Workplace violence in the healthcare industry has been declining, but that doesn’t mean it’s completely absent from hospitals and other medical clinics. According to the Bureau of Labor Statistics, almost half of non-fatal injuries from occupational assaults and violence occur in healthcare and social services settings.

Who is most at risk? Statistics indicate that nurses were the most likely victims of assault, most of which are committed by a patient on an employee. Other assaults occurred between a stranger and an employee, and between two or more former or current co-workers. Given the risks, there is an imperative need for healthcare facilities to establish violence prevention policies to protect their employees.

According to the Occupational Safety and Health Administration (OSHA), healthcare facilities should instill a violence prevention program as part of their larger safety and health program. This program serves to reduce the severity and frequency of injuries that employees face, track the facility’s progress in reducing violence and decrease the threat of violence to employees’ safety. Specifically, the program:

• Outlines a clear policy detailing that violence including verbal and nonverbal threats, will not be tolerated in the workplace
• Eliminates the chance that individuals would seek revenge on an employee for reporting violence
• Encourages employees to report violent acts quickly
• Outlines a plan to maintain safety in the workplace
• Explains management concerns for employee physical and emotional health
• The goal of such a program is to guarantee that:
• Employees comply with and support a violence-free workplace
• Employees feel comfortable reporting violence

Training

When designing violence prevention programs, orchestrate prevention training that is mandatory for all employees. According to OSHA, training is a key element in violence prevention, as the employees receive extensive information about how to conduct themselves in the workplace in the event of violence. They are also formally warned about the no-tolerance policy, in the event that they feel like instigating a fight down the road. Essentially, the intentions of the facility are made extremely clear in the training session.

In addition, by getting to know staff members who are part of the violence prevention initiative, employees may feel more comfortable reporting injuries or threats in the event that they occur. The training may include:

• An explanation of the violence policy and program initiatives
• Encouragement to report threats or violent incidents
• Tactics for preventing or reducing hostile situations, conflict or anger
• Ways to manage anger
• Suggestions for how to resolve conflicts without violence
• Suggestions for how to reduce stress and relax
• Outlining the security procedures for the facility
• Self-defense tips
• Ways to assist a victim in need of support

Facility Analysis

OSHA also recommends that a healthcare facility conduct an analysis of records, security measures and trends regarding violence. By doing an analysis, management can identify the recurring threats to their employees, security breaches of any kind and ways to protect their employees in the future. Healthcare facilities are particularly hazardous, according to OSHA, because of the following:

• Medications and money available in the pharmacy area (robbery target)
• Employees must work evenings in potentially high crime areas
• Employees are exposed to sometimes violent, mentally unstable patients
• Patients may be uncooperative or combative at times
• Rooms may contain furniture or items that could potentially be used as a weapon against employees

After conducting an analysis of the facility, management should instill additional safety controls, including:

• Increase lighting in high risk areas such as patient rooms, isolated treatment areas or outside the facility
• Install metal detectors to alert security staff if patrons are bringing guns or knives into the facility
• Install plexiglass windows around the pharmacy check-out window to minimize the threat of theft
• Use safety devices such as alarms, panic buttons, cameras, two-way mirrors, key-card access systems and hire security personnel
• Install curved mirrors at hallway intersections
• Train staff on how to recognize hostile situations and behavior
• Increase staffing in the evenings or in places where patients may become violent
• Encourage employees to carpool so they arrive and depart in groups
• Provide a complimentary shuttle service or security guards to escort employees out of the building
• Explain the zero tolerance policy for violence to patients
• Have relationships with the local police and alert them of the emergency action plans in the event of violence
• Gather previous records of patients to determine if they pose threats to employees
• Design a program to deal with violent and combative patients including:
  • Arrange furniture in such a way to prevent the staff from becoming trapped in the room
  • Place minimal, lightweight furniture in the rooms without any sharp corners
  • Affix the furniture to the floor
  • Remove excess clutter from the rooms, especially items on countertops that could be used as weapons
  • Make sure that there is a second exit in patient rooms for employees in the event that the patient becomes violent
  • Require that employees implement a buddy system when treating high-risk patients so they are never alone

Response to Violence

In the event that a violent act is committed in the facility, employees need a supportive management staff to rely on to get through the trying time. To ensure that employees receive the support they need, the healthcare facility should establish a response team to deal with the situation.

This team is responsible for providing medical care for the injured employee(s) and counseling after the fact.

OSHA also requires that facilities fill out an OSHA Form 300 within eight hours of the incident to document all work-related injuries if three or more employees were hospitalized. By documenting violence, OSHA and the facility can determine the severity of the incident and determine how the situation can be prevented in the future.

Remember that it is the facility’s responsibility to take steps to protect its employees from violence and maintain a safe working environment.

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This is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice. © 2025 Zywave, Inc. All rights reserved.