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Workplace Violence Overview

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Healthcare workers face significant risks of job-related violence

According to the Occupational Safety and Health Administration (OSHA), workplace violence is “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.” Acts of violence are the third leading cause of fatal workplace injuries in the United States. Violence may occur on a continuum beginning with argumentative or belligerent behavior. It can involve or affect anyone in the healthcare setting, including staff, patients, visitors, or bystanders. The vast majority of hospital violence perpetrators have a relationship with the victim(s); common motives are revenge, suicide, and treatment of a relative.

Healthcare workers are five times more likely to be victimized on the job than other workers overall, according to the U.S. Bureau of Labor Statistics (BLS). The BLS found that healthcare workers accounted for 73% of all nonfatal workplace injuries and illness due to violence in 2018. A recent study of hospital workplace violence found that 154 shootings occurred in hospitals over an 11-year period, 30% of which occurred in the Emergency Department. Hospital shootings over the last decade have resulted in more than 230 deaths or injuries. Emergency rooms, community clinics, drug-health clinics, and long-term care facilities are considered to be high risk locations. Certain situations such as late or early work hours, working alone, or working in high crime areas can increase the risks of workplace violence. Similarly, situations beyond the control of a healthcare worker such as reduced staff, long wait times, work productivity pressures, and low socioeconomic patient pool can make one vulnerable to violence. While internal security measures can be effective, 40% of shootings occurred on hospital grounds outside the facilities.

Workplace violence can broadly be classified as:

Type 1: Violence perpetrated by criminals who have no connection with the workplace (e.g., thieves).

Type 2: Violence perpetrated by those whom an organization serves (e.g., patients, families, visitors). This is the most common type.

Type 3: Violence perpetrated against coworkers, supervisors, or managers by a present or former employee.

Type 4: Violence perpetrated by someone who has a personal relationship with an employee (e.g., an abusive spouse).

The healthcare field has experienced an increase in workplace violence since the beginning of the COVID-19 pandemic. Recent studies indicate that 44% of nurses reported experiencing physical violence and 68% reported experiencing verbal abuse during the COVID-19 pandemic. In 2022, five people died and multiple others were injured when an armed assailant opened fire at an orthopaedic practice in Tulsa, Oklahoma. Among the victims were Preston J. Phillips, MD, FAAOS, and sports medicine physician Stephanie J. Husen, DO.

Despite the incidence of workplace violence and its harmful effects on our healthcare system, no federal law protects healthcare employees from workplace assault or intimidation. By contrast, there are federal laws criminalizing assault and intimidation against airline employees. OSHA has statutory authority over unsafe working conditions and has introduced several guidelines for preventing workplace violence in the healthcare field.

Resources

  1. Ebrahimji A, Alvarado C, Watts A, Maxouris C. A patient who sacrificed his life, 2 gifted doctors, a beloved receptionist: These are the people killed in the Tulsa Hospital shooting. CNN. https://www.cnn.com/2022/06/02/us/tulsa-shooting-victims-what-we-know/index.html. Published June 3, 2022. Accessed February 7, 2023.
  2. OSHA & Worker Safety Guidelines for Zero Tolerance. The Joint Commission Environment of Care News. 2015;18(8). doi:https://www.jointcommission.org/-/media/jcr/jcr-documents/about-jcr/osha-alliance/august_2015pdf.pdf
  3. Shootings in U.S. hospitals rare but shooter typically "determined". Johns Hopkins Medicine. https://www.hopkinsmedicine.org/news/media/releases/shootings_in_us_hospitals_rare_but_shooter_typically_determined. Published September 21, 2012. Accessed February 7, 2023.
  4. Tarm M, Babwin D. Shooting at Tulsa Hospital exposes vulnerability of health care facilities. PBS. https://www.pbs.org/newshour/nation/shooting-at-tulsa-hospital-exposes-vulnerability-of-health-care-facilities. Published June 3, 2022. Accessed February 7, 2023.
  5. Text - H.R.7961 - 117th Congress (2021-2022): Save act. Congress.Gov. https://www.congress.gov/bill/117th-congress/house-bill/7961/text. Published June 7, 2022. Accessed February 7, 2023.
  6. United States Department of Labor: Workplace Violence. Workplace Violence - Overview | Occupational Safety and Health Administration. https://www.osha.gov/workplace-violence. Accessed January 7, 2023.