Addressing management issues

Sept. 1, 2010

Concerns about workplace violence

Q Some of my co-workers and I are concerned about the potential for violence in our facility. We have had a few incidents that did not result in actual violence; but they were, nonetheless, frightening. We are unsure of what to do or to whom to turn with our concerns. Should there be some sort of policy in place that addresses violence like the plans we have for fire and tornado drills?

A Violence in the workplace is a serious safety issue, and in fact, homicide is the fourth-leading cause of fatal occupational injury in the United States, according to the U.S. Department of Labor.1

While murders in the workplace have grabbed media attention recently and, while tragic, they are unfortunately only part of the problem. Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting, according to the National Institute for Occupational Safety and Health. This definition includes, but is not limited to, beatings, stabbing, suicides, shootings, rapes, psychological traumas (e.g., threats, obscene, or harassing phone calls), an intimidating presence, and harassment of any nature (e.g., being followed, sworn at, or shouted at).1

For each murder, countless other incidents of violence occur in the workplace where victims are harassed, threatened, or injured, and an increasing number of violent crimes are occurring in America's healthcare facilities.2 The Joint Commission's Sentinel Event Alert issued June 3, 2010, specifically addresses assault, rape, or homicide of patients and visitors committed by staff, visitors, other patients, and intruders to the institution — with 256 reports since 1995 — numbers that are likely to be below the actual number of incidents due to the under-reporting of violent crimes in healthcare institutions.2

Employers have a legal duty and a moral obligation to provide a safe workplace. The Occupational Safety and Health Act (OSHA) of 1970 states that employers are required to provide their employees with a place of employment that “is free from recognizable hazards that are causing or likely to cause death or serious harm to employees.”1 This duty includes inspecting the workplace to discover and correct a dangerous condition or hazard in the workplace and to give adequate warning of its existence.1

Most facilities already have emergency plans that describe procedures to follow during a fire or other emergencies. Many, however, do not cover workplace-violence emergencies. Every employer should establish, implement, and maintain a written workplace-violence prevention (WPV) program. It should be made available to all employees, and all employees should receive specific training concerning its content and implementation.1

Workplace violence-prevention efforts must have commitment from top management and must involve all supervisors and employees. A questionnaire or survey should be distributed to all staff members to identify any potential for violent incidents and to identify or confirm the need for improved security measures.1

The Joint Commission's Environment of Care standards require healthcare facilities to address and maintain a written plan describing how an institution provides for the security of patients, staff, and visitors. Institutions are also required to conduct risk assessments to determine the potential for violence, provide strategies for preventing instances of violence, and establish a response plan that is enacted when an incident occurs. The Joint Commission's alert offers these steps healthcare facilities should take to prevent violence.2

  • Work with security staff to assess the facility's risk;
  • work with the human resources (HR) department to make sure it thoroughly screens job applicants and conducts background checks of prospective employees;
  • confirm that the HR department ensures that procedures for disciplining and firing employees minimize the chance of provoking violence;
  • require appropriate staff members to undergo training in responding to agitated and potentially violent patients; include procedures for notifying supervisors and security staff;
  • ensure that procedures for responding to incidents of workplace violence (e.g., notifying department managers or security, activating codes) are in place and that employees receive instruction on these procedures;
  • encourage staff to report incidents of violent activity and any perceived threats of violence; and
  • educate supervisors that all reports of suspicious behavior or threats must be treated seriously and investigated.

Each institution must determine how to protect the facility and its employees, which can be started by performing a risk assessment, identifying situations that could arise, and how to address them. Search for workplace violence publications and tools for healthcare facilities.

—T.J. Mitchell
Safety Coordinator
Arlington, VA


  1. U.S. Department of Labor, Occupational Safety and Health Administration. Workplace violence awareness and prevention. Accessed August 1, 2010.
  2. The Joint Commission. Sentinel Event Alert. Preventing violence in the health care setting. Published June 3, 2010. Accessed August 1, 2010.

A A Society for Human Resource Management study based on 2006 data from the U.S. Bureau of Labor Statistics indicates that more than half the companies in the United States have experienced some sort of workplace violence, with verbal threats being cited by 41% of respondents, so your concern about possible violence in your workplace is understandable. We have all heard the stories on the evening news of violent incidents in workplaces that have ended in tragedy. Violent or threatening behavior in the workplace can generate from various sources, including current and former employees, family, friends, or the general public.

Employees have a right to expect their employers to care about their safety and to provide a safe a working environment by having preventive measures in place and, when necessary, by dealing with violent (or potentially violent) situations. With safety issues, prevention is the best plan, and this is holds true for workplace violence as well. Organizations minimize risks when they establish policies to address violent or threatening behavior and how individuals will be treated if they exhibit violent tendencies. A WPV program can help prevent workplace violence as well as help employees know how to react when it occurs.

If fear exists in the workplace due to the violent behavior of a fellow employee, alert management and/or administration immediately. Supervisors have an obligation to deal with inappropriate behavior by their employees. If fear of workplace violence comes from another source (e.g., visitors, patients, or others who enter the facility), alert management and security personnel of the potential threat. And always take all threats seriously.

Every facility should have an emergency plan outlining procedures to follow in the event of fire, natural disaster, biohazardous threat, as well as threats of violence from both inside and outside the facility. Management also has a duty to provide employees with information and training on workplace violence and to put effective security measures in place. Management must make certain all employees know the procedures for dealing with emergencies, which includes workplace violence. Find out if your facility has a WPV program. The safety officer should be the first contact. If a WPV program does not exist or is not known to employees, address this issue with management immediately.

One of the most important components of any WPV program is training. Training is essential for employees, supervisors, and security staff who are expected to respond to any incident of workplace violence. All employees should know how to report incidents of violent, intimidating, threatening, and disruptive behavior. Determining if a situation or individual is potentially violent is not an exact science, but training is helpful.

Phone numbers for quick reference during an emergency should be readily available. Employees should be encouraged to report incidents where they feel threatened. Supervisors do not need to be experts in dealing with violent behavior, but they do need to know how to spot potentially violent behaviors and who to contact immediately if a potentially violent person begins to act out in the workplace. And all staff members should know the facility's security procedures (e.g., the location and operation of safety devices, like alarm systems).

Supervisors and managers should have training that includes basic leadership skills, including setting clear standards, addressing employee problems promptly, and using counseling, discipline, and other management tools judiciously; they should learn to recognize and respond to inappropriate and disruptive behaviors immediately. All employees should practice responding to an incident of violence just as they practice fire and tornado drills. It is every employee's duty to report incidents of workplace violence and threatening behavior to management so someone who is specifically trained in conducting threat assessments can deal with the situation before it escalates to violence. Do not ignore a gut instinct that something may be wrong, and do not try to resolve the situation alone. Employee safety is paramount.

—Susan Johnson
Healthcare Safety Consultant
Los Angeles, CA

Bottom line: Workplace violence continues to make the news, but the level of violence does not have to be worthy of TV coverage to be significant. Violence comes in many forms and it is important for staff to recognize and be educated on how to handle potential situations. As the experts have stated, a policy, along with proper training, is a must.

C. Anne Pontius is a senior medical practice consultant with
State Volunteer Mutual Insurance Co. in Brentwood, TN, and president of CLMA. Send questions to Ms. Pontius at [email protected].