Risk Factors for Workplace Violence in Healthcare Settings

A National Institute of Occupational Safety and Health (NIOSH) study in 2003 found an increase in health care workplace violence involving personnel, patients and visitors. NIOSH found that the violence took the form of threats, physical assaults (including rape, homicide and weapon use) and muggings. In the previous year, hospital workers suffered 2,637 nonfatal assaults (8.3 for every 10,000 employees, compared to 2 per 10,000 employees for private sector assaults). Without appropriate prevention, management and post-traumatic training, many people believe facilities are vulnerable to violence.

Risks with Individuals

• Health care settings can be full of tension, and a number of factors could provoke a person to violent acts. People in high stress scenarios, with a history of violence, certain psychotic diagnoses or are inebriated through drug or alcohol use, pose significant risks. Some chronically mentally ill individuals are released from the hospital after being taken in for an incident and are released because they can not be held unless perceived to be a danger. Without proper followup, any number of factors could trigger a violence-motivated return to the facilities. An increase in police, the justice system using hospitals for criminal holding and patients with violent tendencies have created additional risks. Risks of violence in these individuals can increase if they feel they are being threatened orally or through body language.

Risks with Scenarios

• Several scenarios can increase risk factors in health care settings. If the facility is
  understaffed or an employee is alone, and especially if security is below what's needed, violence is more likely to erupt. Long waits in overcrowded, uncomfortable waiting rooms can trigger erratic behavior in people. Examinations, treatments and physical therapy can create situations where an employee is alone with someone, without support. Many of these isolated situations occur in areas without alarms or communication systems, which can be especially true in high-crime areas.

Other Risks

• When transporting patients, extra caution should be taken so employees are not caught off guard. The same principles apply to working in poorly lit hallways, rooms and parking lots. Facilities with money or drugs, such as clinics and pharmacies, have a higher chance of experiencing violent robberies.

Deterrents

• The most commonly advised strategy to deter violence in health care settings is to be well-staffed. In response to the NIOSH study, hospitals joined with the Occupational Safety and Health Administration to develop initiatives to enhance safety and preventative measures, as well as preparedness and post-traumatic strategies.

Post-trauma

• NIOSH speculates that continuing violence occurs because employees do not appropriately address the incident. After an incident of unexpected workplace violence, shocked medical professionals still need to be calm enough to deal with the aftermath, which could include panic and irate individuals. Individual organizations will need to formulate a plan for continuing to provide optimal care after violence, while allowing personnel an opportunity to process the event as a group and individuals.