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Preventing Workplace Violence in Healthcare

Unique Risk Factors in Healthcare Settings

Healthcare settings present a unique set of risk factors that make workplace violence more likely. These include:

Frustrated Patients and Families

Stress, anxiety, and long wait times can lead to frustration and aggression. Misunderstandings and poor communication can further escalate these situations.

Mentally Unstable Individuals

Healthcare facilities often serve individuals with severe psychiatric disorders. Acute mental health crises, lack of adequate mental health resources, and insufficient psychiatric support can result in unpredictable and violent behavior

Patients Demonstrating Drug-Seeking Behavior

Individuals desperate for prescription medications, especially opioids, may become violent in their attempts to obtain them from healthcare facilities. The opioid crisis has intensified drug-seeking behavior. The risks associated with drug-seeking behavior are particularly high in emergency departments, pain management clinics, and pharmacies..

Workplace Stress

The healthcare environment is inherently stressful. High patient volumes, long working hours, and the emotional and physical demands associated with these jobs contribute to decreased job satisfaction, and ultimately, burnout. This high-stress atmosphere can lead to increased tensions and conflicts, potentially resulting in physical violence.

Legal Mandates for Healthcare Employers Preventing Workplace Violence in Healthcare

The legal ramifications of workplace violence in healthcare settings are significant. However, employers are bound by certain legal requirements that, if followed, can lower the risk of workplace violence significantly.

OSHA's General Duty Clause

The Occupational Safety and Health Administration (OSHA) adopted the Occupational Safety and Health Act over 50 years ago. The General Duty Clause, Section 5(a)(1), of this act requires employers to provide employees with a workplace free from recognized hazards likely to cause death or serious physical harm.

Key Requirements

Hazard Identification

Employers must identify and assess workplace hazards, including potentials for violence.

Preventive Measures

Employers must implement measures to mitigate identified risks

Training and Education

Employers must provide employees with training on recognizing and avoiding workplace violence.

Incident Reporting

Employers must establish clear procedures for reporting and responding to workplace violence incidents

Non-compliance with OSHA’s General Duty Clause can lead to significant consequences. These include:

Substantial Fines

Employers failing to protect workers from violence can face hefty financial penalties.

Legal Actions

Non-compliant healthcare organizations may be subject to lawsuits from employees who have experienced workplace violence.

Increased Regulatory Scrutiny

Facilities with inadequate violence prevention procedures may undergo more frequent and detailed inspections by OSHA.

Reputation Damage

Publicized incidents of non-compliance can tarnish a healthcare facility’s reputation, impacting patient trust and staff recruitment.

Example: A hospital in California was fined $100,000 for failing to implement adequate safety measures after a nurse was assaulted by a patient. This clearly illustrates the severe penalties that can result from non-compliance with workplace violence prevention standards.

Workplace Violence Prevention for Health Care and Social Workers Act

The Workplace Violence and Prevention for Health Care and Social Workers Act is a bill that was passed by the House of Representatives in 2021, and is now under review by the Senate.

Preventing Workplace Violence in Healthcare

Though legal professionals remain divided on whether the Act will ever achieve Senate approval, the most notable portion of its content would require OSHA to create concrete, enforceable safety standards for healthcare workers by 2025. If accomplished, this would create an additional protection for healthcare workers, as well as an additional requirement for healthcare employers to satisfy. It would be a significant step forward in the prevention of workplace violence in healthcare.

State Laws and Regulations

In addition to federal requirements, many states have specific laws that address workplace violence in healthcare settings. For instance, the state of California mandates healthcare facilities to develop written prevention plans, conduct employee training, and maintain records of violent incidents. Likewise, the state of New York requires comprehensive workplace violence prevention programs. Regulations such as these vary by state, which require healthcare facilities to stay informed and compliant and the particular requirements in their state.

Legal Repercussions for Healthcare Employers

Failure to prevent workplace violence can lead to severe legal and financial consequences for healthcare facilities. Legal repercussions can also include lawsuits filed by employees who have suffered from workplace violence, leading to costly settlements and reputational damage. This reputational harm can affect a facility’s ability to attract and retain staff and patients, further compounding the financial impact.


In summary, healthcare facilities must address unique risk factors such as frustrated patients, mentally unstable individuals, patients with drug-seeking behavior, and workplace stress. The legal and financial consequences of failing to mitigate these risks are extremely high, and highlight the need for comprehensive workplace violence prevention programs. Compliance with OSHA's General Duty Clause and relevant state laws is essential to protect health care professionals and ensure a safe working environment. Some ways that healthcare employers can avoid workplace violence, as well as the legal consequences of workplace violence, are as follows.

Full Leadership Support

CEO and senior management commitment is essential for the effectiveness of a Workplace Violence Prevention Program (WVP). Leaders of these facilities must actively endorse and participate in the program's development and implementation, allocate resources for its continued operation, and set a positive example for employees and other employers, alike.

Preventing Workplace Violence in Healthcare

Regular assessments of the physical environment of a facility can help identify potential hazards that could contribute to workplace violence. Key areas to evaluate include:

  • Lighting : Ensure all areas are well-lit.

  • Security Personnel: Review the presence and effectiveness of security staff.

  • Access Control: Implement measures to monitor and control building entry points.

  • Emergency Exits: Maintain clearly marked and accessible emergency exits.​

Proactive De-escalation Techniques


Training staff to recognize the warning signs of workplace violence, use verbal de-escalation tactics, and perform bystander intervention is essential for preventing violent situations.

  • Recognizing Warning Signs: Identifying behaviors that have the propensity to signal impending violence.

  • Verbal De-escalation Tactics: Utilizing calm and effective communication skills to defuse tense situations.

  • Bystander Intervention: Empowering staff to safely intervene or seek help.

Engineering Controls


Implementing physical modifications can significantly reduce the risk of violence. Effective engineering controls include:

  • Security Cameras: Install 24-hour cameras to monitor high-risk areas.

  • Alarms and Panic Buttons: Provide easy access to emergency alerts.

  • Proper Signage: Use clear signs for directions and exits.

  • Facility Design: Design patient areas to ensure clear sightlines and avoid isolated corners.

Administrative Controls

Develop and enforce clear policies and procedures to create a safe workplace. Key administrative controls include:

  • Zero-Tolerance Violence Policy: Communicate a zero-tolerance stance on violence to staff, patients, and visitors.

  • Visitor Screening Procedures: Implement processes to identify potential threats.

  • Adequate Staffing Levels: Ensure sufficient staff to supervise and support each other.

  • Compliance with Regulations: Adhere to federal (OSHA) and state regulations regarding workplace violence prevention.

Preventing Workplace Violence in Healthcare

Conn Maciel Carey LLP can assist healthcare facilities in developing, implementing, and maintaining these strategies to ensure a safe and legally compliant workplace.

Staff Training and Education

Healthcare facilities should implement interactive training programs. These programs engage staff through realistic scenarios. These include:

  • Scenario-Based Exercises: Simulate real-life situations to prepare staff for potential violence.

  • Role-Playing: Practice responses to violent or potentially violent situations in a controlled environment.

  • Bystander Intervention Techniques: Train employees to safely intervene or seek help when witnessing potential violence.

It is also vital that training of this nature be tailored to the different roles in the healthcare industry. This is important because different staff positions face unique challenges and require specialized training for how to manage them. For instance, nurses need training in emergency protocols and de-escalation techniques for handling aggressive patients; receptionists benefit from self-defense training and strategies for managing disruptive visitors; security personnel require advanced training in mitigating violent incidents and coordinating with law enforcement.


Ongoing education is key for maintaining preparedness and adapting to new threats. Regular refresher courses help ensure that all staff members remain:

  • Informed: Up-to-date with the latest practices and protocols.

  • Prepared: Ready to respond effectively to potential violence.

  • Engaged: Continuously improving their skills and knowledge base.

By prioritizing comprehensive and ongoing training, healthcare facilities can better equip their staff to handle and prevent workplace violence, creating a safer environment for everyone.

Effective Response and Reporting

Establish Clear and Accessible Reporting Procedures

Healthcare facilities need straightforward and accessible reporting systems for all violent incidents, including verbal violence, such as threats and intimidation. Clear procedures help staff report incidents promptly and safely. An effective reporting system encompasses:

Preventing Workplace Violence in Healthcare

  • Multiple Reporting Channels: Offers various methods (e.g., online forms, hotlines, direct reporting) to accommodate different preferences.

  • Anonymity Options: Allows anonymous reporting to protect reporters' identities.

  • Promotes Awareness: Regularly informs staff about reporting procedures through training and internal communications.

  • Accessibility: Ensures reporting tools are easily accessible to all employees

Implement a Thorough Incident Investigation and Follow-Up Process

A detailed investigation and follow-up process is necessary for addressing violent incidents effectively and preventing future occurrences. This process should include:

  • Immediate Response: Secure the safety of everyone involved.

  • Fact-Finding: Collect detailed accounts from witnesses and review evidence.

  • Documentation: Maintain records of the incident.

  • Analysis: Identify root causes and contributing factors.

  • Disciplinary Actions: Apply appropriate measures based on findings, ensuring compliance with policies and legal requirements.

  • Feedback Loop: Provide feedback to involved employees about the investigation's outcome and measures taken

Offer Employee Support Services
Supporting employees who experience violence is essential for their recovery and well-being. Effective support services can include:

  • Critical Incident Stress Debriefing (CISD): Provide CISD sessions soon after an incident to help employees process their experiences.

  • Professional Support: Engage trained mental health professionals for CISD sessions and ongoing support.

  • Peer Support Programs: Establish networks where employees can share experiences and offer mutual support.

  • Counseling Services: Offer access to individual counseling and therapy sessions.

  • Follow-Up: Monitor affected employees' recovery and provide additional support as needed.

Clear reporting procedures, detailed incident investigations, and comprehensive employee support services enable healthcare facilities to manage and mitigate the impact of workplace violence.

Preventing Workplace Violence in Healthcare


A comprehensive and legally compliant Workplace Violence Prevention Program creates a safer work environment for healthcare staff by addressing unique risk factors and ensuring adherence to OSHA and state regulations.


Conn Maciel Carey LLP offers expertise in developing, implementing, and maintaining effective workplace violence prevention programs for healthcare facilities. Our custom solutions help organizations meet legal requirements and protect their workforce. Reach out to us by phone or by email using our contact form.


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