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Course 776 - Preventing Workplace Violence in Healthcare

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

Hazard Prevention and Control

alarm systems
A panic button, such as this one, is an example of an engineering control.


After hazards are identified through the worksite analysis, the next step is to design measures through engineering or administrative and work practices to prevent or control these hazards.

If violence does occur, post-incident response can be an important tool in preventing future incidents.

Engineering Controls

Engineering controls remove the hazard from the workplace or create a barrier between the worker and the hazard. There are several measures that can effectively prevent or control workplace hazards, such as those described below. The selection of any measure, of course, should be based on the hazards identified in the workplace security analysis of each facility.

In the next tab, we'll discuss the options employers may choose to protect their employees.

Engineering Controls

  • Assess any plans for new construction or physical changes to the facility or workplace to eliminate or reduce security hazards.
  • Install and regularly maintain alarm systems and other security devices, panic buttons, hand-held alarms or noise devices, cellular phones and private channel radios where risk is apparent or may be anticipated. Arrange for a reliable response system when an alarm is triggered.
  • Provide metal detectors—installed or hand-held, where appropriate—to detect guns, knives or other weapons, according to the recommendations of security consultants.
  • Use a closed-circuit video recording for high-risk areas on a 24-hour basis. Public safety is a greater concern than privacy in these situations.
  • Place curved mirrors at hallway intersections or concealed areas.
  • Enclose nurses' stations and install deep service counters or bullet-resistant, shatter-proof glass in reception, triage and admitting areas or client service rooms.
  • Provide employee "safe rooms" for use during emergencies.
  • Establish "time-out" or seclusion areas with high ceilings without grids for patients who "act out" and establish separate rooms for criminal patients.
  • Provide comfortable client or patient waiting rooms designed to minimize stress.
  • Ensure that counseling or patient care rooms have two exits.
  • Lock doors to staff counseling rooms and treatment rooms to limit access.
  • Arrange furniture to prevent entrapment of staff.
  • Use minimal furniture in interview rooms or crisis treatment areas and ensure that it is lightweight, without sharp corners or edges and affixed to the floor, if possible. Limit the number of pictures, vases, ashtrays or other items that can be used as weapons.
  • Provide lockable and secure bathrooms for staff members separate from patient/client and visitor facilities.
  • Lock all unused doors to limit access, in accordance with local fire codes.
  • Install bright, effective lighting, both indoors and outdoors.
  • Replace burned-out lights and broken windows and locks.

Administrative and Work Practice Controls

alarm systems

Administrative and work practice controls affect the way staff perform jobs or tasks. Changes in work practices and administrative procedures can help prevent violent incidents. Some options for employers are to:

  • State clearly to patients, clients and employees that violence is not permitted or tolerated.
  • Require employees to report all assaults or threats to a supervisor or manager (for example, through a confidential interview). Keep log books and reports of such incidents to help determine any necessary actions to prevent recurrences.
  • Advise employees of company procedures for requesting police assistance or filing charges when assaulted and help them do so, if necessary.
  • Provide management support during emergencies. Respond promptly to all complaints.
  • Set up a trained response team to respond to emergencies.
  • Use properly trained security officers to deal with aggressive behavior. Follow written security procedures.
  • Ensure that adequate and properly trained staff are available to restrain patients or clients, if necessary.

Administrative and Work Practice Controls


Here are some more options for employers to help prevent violent incidents:

  • Institute a sign-in procedure with passes for visitors. Enforce visitor hours and procedures.
  • Supervise the movement of psychiatric clients and patients throughout the facility.
  • Prohibit employees from working alone in emergency areas or walk-in clinics, particularly at night or when assistance is unavailable. Do not allow employees to enter seclusion rooms alone.
  • Treat and interview aggressive or agitated clients in relatively open areas that still maintain privacy and confidentiality (such as rooms with removable partitions).
  • Prepare contingency plans to treat clients who are "acting out" or making verbal or physical attacks or threats.
  • Ensure that nurses and physicians are not alone when performing intimate physical examinations of patients.
  • Provide staff members with security escorts to parking areas in evening or late hours. Ensure that parking areas are highly visible, well lit and safely accessible to the building.
  • Use the "buddy system," especially when personal safety may be threatened.

Employer Responses to Incidents of Violence

Post-incident response and evaluation are essential to an effective violence prevention program. All workplace violence programs should provide comprehensive treatment for employees who are victimized personally or may be traumatized by witnessing a workplace violence incident. Injured staff should receive prompt treatment and psychological evaluation whenever an assault takes place, regardless of its severity. Provide the injured transportation to medical care if it is not available onsite.

Victims of workplace violence suffer a variety of consequences in addition to their actual physical injuries. These may include:

  • short- and long-term psychological trauma
  • fear of returning to work
  • changes in relationships with coworkers and family
  • feelings of incompetence, guilt, powerlessness
  • fear of criticism by supervisors or managers

Employer Responses to Incidents of Violence


Consequently, a strong follow-up program for these employees will not only help them to deal with these problems, but it will also help prepare them to confront or prevent future incidents of violence.

Several types of assistance can be incorporated into the post-incident response. For example, trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs may be provided to assist victims.

Certified employee assistance professionals, psychologists, psychiatrists, clinical nurse specialists or social workers may provide this counseling or the employer may refer staff victims to an outside specialist. In addition, the employer may establish an employee counseling service, peer counseling or support groups.

Counselors should be well trained and have a good understanding of the issues and consequences of assaults and other aggressive, violent behavior. Appropriate and promptly rendered post-incident debriefings and counseling reduce acute psychological trauma and general stress levels among victims and witnesses. In addition, this type of counseling educates staff about workplace violence and positively influences workplace and organizational cultural norms to reduce trauma associated with future incidents.

Safety Tips for Hospital Workers

Watch for signals that may be associated with impending violence:

  • verbally expressed anger and frustration
  • body language such as threatening gestures
  • signs of drug or alcohol use
  • presence of a weapon

Maintain behavior that helps diffuse anger:

  • Present a calm, caring attitude.
  • Don't match the threats.
  • Don't give orders.
  • Acknowledge the person's feelings (for example, "I know you are frustrated").
  • Avoid any behavior that may be interpreted as aggressive (for example, moving rapidly, getting too close, touching, or speaking loudly).

Safety Tips for Hospital Workers

Be alert:

  • Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor.
  • Be vigilant throughout the encounter.
  • Don't isolate yourself with a potentially violent person.
  • Always keep an open path for exiting - don't let the potentially violent person stand between you and the door.

Take these steps if you can't defuse the situation quickly:

  • Remove yourself from the situation.
  • Call security for help.
  • Report any violent incidents to your management.

Case Reports

  • A security screening system in a Detroit hospital included stationary metal detectors supplemented by hand-held units. The system prevented the entry of 33 handguns, 1,324 knives, and 97 mace-type sprays during a 6-month period.
  • A violence reporting program in the Portland, Oregon, VA Medical Center identified patients with a history of violence in a computerized database. The program helped reduce the number of all violent attacks by almost 92% by alerting staff to take additional safety measures when serving these patients.
  • A system restricting movement of visitors in a New York City hospital used identification badges and color-coded passes to limit each visitor to a specific floor. The hospital also enforced the limit of two visitors at a time per patient. In 18 months, these actions reduced the number of reported violent crimes by 65%.

Hospital Strategies

All hospitals should develop a comprehensive violence prevention program. No universal strategy exists to prevent violence. The risk factors vary from hospital to hospital and from unit to unit. Hospitals should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them.

All hospital workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.

AnMed Health Medical Center: Staff Talent to Motivate Safety


Here is a good example of employees taking an active role in safety training:

AnMed Health employees take pride in writing, producing, and starring in worker safety training videos. Employees re¬spond better when they see familiar faces; they find this form of training efficient and effective.



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. If violence occurs, _____ response can be an important tool in preventing future incidents.

2. Providing employee “safe rooms” for use during emergencies is an example of a(n) _____.

3. Which of the following could be signals that may be associated with impending violence?

4. If you cannot defuse a violent situation, you should _____.

5. Changes in work practices can help prevent violent incidents.

Have a great day!

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