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Workplace Violence Prevention in Hospitals

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Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behaviour that occurs at the work site. This violence can range from threats and verbal abuse to physical assaults and even homicide. 

In recent years, incidents of workplace violence have increased dramatically in healthcare institutions across the US. In 2020, 10.3 out of every 10,000 caregivers received injuries from assaults and violent acts. Nurses experienced physical assaults at a rate of 13.2 per 100 and non-physical violent events, including verbal threats, at a rate of 38.8 per 100. 

Hospital safety is critical in preventing these incidents and ensuring that caregivers can provide quality care. Employees can perform their duties to the highest standard in a safe workplace. For hospitals, this means increased patient satisfaction and cost savings. For caregivers, this means improved mental health and the ability to stay on the job. 

Workplace violence in hospitals

Hospital workers are particularly susceptible to workplace violence. Research has identified factors that may increase the risk of violence for workers. These include working with volatile, unstable people and working alone or in isolated areas. In a hospital environment, care providers must work directly with stressed, uncomfortable, and potentially volatile patients. Given current staffing shortages in healthcare, caregivers may often work in isolated areas of the hospital or interact with volatile patients on their own. These factors increase the risk of violence and providers’ stress levels and anxiety. 

Incidents of workplace violence in hospitals are on the rise. According to the National Nurses United survey of hospital nurses, nearly half (48%) reported a small or significant increase in workplace violence. This represents a 57 percent increase from September 2021 and a 119 percent increase from March 2021.

Hospital work can be surprisingly dangerous. The likelihood of injury or illness resulting in days away from work is higher in hospitals than in construction and manufacturing. Caregiver absences come at a high cost. When an employee gets hurt on the job, hospitals pay the price in many ways:

  • Workers’ compensation for lost wages and medical costs
  • Temporary staffing, backfilling, and overtime when injured employees miss work
  • Turnover costs when an injured employee quits
  • Decreased productivity and morale as employees become physically and emotionally fatigued

Employee injuries and absences also negatively impact patient care. According to the Occupational Safety and Health Administration (OSHA), caregiver fatigue, injury, and stress are tied to a higher risk of medication errors and patient infections. All of these symptoms are direct results of workplace violence. 

Types of workplace violence in healthcare

According to the Centers for Disease Control (CDC), incidents of workplace violence in healthcare fall into four categories:

  1. The perpetrator has no legitimate relationship with the hospital or its employees and is usually committing a crime (robbery, shoplifting, etc.) in conjunction with violence. This type of incident occurs less frequently than others.
  2. A patient, family member, or visitor perpetrates violence on a healthcare worker. This is the most common form of violence in healthcare settings. Research shows that this type of violence occurs most frequently in emergency and psychiatric treatment settings, waiting rooms, and geriatric departments but is not limited to these.
  3. One worker perpetrates violence on another. This type of violence ranges from bullying and emotional abuse to homicide. Worker-on-worker violence is often directed at employees of a lower rank than the perpetrator, though peer-to-peer violence is also common.
  4. The perpetrator has a relationship with the caregiver outside of work that spills over into the work environment. 

When these types of violence occur on a hospital floor, they threaten the well-being of staff, patients, and visitors. To protect their workers’ safety and create an environment conducive to high-quality patient care, hospitals must work to prevent incidents of violence.  

Strategies for preventing workplace violence in hospitals

A proactive approach to preventing violence in hospitals can be effective. Increasingly, hospitals are implementing protocols, systems, and solutions aimed directly at the problem of workplace violence in healthcare.

  • Staff training and education. Healthcare researchers recommend that hospitals supplement purchased training programmes with specific training in organisational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. A dedicated programme manager is critical to the success of staff training programmes.
  • Policies and procedures. Reducing violence in the workplace begins with identifying risk factors that increase the likelihood of violence. Building an appropriate safety protocol based on these findings, and ensuring all workers understand the protocol and policies, creates a safer workplace.
  • Environmental and technological solutions. Caregivers who have access to reliable and effective support systems on the job are safer and happier. By implementing hospital safety solutions that work, institutions improve morale, decrease employee turnover, and improve patient satisfaction. 
  • Communication and reporting systems. Reporting violence in healthcare is critical to institutional improvement. Hospital safety solutions that record the details about violent incidents – the where, when, and how – produce valuable data that inform administrative safety decisions. 

Effective hospital responses 

When incidents of violence occur on the hospital floor, caregivers need immediate access to intervention and support. According to the American Association of Critical-Care Nurses, sufficient security systems, including alarms, emergency response, and available security personnel, should be a core component of every hospital’s efforts to keep staff safe. 

Whereas traditional approaches to safety protocol often focus on reactive strategies, effective healthcare safety solutions focus on preventative measures. Hospitals should develop their workplace violence prevention plans in response to current threats and with the hospital’s layout and specific features in mind. An effective workplace violence prevention plan also includes follow-up and support for staff and patients. Healthcare researchers found that 71% of psychiatric hospital workers who had experienced an assault by a patient desired employer support. Generally, adequate support from supervisors, coworkers, and their combination was associated with better well-being. Hospitals must therefore intervene not only during incidents of violence but also during employees’ physical and emotional recovery. 

Make workplace safety a priority

The statistics regarding workplace violence in hospitals are daunting. Administrators must acknowledge that effective safety measures are necessary to retain and support staff. Employers are increasingly investing in safety systems and protocols to reduce costs, prevent employee turnover, and protect their workers’ mental health. Given the reality of today’s healthcare environment, hospital decision-makers must see investments in effective hospital safety solutions as a mandate. These investments improve a hospital’s ability to provide quality care and carry out its mission in the community. 

Dennis Relojo-Howell is the managing director of Psychreg.


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