Health Care Facilities and Workplace Violence Prevention Safety Training Program
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Health Care Facilities and
Workplace Violence Prevention
Safety Training Program
Goal Several studies indicate that health care
The purpose of this safety training program is industry violence often takes place during
to increase worker and employer awareness times of high activity and interaction with
of the risk factors for violence in health care patients. Among the most common times for
facilities and to provide strategies for reducing violence in health care workplaces is during
exposure to these factors. patient transportation, emergency room
stabilization, mealtimes, and visiting hours.
Assaults often occur when service is denied,
Background when a patient is involuntarily admitted,
Today more than 15 million U.S. employees or when a health care worker attempts to
work in the health care industry.1 They set limits on the use of eating, drinking, or
comprise about 11% of the national workforce smoking.
yet experience four times more job-related
violence than those working in the private
sector.2 What is Workplace
Violence?
The physical and financial cost of workplace Workplace violence ranges from offensive
violence is dire to health care workers and or threatening language to homicide. The
organizations. However, the mental cost to National Institute for Occupational Safety and
employees is often higher. The stress, fatigue, Health defines workplace violence as “violent
and job dissatisfaction following a violent acts (including physical assaults and threats
workplace injury ultimately lead to poorer care of assaults) directed toward persons at work
delivery.3 or on duty.” Examples of violence include the
following:
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
HS02-035D (05-21) 1
• Threats involved in patient care are at higher risk.
Threats may include expressions of Other hospital personnel at increased risk
intent to cause harm, such as verbal of violence include emergency room staff,
threats, threatening body language, or paramedics, and hospital safety officers.
written threats.
• Physical assaults
Where May Violence Occur?
Violence may occur anywhere in the hospital
Physical assaults may include attacks
or health care facility, but it is most frequent in
ranging from slapping, beating, rape,
the following areas:
the use of weapons, or homicide.
• psychiatric wards;
• Muggings
• emergency rooms;
Muggings include aggravated assaults
• waiting rooms; and
and are usually conducted by surprise
• geriatric units.
with the intent to rob.
Who is at Risk? What are the Effects of
Although anyone working in a hospital or Violence?
health care facility may become a victim The effects of violence can range from
of violence, nurses and other staff directly physical injuries to psychological trauma or
2018 Crime Rates per 100 Beds by Type of Crime*
45.2
11.7
7.6
2.5 1.4 0.6 0.4
Disorderly Assault Theft Vandalism Violent Crime Motor Burglary
Conduct Vehicle Theft
*Data source: The International Association of Health Care Security and Safety Foundation, “2019 Health Care Crime
Survey.” For analytical purposes and consistency with FBI practice, Murder, Rape, Robbery, and Aggravated Assault were aggregated
into one group called Violent Crime.
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
2 HS02-035D (05-21)even death. However, workplace violence is • limited lighting in corridors, rooms,
also associated with: parking lots, garages, and surrounding
• reduced productivity; public areas and walkways that access
separate buildings;
• increased turnover;
• transporting or delivering patients;
• absenteeism;
• long waits for service in emergency
• counseling costs; rooms and clinics;
• decreased staff morale; • overcrowded, uncomfortable waiting
• reduced quality of life; and rooms;
• deteriorating quality of patient care. • inadequate security; and
• unrestricted access to the public.
What are the Risk Factors
for Violence? Prevention Strategies for
The risk factors for violence vary from one Employers
health care facility to another, depending on Employers should develop a Workplace
location, size, and type of care. Common risk Violence Prevention Safety Training Program
factors for violence in health care facilities to help prevent violent injuries in health care
include: facilities. The Program’s success depends
upon management commitment, employee
• work in a high-crime area;
participation, hazard identification, safety
• increased use of the health care facility and health training, hazard prevention,
by law enforcement or criminal justice reporting, and periodic evaluation. Employers
personnel for criminal patient holds; are encouraged to form multidisciplinary
committees that include direct-care staff and
• care for volatile patients with specific
union representatives (if available) to identify
psychotic diagnoses or who are under
and reduce risk factors in specific work
the influence of drugs or alcohol;
scenarios. Although risk factors for violence
• increased treatment of mentally ill are specific for each health care facility,
patients released from hospitals employers can use the following general
without outpatient follow-up; prevention strategies:
• lack of staff training and policies for
Environmental Designs
preventing and managing crises with
potentially volatile patients; • Develop emergency signaling, alarms,
• availability of drugs, money, or other and monitoring systems.
valuable items at hospitals, clinics, or • Install metal detectors to prevent armed
pharmacies; persons from entering the facility.
• understaffing, especially during • Install cameras and good lighting in
mealtimes and visiting hours: hallways for added security.
• working alone or isolated during patient • Provide employees with security escorts
care; to parking areas at night.
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
HS02-035D (05-21) 3• Design comfortable waiting and
Largest Sources of Violence
assistance areas for visitors and
patients who may have a delay in in Health Care Settings
service.
• Design the triage area and other public
areas to minimize the risk of assault by:
º providing staff restrooms and
emergency exits;
º installing enclosed nurses’ stations;
º installing deep service counters or
bullet-resistant and shatterproof
glass enclosures in reception
areas; and
º arranging furniture and other
objects to minimize the use of Data source: Bureau of Labor Statistics (BLS). Data covers
three broad industry sectors: ambulatory healthcare services,
weapons. hospitals, and nursing and residential care facilities as defined
by BLS.
Administrative Controls offer and encourage counseling whenever a
worker is threatened or assaulted.
• Design staff scheduling to reduce
patient wait times and prevent
personnel from working alone. Safety Tips for
• Restrict the movement of the public in Health Care Workers
health care facilities by card-controlled
access. Warning Signs
While it is impossible to detect volatile
• Develop a system for alerting security patients 100% of the time, these warning signs
personnel when violence is threatened. can aid in their identification:
Behavior Modifications • verbal anger and frustration;
Provide all workers with training in recognizing
and managing assaults, resolving conflicts, • extreme physical agitation;
and maintaining hazard awareness. • the use of threatening gestures;
Dealing With the Consequences of Violence • aggressive movements, including hitting
Violence may occur in the workplace despite walls or other items;
preventive measures. Employers should • inappropriate laughter or excessive
prepare to deal with the consequences of sarcasm;
this violence by providing an environment
that promotes open communication and • signs of drug or alcohol use; or
develops written procedures for reporting • presence of a weapon.
and responding to violence. Employers should
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
HS02-035D (05-21)Diffuse Anger
Behavioral techniques to help de-escalate Review Questions
anger include:
1. Health care workers do not need
• maintain a calm, caring attitude; to be concerned about violence at
work. True or False
• do not match threats;
• do not give orders; 2. Body language such as threatening
gestures should not be treated as
• acknowledge the person’s feelings an act of violence. True or False
(example: “I know you are frustrated…”)
• avoid any behavior that may be 3. Management commitment is not
interpreted as aggressive (example: necessary to prevent workplace
hurrying, getting too close, touching, or violence. True or False
speaking loudly).
Be Alert Answers
1. False.
• Evaluate each situation for potential Health care workers are at high
violence when entering a room or risk for experiencing violence in the
beginning to interact with a patient or workplace.
visitor.
2. False.
• Be vigilant throughout the encounter. Threatening gestures can be a
• Do not become isolated with a signal of impending violence. Take
potentially violent person. the following steps:
• Always keep an open path for exiting • remove yourself from the
and never let a potentially violent situation;
person block a health care worker from • call security for help; and
the door.
• report any violent incidents to
Retreat your management.
Take these steps when the situation cannot be 3. False.
diffused quickly: Employers should develop a safety
and health violence prevention
• Walk away from the situation. program that includes management
• Call security for help. commitment, employee
participation, hazard identification,
• Report all violent incidents to training, hazard prevention,
management. reporting, and periodic evaluation.
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
HS02-035D (05-21) 5References
1 U.S. Bureau of Labor Statistics, May 2020 National Occupational Employment and Wage Estimates, United States. Combined
29-000 Health Care Practitioners and Technical Occupations and 31-000 Health Care Support Occupations. Website. https://www.
bls.gov/oes/current/oes_nat.htm. Accessed May 20, 2021.
2 Occupational Safety and Health Administration. “Workplace Violence in Health Care: Understanding the Challenge.” PDF.
https://www.osha.gov/sites/default/files/OSHA3826.pdf. Accessed May 20, 2021.
3 Balasubramanian, Sai. “Violence Against Health Care Workers is a Growing Problem.” Website. https://www.forbes.com/sites/
saibala/2021/04/29/violence-against-healthcare-workers-is-a-growing-problem/?sh=6111fdae446c. Accessed May 20, 2021.
www.txsafetyatwork.com
1-800-252-7031, Option 2
The Texas Department of Insurance,
Division of Workers’ Compensation (DWC)-Workplace Safety
P.O. Box 12050
Austin, TX 78711-2050
Disclaimer: Unless otherwise noted, this document was produced by the Texas Department of Insurance, Division of Workers’ Compensation
using information from staff subject specialists, government entities, or other authoritative sources. Information contained in this fact sheet is
considered accurate at the time of publication. For more free publications and other occupational safety and health resources, visit
www. txsafetyatwork.com, call 800-252-7031, option 2, or email resourcecenter@tdi.texas.gov.
Texas Department of Insurance, Division of Workers’ Compensation
www.txsafetyatwork.com
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