Violence Against Healthcare Workers: How Can We Do Better?

Hospital Violence Is Pervasive and Disproportionate to Other Industries

Violence against clinicians has long been a pressing concern for the healthcare industry – with violence in healthcare about four times more prevalent than in any other industry.¹ According to the Occupational Safety and Health Administration (OSHA):

• 21% of registered nurses and nursing students reported being physically assaulted — and over 50% ver­bally abused — in a 12-month period²
• 12% of emergency department nurses experienced physical violence — and 59% experienced verbal abuse — during a seven-day period³
• 13% of Veterans Health Administration hospital healthcare workers reported being assaulted in a year⁴

Many Factors Contribute to Violence in Healthcare Facilities

Healthcare organizations are naturally prone to many common risk factors for workplace violence, including:⁵

• Working with people who are delirious or under the influence of drugs
• Working with people with a history of violence
• Working alone
• Lifting, moving and transporting patients

Violence Against Nurses and Other Healthcare Workers Increased During the Pandemic⁶

Covid-19 brought with it social distancing, new safety protocols and heightened stress for patients and clinicians alike. While these practices were important to help prevent the spread of disease, they also introduced new stressors into an already strained environment. It is not surprising, then, that global surveys found an increased perception of violence against healthcare workers around the world.⁶

For patients, the lack of visitors and family members at the bedside removed an important source of comfort. Masks, face shields and limited staff in patient rooms also presented challenges to building trusting connections between patients and care teams.

And as Schmitz points out, the added stress for healthcare workers only compounded the issue — and continues to do so today:

“For [hospital workers], there is no break from the stress. People have the same stress they’re coming in to see you for, but home is also stressful. They come in with greater tensions than they would have prior.”

Can Training Help Prevent Violence Against Healthcare Workers?

Although studies have shown it to be effective in healthcare, workplace violence training is underrepresented in many nursing school curricula.⁷ The CDC, NIOSH and OSHA all recommend and/or offer workplace violence prevention programs to support employee and patient safety, improve quality of care and enhance employee relations.^8,9

Schmitz and Lloyd agree that all vulnerable employees should be trained on personal safety and de-escalation procedures.

“Anxiety levels are high right now for patients and caregivers. You can feel that,” comments Lloyd. “And sometimes it’s hard to recognize when something is going to pop off to a level where you’re in danger. We tend to ride a fine line … and it’s very easy to miss subtle signs that things are escalating.”

“De-escalation is a skill set in and of itself,” points out Schmitz. “And it’s not just in the emergency department. If you’re in an inpatient unit for three days, it might be on day three that you’re really frustrated. So healthcare workers across the board need to know how to manage that conversation to prevent escalation, but also to reassure patients and give them that true sense of security that you’re doing everything you can to take care of them.”

How Can Processes and Technology Help?

Rather than counting on a single program or intervention to address violence against nurses and other healthcare workers, both Lloyd and Schmitz recommend a layered approach. Training staff on safety, clearly communicating behavioral expectations to patients and visitors, and fostering a culture where employees are encouraged to voice their concerns are all important.

The right technology investments can also help create safer environments:

• Metal detectors, particularly in the emergency department, can help prevent unsafe situations in the units
• Duress buttons can help employees request emergency assistance when they need it
• Real-time staff locating systems can further improve safety by tracking their locations for quicker responses to their duress alerts

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