics, healthcare and social service workers face a five times higher likelihood of experiencing a workplace violence injury compared to professionals in other fields. In 2018, 73% of all nonfatal workplace violence-related injuries occurred within the healthcare sector. The highest rate of violence comes from psychiatric and substance use hospitals, and nurses, in particular, often face the highest incidence of workplace violence in healthcare settings. The nature of their roles and direct patient interactions places them at an elevated risk compared to other healthcare professionals.

The most frequent form of violence is when patients, families, or visitors direct aggression toward healthcare staff, per the 2019 Healthcare Crime Survey produced by the International Association for Healthcare Security and Safety Foundation. Specifically, 78% of aggravated assaults and a staggering 88% of all assaults recorded in hospitals were instances of patients and their families targeting healthcare workers. Emergency rooms are particularly susceptible to workplace violence, with 34% of aggravated assaults and 46% of all assaults occurring in the emergency department as compared to all other spaces in a hospital.

Barriers and Solutions to Reporting Incidents

Workplace violence incidents often go unreported in the healthcare industry due to fear of negative consequences. The absence of clear reporting guidelines or policies, a lack of accessibility or trust in the reporting system, and the fear of potential retaliation contribute to the pervasive issue of underreporting. Retaliation, when an individual faces adverse actions in response to reporting harassment or discrimination, is illegal because employees are protected both from workplace discrimination and reporting it by the Equal Employment Opportunity Commission (EEOC). Employers who fail to comply with these regulations may face legal consequences.

Even with the existence of formal incident reporting systems, numerous workplace violence incidents, particularly instances of cyberbullying and online verbal abuse from coworkers or patients, still go unreported. Healthcare, like many other industries, has witnessed the emergence of online harassment in recent years. This includes activities such as humiliation, defamation, and illicit video recording, adding a new dimension to the challenges faced by healthcare workers and their desire or ability to report. The difficulties in reporting such incidents can be attributed to factors such as the stigma associated with online harassment and the lack of specific reporting guidelines tailored to the nuances of cyberbullying.

Healthcare employers can create a supportive environment where their staff feel safe reporting incidents by implementing reporting systems and educating employees about how to use them. Explaining the operational details of your new reporting system, including the submission process and dashboard navigation, is as crucial as developing an effective communication strategy. In particular, anonymous reporting systems where users have the option to chat confidentially with administrators can instill confidence in the system and encourage employees to utilize it when necessary, improving transparency and trust within the organization.

Implementing Standards and Cultivating a Culture of Safety

To foster a safer healthcare environment for patients, families, and providers, both organizational and individual levels must be addressed. Research evaluating violence prevention training for nurses reveals its positive impact on enhancing confidence and communication skills. However, training alone is not enough. Healthcare leaders must also model a culture of safety, which requires a zero-tolerance approach to bullying, implementing anti-bullying interventions, and establishing clear reporting systems to promote trust and proactively tackle barriers to reporting incidents.

New standards from The Joint Commission, effective as of January 2022, mandate hospitals to monitor, report, and investigate violent incidents while also prioritizing staff education, training, and cultivating a culture of safety. They also emphasize organizational responsibility in handling workplace violence and advocate for clear protocols, addressing staffing issues, and evaluating incidents from various sources for quality improvement.

A Systemic Approach to Workplace Safety

Mitigating workplace violence requires a systemic approach, including communication from workplace leadership, comprehensive safety programs, and robust training initiatives. Beyond physical safety, promoting psychological safety through education plays a crucial role in creating an environment where healthcare workers can perform their duties without fear. Organizations can leverage resources like EasyLlama’s Workplace Violence training to enhance employee education about responding to violent incidents as safely as possible. Our healthcare-specific course on Workplace Violence can help contribute to a safer healthcare workplace for both workers and patients alike. It's time to address workplace violence in healthcare comprehensively and create a culture where safety is paramount. Access your free EasyLlama course preview today to learn more.