Preventing Workplace Violence in Health Care: A Nurse’s Perspective

Added on May 22, 2018

nurse_stress“I’m going to punch you!”

“When I get out of here, you better watch your back!”

Verbal threats like these—the first from a 90-year-old woman suffering from dementia exacerbated by a new-onset urinary tract infection, the second from a young patient who disagreed with the physician’s treatment plan—are all too familiar to acute care nurses. Despite the explicitness of these threats, however, I don’t know a nurse who would report either one, and I know too many who would excuse the behavior because of the patient’s age or condition.

Sometimes it seems as if it’s in our DNA as caregivers, providers and health care workers to place our own safety and well-being second to that of our patients. In our efforts to provide a patient-centered experience, we often tolerate aggressive or violent behavior and disregard our experiences. Unfortunately, verbal abuse is not the extent of caregivers’ exposure to violence in the workplace. Too often, the threats escalate to physical assaults. 

Data from the U.S. Bureau of Labor Statistics show that health care workers are more than four times as likely to experience assaults at work that result in injuries requiring time off than any other private sector employees in the United States. It’s no secret that this exposure leads to decreased productivity and morale and increased turnover.

In some ways, the environment in which care is delivered creates the “perfect storm” for violence against care providers. We see people at their worst, families at their most vulnerable. Add to that the pain, fear and uncertainty that often accompany health care visits or procedures; any number of personal, emotional, logistical and financial problems that patients and families may face; and an open-door policy that allows the public to enter freely, and it’s not surprising that emotions can run high and routine interactions can escalate into dangerous confrontations.

But that doesn’t make it okay. It’s time for health care organizations to make sure their efforts to deliver a positive patient experience do not come at the cost of workforce safety. They must begin to ask—and answer—some tough questions to accelerate their safety journey.  

  • Have we made workforce safety a core value of our organization?
  • What can we do to ensure the safety of our work environments?
  • How can we support our employees with training, resources and leadership commitment to recognize and report threats and violence?

While there is no single solution to reduce workplace violence, we as health care leaders can begin by committing to a policy of zero tolerance for verbal threats or violence of any kind. Our experience in workforce safety in health care shows us that there is a strong cultural influence on the behaviors leading to workforce injuries, including violence, but focusing on culture alone will not get us to Zero Harm. To move closer to that goal, an organization must also remain focused on continuous improvement and implement hazard-specific prevention and safety protocols such as panic buttons, safe rooms, code responses to violence, and de-escalation and self-defense training.

Creating a safety culture that decreases workplace violence and protects your workforce is not at odds with delivering patient-centered care. In fact, research shows that nurse workplace safety, in particular, is essential to a positive patient experience. Care providers who feel safe in their work environment and who have confidence that their safety is an organizational core value demonstrate higher levels of engagement than those who do not, and higher engagement is linked to improved outcomes in the safety, quality and patient experience of care.

This is the first in a two-part series on violence in the health care workplace. Part 2 will provide actionable insights into supporting a safety culture, implementing hazard-specific prevention and driving continuous improvement across an organization.