1. Workplace Violence in
the Healthcare Setting
SCSU Leadership Students
Matt Baumann and Kayla Dube

2. Overview
• As healthcare professionals, we see the consequences of
violence in the patients we treat.
• However, healthcare professionals are increasingly
becoming the targets for violence in our work
environment.
• Workplace violence is preventable and should NEVER be
accepted as part of a healthcare professional’s job.

3. Objectives
1. Define workplace violence
2. Understand the prevalence of workplace violence in the
healthcare setting and its impact on healthcare workers’
career
3. Learn strategies to prevent workplace violence
4. Identify risk factors for potentially violent patients
5. Identify appropriate situations when to report workplace
violence to the authorities

4. Definitions
• The National Institute for Occupational Safety and
Health (NIOSH)
• “Any physical assault, threatening behavior, or verbal abuse
occurring in the work setting”
• The World Health Organization (WHO) and the
International Council of Nurses (ICN)
• “Incidents where staff are abused, threatened or assaulted in
circumstances related to their work, including commuting to
and from work, involving an explicit or implicit challenge
to their safety, well-being or health.

5. Prevalence
• According to the Bureau of Labor Statistics (BLS) data
records, healthcare and social assistance workers were
victims of approximately 11,370 assaults by persons in
2010.
• This is a greater than 13 % increase over the number of
assaults in 2009.
• From 1997 to 2009, there were 130 workplace homicides
in the healthcare and social assistance industry and
private sector.
• Many incidents probably go unreported.

6. Impact on Career
• Increased stress-related outcomes (ex. psychological
distress)
• Associated with decreased organizational skills
• Increase in errors
• Decreased job satisfaction
• May intentionally avoid patients to avoid a recurrent
violent act
• Financial burden for health economy and society

7. Prevention Strategies
• What not to wear:
• Long hair down
• Jewelry
• Overly tight clothing (restricts movement)
• Overly loose clothing
• Stethoscope around neck
• Glasses, keys, or name tags dangling from cords/chains (use
break away safety cords or lanyards)

8. Prevention Strategies
• Be aware of your environment
• Know the exits and location of emergency phones
• Confusion, background noises, and crowding can ↑ stress
levels
• Meal times, shift changes, and patient transportation are
times of ↑ disruptive behaviors

9. Prevention Strategies
• Pay attention to your own responses
• Be aware of your own feelings, responses,
instincts and sensitivities (ex. Flight or Fight
response)
• Be aware of the way you express yourself
• Acknowledgement of a personal history of abuse
• Fatigue (diminishes alertness and ability to
respond)

10. Prevention Strategies
Verbal
• Lower pitch and loudness of
voice
• Speak with confidence
• Things never to say:
• Come here!
• Calm down!
• Those are the rules/policy
• What do you want ME to do about
it?
• I am doing this for your own good.
Non-Verbal
• Approach person form side
(not front or back)
• Never block a doorway
• Align yourself with the
speaker
• Keep at least one arms
lengths away
• If agitated or aggressive at
least two arms lengths away.

11. What to Watch For
Verbal cues
• Raised voice/yelling
• Swearing
• Threating tone of voice
Non-verbal cues
• Physical appearance (neglected
hygiene and clothing)
• Arms folded tight against chest
• Clenched fists
• Heavy breathing
• Pacing or agitation
• A terrified look (signifying fear or
high anxiety)
• A fixed stare
• Aggressive or threatening posture
• Thrown objects
• Sudden changes in behavior
• Indications of drunkenness or
substance abuse

12. Violent Behavior Indicator
• Staring and eye contact
• Tone and volume of voice
• Anxiety
• Mumbling
• Pacing

13. Activity!
Threat vs Limit Setting

14. Threat or Limit Setting?
“Please sit down. I don’t want to involve
security but I may have to if you can’t
control yourself.”

15. “Please sit down. I don’t want to
involve security but I may have to if
you can’t control yourself.”
Answer: Limit Setting

16. Threat or Limit Setting?
“If you keep pushing the call button
like that I won’t help you.”

17. “If you keep pushing the call button
like that I won’t help you.”
Answer: Threat

18. Threat or Limit Setting?
“That type of behavior won’t be
tolerated.”

19. “That type of behavior won’t be
tolerated.”
Answer: Threat

20. Threat or Limit Setting?
“Ms. Ferris: I know you need help, but
please don’t ring your call like that, and
give me a chance to get to your room.”

21. “Ms. Ferris: I know you need help, but
please don’t ring your call like that, and
give me a chance to get to your room.”
Answer: Limit Setting

22. Threat or Limit Setting
“Mr. Barren: Would you please stop
yelling and screaming at me… I’m
trying to help you.”

23. “Mr. Barren: Would you please stop
yelling and screaming at me… I’m
trying to help you.”
Answer: Limit Setting

24. Threat or Limit Setting
“If you don’t stop I’m going to call
security!”

25. “If you don’t stop I’m going to call
security!”
Answer: Threat

26. Legal Action
• The nurse has the right to press criminal charges when
threatened or intentionally harmed by a patient
• Notify the law enforcement as soon as possible
• Summit a detailed written report to your supervisor
• Utilize iCare, “fight against non-reporting culture”
• Utilize the security available at the facility

27. References
Esmaeilpour, M., Salsali, M., & Ahmadi, F. (2011). Workplace violence
against Iranian nurses working in emergency departments.
International Nursing Review, 58(1), 130-137.
doi:10.1111/j.1466-7657.2010.00834.x
NIOSH-WPVHC-Workplace Violence Prevention for Nurse.
Retrieved from
http://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Intro_1
Safety and Health Topics | Healthcare - Workplace Violence.
Retrieved from
https://www.osha.gov/SLTC/healthcarefacilities/violence
.html
Stressful Incidents of Physical Violence Against Emergency Nurses.
Retrieved from
http://www.nursingworld.org/MainMenuCategories/AN
AMarketplace/ANAPeriodicals/OJIN/TableofContents/V
ol-18-2013/No1-Jan-2013/Stressful-Incidents-of-Physical-
Violence-against-Emergency-Nurses.html