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4 Types of Healthcare Workplace Violence and ECRI's Guidance for Action Plans

Stop Violence educacional message on blackboard

Healthcare workers are known to suffer slip and falls, needle sticks, and back pain, but unfortunately, they also can face violence on the job. Recent shocking headlines include: Nurse Found Dead from Self-Inflicted Gunshot Wound after Allegedly Setting Colleague on Fire; Maine Nurses Face Increased Levels of Physical, Verbal Abuse by Patients; Nursing Assistant Gunned Down by Coworker Left Behind Three Children… And while workplace violence has been a dangerous risk among healthcare workers for years, experts believe the COVID-19 pandemic, and its added stresses and mental health challenges, have exacerbated violence.

According to the Centers for Disease Control, researchers have identified four categories of healthcare workplace violence:

  1.  The perpetrator has no relationship to the institution or its employees, rather, the violence takes place in the context of another crime such as a robbery or trespassing. For example, a hospital employee can be robbed in the parking garage while leaving work.
  2. A patient, family member, or visitor, will commit what is called client-on-worker violence. It is most frequent in emergency departments, psychiatric care, waiting rooms, and geriatric settings. For example, a patient asks a family member to leave the care setting, but the family member refuses. A nurse may ask the family to respect the patient’s wish, and be attacked, verbally or physically – even both. This is the most frequent form of healthcare workplace violence.
  3. Worker on worker violence is called lateral or horizontal violence, and includes actions such as bullying right up to physical violence, as evidenced in two of the headlines above.
  4. The perpetrator and victim have a relationship outside the workplace that spills into the workplace. For example, an estranged spouse may enter a hospital and attack or threaten a healthcare worker in the midst of a contentious divorce or a domestic violence situation. This puts the victim, workers, and patients all at risk.

Risk factors for healthcare workplace violence vary, but OSHA identify several causes, including, but not limited to: Working with people who may be delirious or under the influence of drugs; Lifting and transporting patients; Poor environmental design; Working alone, Lack of emergency communication mechanisms; Long wait times and overcrowded waiting rooms; and Unrestricted public access.

ECRI has called attention to this problem, noting that “When violence erupts in a healthcare facility, the consequences are often many and unpredictable, potentially including injury or death; property damage; lawsuits; and diminished patient, staff, and community trust.”

ECRI’s guidance article, Violence in Healthcare Facilities, can help healthcare leaders and workers understand this complex issue and take steps to prevent violence. The information includes strategies for developing action plans including: creating policies and procedures, leveraging data, encouraging reporting,  preventing violence, managing violent events as they unfold and during their aftermath, ensuring that violence prevention programs addresses the possibility of gun violence (including active shooters), as well as on training employees in violence prevention and response.​​

​​Health workplace leaders must work to promote safe environments for everyone from staff to families, to patients alike. Contact ECRI to learn how you can get our guidance  on this topic and strengthen your ability to create a safe care environment for all. 

Topics: Risk Management, Patient Safety, COVID-19, Clinical Excellence, ECRI, Leadership, Pandemic Leadership, Thought Leadership, Public Health, workplace violence

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