Violence in the Workplace
by ANNA President JoAnne Gilmore

Violence in the workplace has become an increasing risk factor for health care workers, especially nurses. The National Institute for Occupational Safety and Health (NIOSH) has found that an average of 20 workers are murdered each week in the United States. In addition, an estimated 1 million workers – 18,000 per week – are victims of nonfatal workplace assaults each year (NIOSH, 1997).

The American Association of Critical-Care Nurses (AACN) Position Statement titled Workplace Violence Prevention (AACN, 2004) states, “There is a growing concern over the increase in violent incidents in the healthcare workplace and the resulting negative effects of current cultures that tolerate violence toward nurses and other healthcare workers. A perception within the healthcare industry that “assaults are part of the job” leads to underreporting of violent incidents and barriers to the institution of effective programs to assess and manage workplace violence. Violence undermines the healing mission of the healthcare organization, jeopardizes the physical and emotional safety of patients and caregivers and interferes with the ability of the healthcare team to optimally contribute to positive patient outcomes.”

According to the Bureau of Labor Statistics (2004), healthcare and social services workers have the highest rate of nonfatal assault injuries in the workplace and nurses are three times more likely to experience violence than other professionals. Erickson and Williams-Evans (2000) reported that 82% of nurses surveyed had been assaulted during their careers, and that many assaults go unreported.

It is estimated that more than 80% of all assaults on registered nurses go unreported. Studies have shown that working conditions in healthcare environments place nurses and other healthcare personnel at greater risk of violence. Characteristics such as demanding workloads, inadequate staffing levels, interventions demanding close physical contact, emotionally charged environments, shift work, highly assessable worksites, and poor security measures have been associated with increased incidences of violence (ICN, 1999; ICN, 2001; Occupational Safety & Health Administration [OSHA] & U.S. Department of Labor [USDL], 2003).

Research reveals that most workplace assaults occur in healthcare service settings. Forty-eight percent of nonfatal assaults in the workplace are committed by patients.

• Threatening behavior – such as shaking fists, destroying property or throwing objects
• Verbal or written threats – any expression of an intent to inflict harm
• Harassment – any behavior that demeans, embarrasses, humiliates, annoys, alarms or verbally abuses a person that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities
• Physical attacks – hitting, shoving, pushing or kicking

• Working with the public
• Providing service, care, advice, or education
• Working with unstable or volatile patients
• Working in community-based settings

• Provide a safe workplace, including written policies, employee training, proper staffing and follow-up of any incidents.
• Implement a comprehensive policy for preventing and managing workplace violence that establishes clear expectations of employee behavior and a course of action for employees and managers to take when incidents of violence occur. The policy should include confidential reporting, freedom for reprisals and disciplinary action for violations.
• Ensure full administrative support for policies.
• Develop and implement a violence prevention program that includes management commitment, employee participation, hazard identification, safety and health training and hazard prevention, control and reporting.
• Listen closely to concerns of staff, especially those regarding staff morale and patient safety and outcomes, and involve staff in resolving these issues.

• Actively develop a culture where violence is not tolerated, incidents are promptly addressed and managed, and comprehensive support for coworkers who experience violence is provided.
• Advocate for enforceable violence management policies in the workplace and hold others accountable for their behavior.
• Participate in educational training on violence awareness and prevention.
• Mentor colleagues on how to respond when incidents of violence occur.