Skip Navigation

Course 776 - Preventing Workplace Violence in Healthcare

Safety guides and audits to make your job as a safety professional easier

What is Workplace Violence?


Workplace violence ranges from offensive or threatening language to homicide. NIOSH (National Institute of Occupational Safety and Health) defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.

Examples of violence include the following:

  • Threats: Expressions of intent to cause harm, including verbal threats, threatening body language, and written threats.
  • Physical assaults: Attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives.
  • Muggings: Aggravated assaults, usually conducted by surprise and with intent to rob.

Case Reports

Here are some recent case reports provided by NIOSH:

  • An elderly patient verbally abused a nurse and pulled her hair when she prevented him from leaving the hospital to go home in the middle of the night.
  • An agitated psychotic patient attacked a nurse, broke her arm, and scratched and bruised her.
  • A disturbed family member whose father had died in surgery at the community hospital walked into the emergency department and fired a small-caliber handgun, killing a nurse and an emergency medical technician and wounding the emergency physician.

These circumstances of hospital violence differ from the circumstances of workplace violence in general. In other workplaces such as convenience stores and taxicabs, violence most often relates to robbery. Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.

Who is at Risk?


Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all health care providers.

Violence may occur anywhere in the hospital, but it is most frequent in the following areas:

  • psychiatric wards
  • emergency rooms
  • waiting rooms
  • geriatric units

Case Report

A psychiatric technician died after she was strangled by a patient at a forensic psychiatric facility in California. The patient assaulted the victim while the victim was walking alone across the large, open grounds of the facility Secure Treatment Area (STA)). The victim carried a personal alarm that was not able to transmit a signal inside to security personnel or treatment team staff from the STA grounds.

At the time of the assault, security personnel were at the entrance to the STA but nowhere else within the grounds. The alleged assailant had been admitted to this facility in 1999 after conviction for violent assault and being declared not guilty by reason of insanity. He had a long, documented history of assault and verbal abuse to other patients and staff.

The alleged assailant’s unrestricted grounds pass had been suspended by his treatment team on two occasions because of physical and verbal assaults within three weeks prior to this incident. However, the treatment team restored his grounds pass and he was on the grounds of the STA without supervision on the day of the incident.

The investigative team determined that, to prevent future occurrences, forensic psychiatric facilities should develop and implement a comprehensive written workplace violence injury prevention program. This program should include the following elements to reduce the risk of violent assaults to staff:

  • Security personnel or co-workers should accompany individual employees when walking through open or unsecured areas.
  • As part of an emergency response plan, personal alarms worn by employees should be operational throughout all areas of the facility.
  • The facility should assign hospital police officers and/or security personnel to locations where they can monitor patients for assaultive behavior.
  • The facility should implement policies for issuing and suspending grounds passes for patients at risk of committing violent assault.

Violence Effects


The effects of violence in healthcare can vary in scope ranging from individuals to organizations. Violence that affects individuals can range in intensity and include the following:

  • minor physical injuries
  • serious physical injuries
  • temporary and permanent physical disability
  • psychological trauma
  • death

Violence may also have negative organizational outcomes such as:

  • low worker morale,
  • increased job stress,
  • increased worker turnover,
  • reduced trust of management and coworkers, and
  • a hostile working environment.

Risk Factors

Interactions with patients is the highest risk factor
Interactions with patients is the highest risk factor. (Click to enlarge.)

The risk factors for violence vary in hospitals, nursing homes, and other healthcare settings depending on location of providers, size of the facility, and type of care provided. Historically, about 80 percent of serious violent incidents reported in healthcare settings were caused by interactions with patients. Other incidents were caused by visitors, coworkers, or other people.

Workplace violence risk factors vary by healthcare setting, but common factors include the following:

  • Working with people who have a history of violence or who may be delirious or under the influence of drugs
  • Lifting, moving, and transporting patients
  • Working alone
  • Poor environmental design that may block vision or escape routes
  • Poor lighting in hallways or exterior areas
  • Lack of means of emergency communication
  • Presence of firearms
  • Working in neighborhoods with high crime rates
  • Lack of training and policies for staff
  • Understaffing in general, and especially during meal times and visiting hours
  • High worker turnover
  • Inadequate security staff
  • Long wait times and overcrowded waiting rooms
  • Unrestricted public access
  • Perception that violence is tolerated and reporting incidents will have no effect

Prevention Strategies for Employers

To prevent violence in hospitals, employers should develop a safety and health program that includes:

  • management commitment
  • employee participation
  • hazard identification
  • safety and health training
  • hazard prevention, control, and reporting

Employers should evaluate this program periodically. Although risk factors for violence are specific for each hospital and its work scenarios, employers can follow general prevention strategies.

Environmental Designs


To lower the risk of violence to employees and the public, it's important to design the workplace to decrease the likelihood that incidents of violence can occur. Below are some design strategies can work to make the healthcare setting more safe for everyone:

  • Develop emergency signaling, alarms, and monitoring systems.
  • Install security devices such as metal detectors to prevent armed persons from entering the hospital.
  • Install other security devices such as cameras and good lighting in hallways.
  • Provide security escorts to the parking lots at night.
  • Design waiting areas to accommodate and assist visitors and patients who may have a delay in service.
  • Design the triage area and other public areas to minimize the risk of assault:
    • Provide staff restrooms and emergency exits.
    • Install enclosed nurses' stations.
    • Install deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas.
    • Arrange furniture and other objects to minimize their use as weapons.

Administrative Controls

Restrict the movement of the public in hospitals by card-controlled access.
  • Design staffing patterns to prevent personnel from working alone and to minimize patient waiting time.
  • Restrict the movement of the public in hospitals by card-controlled access.
  • Develop a system for alerting security personnel when violence is threatened.

Behavior Modifications

  • Provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness.



Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

Read each question carefully. Select the best answer, even if more than one answer seems possible. When done, click on the "Get Quiz Answers" button. If you do not answer all the questions, you will receive an error message.

Good luck!

1. Which of the following is/are examples of workplace violence?

2. Who has the highest risk of becoming a victim of workplace violence in a hospital setting?

3. Violence may occur anywhere in the hospital, but it is most frequent in which areas?

4. Developing a system for alerting security personnel when violence is threatened is an example of _____.

5. Which of the following is an example of a behavior modification?

Have a great day!

Important! You will receive an "error" message unless all questions are answered.