Workplace Violence in Healthcare Explained -- Jul 14
Are you a frontline healthcare worker who has been a victim of violence at your workplace?

Or maybe you know someone who had to go through it? It’s sad, but it’s happening all around us and it’s time we talked about it.

Workplace violence (WPV) is a broad umbrella term used to describe any disruptive or harmful behavior toward employees at a workplace. This includes, but is not limited to:

  • Physical/ verbal abuse.
  • Threats of assault.
  • Sexual and racial harassment/discrimination.
  • Intimidation.
  • Coercion.

WHO demands that any form of physical and psychological harm should be included in workplace violence.

Types of Workplace Violence

According to International Labour Organization (ILO), workplace violence is of two main types:

1. Internal violence:
This is the type of violence that takes place between individuals employed at the same workplace.

2. External violence:
The type of violence that occurs between an employee at his/her workplace and another non-employed individual.

Workplace Violence is Extremely Prevalent in the Healthcare Industry

Healthcare professionals comprise employees such as physicians, dentists, nursing staff, medical responders, psychologists, and caregivers. These healthcare workers are some of the most high-risk professionals of workplace violence.

According to a report by OSHA (Occupational Safety and Health Administration), between 2002 and 2013 the occurrence of serious workplace violence (that required time off for recovery) was observed to be four times more common in the healthcare system as compared to other professions such as retail, manufacturing, etc.

According to WHO, 25% of all WPV incidents take place in the healthcare sector whereas the American journal of managed care (AJMC) places this number at 75% out of every 25,000 workplace assaults.

Who is most at risk within the healthcare system?

Some departments within the healthcare system are more prone to displays of violence/ abuse than others. High-risk areas include:

1. Psychiatric professionals:

Psychiatric facilities and institutes are high on this list owing to volatile patients, high stress levels, and an environment conducive to violent outbursts. Psychiatric units are recipients of 41% of all assaults in healthcare institutes. A staggering 17% of psychiatrist patients are reported to be yielding weapons when subjected to a search.

2. Nursing staff:

Nursing assistants are the second most at-risk group in healthcare. 21% of nurses and nursing students have reported being physically assaulted and over 50% say they have been verbally abused.

3. Physicians and staff in Emergency Rooms:

Emergency rooms (ERs) are also high-risk places because of unrestricted and high people flow and stressful environments. In a study conducted by the American College of Emergency Physicians (ACEP), over 47% of physicians reported having been physically assaulted. Alarmingly, 7 out of 10 believe these incidents to be on the rise.

4. Nursing homes/Geriatric facilities/Assisted living:

Nursing home staff are repeatedly subject to various forms of major (including fractures, cuts, bruises, etc) and minor forms of assault.

The most common sources of workplace violence in healthcare are reported as follows:

  • Patients: 80%
  • Other clients/ attendees etc: 12%
  • Students: 3%
  • Suspects/ inmates: 1%
  • Others: 1%

Common Risk Factors when it comes to Workplace Violence in Healthcare

Some common risk factors for workplace violence in healthcare are:

1. Patient/Client/Environmental related risk factors:

  • Working with people/patients or their attendees with a history of violence and/or substance/alcohol abuse.
  • Poor design of healthcare facilities that block vision or prevent escape from potentially violent situations.
  • Poor lighting in hallways, parking lots, and secluded areas.
  • Unrestricted access for the general public in healthcare settings such as ER.
  • Healthcare facilities that are located in violent neighborhoods.
  • Volatile environments and situations such as emergency rooms, psychiatric wards, long, cramped waiting room hours.

2. Organizational Risk Factors

  • Lack of adequate security provided by the administration.
  • Lack of proper policy and training of healthcare workers regarding workplace violence.
  • Understaffing leaves workers alone and exposed to violence.
  • Working alone.
  • A workplace culture that guilts or silences victims into under-reporting.

Impact of Workplace Violence

The negative consequences that follow incidences of workplace violence are numerous.

The American Federation of Labor and Congress of Industrial Organizations (AFL–CIO) reports that workplace violence leads to an average loss of $250 to $330 billion annually. A number of reasons such as injury, recovery, litigation, loss of clients, property damage, etc account for this loss.

  • Psychological impact
    The long-term psychological impacts following such traumatic events are profound. Most of the victims report suffering from PTSD, major depression, anxiety, and suicidal thoughts. Some particularly dire cases have also lead to suicide.
  • Physical Impact
    According to CDC, 25% of psychiatric nurses receive disabling injuries from patient assaults. The percentage of minor injuries is even higher.
  • Loss of Productivity
    Workplace violence is another major factor that causes burnout and job dissatisfaction in an already stressful profession. Consequently, patient care is also compromised.

Preventing Incidents of Workplace Violence in the Healthcare Sector

Forbes has declared healthcare to be one of the most dangerous occupations to work in. A serious effort needs to be orchestrated to combat this dilemma.

First of all, healthcare management needs to implement a strict zero-tolerance policy towards WPV and create policies that encourage reporting and proper investigations of incidents. They also need to create proper policies and allocate sufficient resources.

Formal training sessions should be arranged for healthcare workers teaching them to recognize the potential warning signs and risk factors as well as what to do in the event of a violent occurrence.

Moreover, a system of accountability needs to be established among the administration and the management regarding documentation, and follow-up of such cases.

Healthcare facilities need to make sure that adequate psychological counseling and representation of legal aid are available to the affected person and that their well-being is not compromised.

An increase in security personnel, alarm systems, and the installation of security cameras can also decrease cases of WPV in hospitals and associated settings.

In short, workplace violence among healthcare professionals is a growing menace that needs aggressive management. On both lower and higher policy-making levels, adequate steps must be taken and implemented.