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:
Here are some recent case reports provided by NIOSH:
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.
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:
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:
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:
Violence may also have negative organizational outcomes such as:
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:
To prevent violence in hospitals, employers should develop a safety and health program that includes:
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.
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:
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