Workplace violence (WPV) is a recognized hazard in the healthcare industry. WPV is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It can affect and involve workers, clients, customers and visitors. WPV ranges from threats and verbal abuse to physical assaults and even homicide. In 2010, the Bureau of Labor Statistics (BLS) data reported healthcare and social assistance workers were the victims of approximately 11,370 assaults by persons; a greater than 13% increase over the number of such assaults reported in 2009. Almost 19% (i.e., 2,130) of these assaults occurred in nursing and residential care facilities alone. Unfortunately, many more incidents probably go unreported.
Hazard Evaluation and Solutions
In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections healthcare employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. The policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with workers of the facility.
By assessing their worksites, employers in the healthcare industry can identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well written and implemented Workplace Violence Prevention Program, combined with engineering controls, administrative controls and training can reduce the incidence of workplace violence. It is critical to ensure that all workers know the policy and understand that all claims of workplace violence will be investigated and remedied promptly.
OSHA has developed a Workplace Violence Safety and Health Topics Page with information that can help you properly evaluate your workplace and prepare to prevent or minimize the likelihood of violence at your workplace. The agency has also developed an OSHA Instruction CPL 02-01-052, Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents (PDF). This instruction provides direction to OSHA officials who conduct inspections in response to complaints of workplace violence or programmed inspections at worksites in industries with a high incidence of workplace violence (e.g., health care).
Identifying risk factors:
Known risk factors to consider include working with persons with a known history of being violent or with unstable or volatile individuals in certain healthcare settings. NIOSH has listed these and other known risk factors in its report NIOSH Current Intelligence Bulletin #57: Violence in the Workplace: Risk Factors and Prevention Strategies (1996). Also included in this guidance document is information on how to develop and implement a workplace violence prevention program and policy.
OSHA has also developed guidance for employers and workers in healthcare and social services:
- Updated Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers (PDF* | EPUB* | MOBI*). OSHA Publication (OSHA-3148), (2015).
Guidance for developing a workplace violence prevention program:
NIOSH recommends that all hospitals develop a comprehensive violence prevention program. Non-hospital settings where violence has been determined to exist are advised to do the same. No universal strategy exists to prevent violence. The risk factors vary from facility to facility and from unit to unit within a facility. Employers are advised to form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All affected workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.
- The US Department of Health and Human services (DHHS) has developed information for Hospital Workers: Violence Occupational Hazards in Hospitals. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-118, (2012, February).
- Workplace Violence Prevention for Nurses. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2013-155.
- Oregon OSHA's recommendations, Violence Prevention Program - Online, provides information about methods to recognize, evaluate and respond to risk factors related to workplace violence.
- The Washington State Department of Labor and Industries has a page with information on workplace violence in healthcare settings. Included on this webpage are various guidance documents and training materials that you may find useful in developing your workplace program.
If you work in a home healthcare environment, the US Department of Health and Human Services provides information highlighting the need to address workplace violence in your workplace. Home Healthcare Workers: How to Prevent Violence on the Job (PDF). US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-118, (2012, February).
California Injury & Illness Prevention Plans for State Mental Hospitals (AB 2399, Allen). Adds 4141 to the Welfare and Institutions Code to require California's five state mental hospitals to update their Injury & Illness Prevention Plans at least annually, and to set up committees to recommend updates and develop incident reporting procedures for patient assaults on employees to assist the hospitals in better identifying the risks of such assaults. Approved by Governor: September 29, 2012
Maine's Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011 (PDF). Maine Department of Labor, (2012, July).
- Associated News Release: Maine Department of Labor Issues Report on 2011 Violence Against Caregivers Maine Department of Labor, (2012, August 10).
*Accessibility Assistance: Contact OSHA's Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance accessing PDF materials.
All other documents, that are not PDF materials or formatted for the web, are available as Microsoft Office® formats and videos and are noted accordingly. If additional assistance is needed with reading, reviewing or accessing these documents or any figures and illustrations, please also contact OSHA's Directorate of Technical Support and Emergency Management at (202) 693-2300.
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