There is extensive media coverage of the various epidemics and other public health crises that providers valiantly face daily. However,  there is one epidemic that is mostly hidden from public view that can directly impact both community and provider health. This epidemic is the rampant and increasing level of violence against healthcare workers themselves – often by the very people they are trying to help.  

It is true that violence – verbal, emotional, physical, and more recently on social media – can, and does, happen in virtually any workplace.  But research suggests that 75 percent – yes, 75 percent – of all workplace violence happens to healthcare workers. This means that healthcare workers are five times more likely to experience workplace violence than their counterparts in other industries.  In fact, in April of 2022 alone, 92 percent of healthcare workers experienced workplace violence. They also miss work because of violent incidents more often than workers in other industries.  

This violence is not limited to one area of a provider’s operations nor to any specific group of workers.  No one nor area is immune.  To give an idea of how serious this epidemic has become:

• More than 80 percent of ED doctors believe violence in this area of the hospital is increasing, with almost half saying it has greatly increased over the past several years.  In fact, almost two-thirds of ED doctors report having been assaulted over the past year. 
• According to one study, two nurses are attacked in the U.S. every hour.  The highest number of assaults take place in EDs, psychiatric units, surgical units, and rehab.  Hospital nurses are the staff most likely to suffer physical or verbal violence. 
• At one provider, a patient who was angry about still being in pain after an operation literally walked into the provider’s facilities and shot the surgeon, another doctor, a visitor, and a receptionist.  In another, a nurse was thrown against a wall and bitten by a patient.

In addition to the physical risks, which cannot be minimized, this workplace violence creates a cascading negative impact on all aspects of a provider’s operations and staff:

• Worrying about, or emotionally recovering from, violence distracts staff from providing the best possible care.  It also can impact patient willingness to get care evidenced by data that suggest that when there is violence in the ED, patients may just leave without getting any treatment.
• Less than optimum care can impact community health, which, in turn, can negatively affect everything from readmission rates to a provider’s reputation and rankings.
• Increasing burn-out and emotional exhaustion of the staff can exacerbate turnover. This presents providers with human resources and financial management challenges given the cost of replacing  staff and training their replacements. It also can impact productivity, recruitment, and retention.
• Another direct cost of workplace violence in healthcare is absenteeism. Estimates are this absenteeism costs providers over $53 million per year.

What Providers Can Do

The best way to address and mitigate any ongoing problem is to look at its causes to identify possible remedies.  The same is true for providers looking for ways to protect staff from workplace violence.  The first is to look at the different types of workplace violence and to determine which are most prevalent in a healthcare setting.  These are, in no specific order:

• Criminal actions such as a robbery or theft where the healthcare worker is not the target but is injured during the act.  
• Patient-on-staff violence where the assaulter has some type of relationship with the provider such as a patient or family member who becomes violent during care.
• Staff-on-staff violence, for example doctor-on-nurse, doctor-on-doctor, or nurse-on-nurse, which can include bullying, intimidation, and physical abuse.
• Relationship violence, where the perpetrator does not have a connection to the provider but rather to the victim of the violence and commits the act at the victim’s workplace.

Research suggests that the second type of workplace violence (committed by patients, their friends or family) is the most common in a healthcare setting.  This is not very surprising given the inherent stress, frustration, worry, anger, confusion, and heightened emotions inherent in receiving medical care and where receiving bad news is unfortunately common.  If you add staff shortages, mental health disorders and economic issues into this equation, you get a volatile situation where violence is easily triggered. 

This situation is so dire that many, if not most, healthcare workers now believe that workplace violence is “just part of the job”. In fact, it is perceived as so common that many healthcare workers experiencing workplace violence don’t talk about it with colleagues or report it to provider administrations.  

Of course, there is no simple nor “one size fits all” solution to workplace violence against healthcare workers, but some tangible steps providers can take include:

• Establish a “zero tolerance” policy against any form of worker-on-worker workplace violence and provide training on this policy including how to identify risks and accessing support programs.
• Empower staff members to report all incidents of workplace violence – both physical and verbal – to administration through staff training, confidential reporting, and internal communications.
• Review current workplace wellness programs to help address the mental health and other causes of worker-on-worker violence (click here to read more on this element).
• Review current physical security measures on the provider campus and expand, if appropriate, to include both visible security (guards, doors, cameras, barriers) to deter attempts at violence as well as “invisible” security measures (panic buttons, staff location badges, check-in areas with secure access to treatment areas, fewer access points).
• Review family/friend communication protocols for keeping them updated on patient status, for example when they are transferred to recovery from the surgical suite, to reduce stress and worry.  Also provide effective communications training to patient-facing staff.
• Look at current floor and treatment area designs to ensure that staff will always have close, unencumbered egress in case of an emergency (this may be as easy as moving a nursing station away from a wall).
• Reinforce and provide continuous training to de-escalation teams, and create them if they don’t already exist, to help reduce potential situations with patients, friends, family, and visitors.
• Provide staff with multidisciplinary training on how to identify risks for workplace violence and how to reduce these risks including employing medical chaperones when appropriate and indicated.
• Consider establishing consequences for patients, relatives and visitors committing violence against provider staff (work with local law enforcement to see what recommendations they may have without necessarily having to immediately take a bereaved family member away in handcuffs).
• Reach out to community groups, nonprofit and business groups asking for support and participation in programs to reduce violence at hospitals and other healthcare locations.

Despite its complexity and prevalence, providers can and should be taking steps to reduce and eliminate all forms of workplace violence.  In doing so, they will be supporting their staff, the communities they serve and their own bottom lines.