Addressing the Escalation of Violence in Healthcare

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Violence in healthcare is an issue that The Healthy Workforce Institute takes seriously.

Our mission is to create healthy workforce’s within healthcare organizations by eliminating bullying and incivility and creating cultures of professionalism, caring, and respectful communication. We focus on the PEOPLE within an organization because it’s the PEOPLE who determine the culture and ultimately, the environment. As we’ve consulted with healthcare executives to strengthen their organizations through appropriate policies and processes, equip their front line leaders through skill development, and empower their employees through nurse-driven caring culture initiatives, the topic of workplace violence ALWAYS comes up.  Some organizations are organizing task forces, while others are now required to include education and training related to workplace violence prevention for every employee.

[easy-tweet tweet=”You should focus on the PEOPLE within an organization because the PEOPLE determine the culture!”]

Why so much attention to workplace violence?

Because just as bullying and incivility are on the rise, so is workplace violence.

More and more, healthcare professionals face a variety of situations that pose threats to their health and personal safety. The spectrum of violence ranges from verbal assault, stalking, and burglary to actual physical violence and homicide. 60% of all non-fatal assaults and violent acts occur within healthcare settings and the most common victims are nurses and nursing assistants.

In fact, 1-in-4 nurses have been assaulted at work.

A few states have executed laws to help protect healthcare employees. For example, in Pennsylvania, where I live, it’s now considered a felony to assault a nurse. However, no federal regulations exist to protect employees from the rise of violence in healthcare settings.

My husband is a retired detective who specialized in crime and violence prevention. He was a master at preventing workplace violence and says that decreasing violence always starts with awareness.

[easy-tweet tweet=”Did you know that 1-in-4 #nurses have been assaulted at work? #endviolenceinhealthcare”]


First, it’s important to understand the different levels of violence and how they may show up in your hospital or clinic. In the healthcare setting, The Center for Disease Control (CDC) has identified four types of workplace violence.

Type 1 violence involves a perpetrator who has no legitimate reason for being in the hospital and is usually committing some sort of crime in relation to the violence, such as a robbery, shoplifting, or trespassing. An example of this might be a nurse who is assaulted during a robbery in the parking garage.

Type 2 violence, which according to the CDC is the most common, is usually seen in the ER and/or psychiatric treatment areas and waiting rooms where a patient attacks a health-care worker. Many of these incidents show up on TV or on Facebook!

Type 3 violence, is commonly known as lateral or horizontal violence and is associated with staff on staff violence. This type of violence ranges from verbal abuse to unfair treatment and can occur between doctor to nurse, nurse to nurse, etc. This is where I spend the majority of my time in relation to workplace violence.

Type 4 violence, is where the perpetrator has some relationship to an employee outside of the hospital, such as a domestic violence situation that carries over into the workplace.

It’s also important to understand the escalation of violence. If you understand how violence escalates, you can pay attention to signs that your patient, their family member, or your coworker might become violent.


Verbal assaults. Assaults might start as openly criticizing, sending hostile emails or text messages, and angry comments in front of others OR when alone with this person.


Throwing inanimate objects. Throwing things, kicking a chair, or punching a wall. Have you ever seen a co-worker (typically physicians) throw things?


This is when their anger escalates to physical violence towards people.

If you are working with someone or caring for a patient who triggers your gut instinct, start paying attention.  Remember, violence starts with verbal assaults, then assaults against inanimate objects, and then violence against people.

Keep in mind that it’s important to intervene early. Don’t wait for someone to get violent and then have regrets that you didn’t take action.

[easy-tweet tweet=”What does your #healthcare organization do to prevent violence? “]


The concept of awareness encompasses both awareness of your surroundings as well as self-awareness, in other words, what would you be willing to do to protect yourself, your coworkers or your patients. The following are just a few of the many examples of how to become more aware:

  1. Recognize that although violence can occur anywhere at any time, certain areas have higher potential, such as in the Emergency room where stress and emotions combined with long waiting times cause people to lash out, in many cases at those trying to help them.
  2. Pay attention to personal space and body language, both yours and your patients or coworkers. Everyone reacts different to someone invading their personal space (usually the area around you about an arm’s length away). Be respectful and mindful of this space and be prepared to back up if someone gets too close.
  3. Evaluate every situation for potential violence, especially when entering a patient’s room for the first time. Make a habit of including any unusual or concerning behaviors of your patients when giving report and hopefully you will get the same type of report when starting your shift. Pay attention not only to the patient but to any visitors in the room.

In addition to the tips above, here are a few extra pointers to keep you safe outside the workplace:

  • Be aware of your surroundings, especially when working on a unit that you’re not used to
  • Maintain eye contact with people
  • Know how to carry your purse, wallet or valuables (don’t get bogged down)
  • Pay attention to what you are doing and where you are going
  • Scan ahead AND behind for dangers
  • Send a message that you are confident and calm. If lost, don’t act like it
  • Know your neighborhood or destination, especially if you are a homecare nurse
  • Use old safety standbys i.e. use well lit sidewalks, don’t take shortcuts, strength in numbers, etc.
  • Think about what you would do if robbed or attacked ahead of time
    • Robbery – Don’t resist, give them your stuff, not worth your life
    • Attacked – Resist with everything you have

Becoming more aware and protecting yourself from violence, aggressive behavior and even bullying is an individual and organizational responsibility and one that should not be taken lightly. By engaging in violence prevention, reading safety literature and attending classes or seminars, you will not only increase your chances of NOT becoming a victim, but also make your workplace a safer place for you, your colleagues, and your patients.

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Be kind. Take care. Stay connected.

Helping you cultivate a healthy happy workforce,

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3 thoughts on “Addressing the Escalation of Violence in Healthcare”

  1. Hello Dr. Renee,

    Thanks for sharing the views. I think It’s hard not to take things personally, especially since angry people often say very personal things. But it’s essential to do your best to remain calm and professional

    1. Renee Thompson

      Thanks Kinley. Funny, I just had this conversation with my daughter last night who struggles dealing with angry parents (she is a school teacher) who want to blame the teacher for their child’s performance. Hard not to take things personal but so important!!!

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