Ending violence against healthcare workers starts with leadership


The statistics are sobering: Violence is five times more likely to occur in a hospital setting than in the rest of the nation’s workplaces, according to recent assessments by the US Bureau of Labor Statistics. Healthcare workplace violence has grown every year since 2011–and the rate of violence against nurses and personal care facility workers is twice the rate for other healthcare employees.

In Pennsylvania, nurses are at far higher risk of workplace injuries attributable to physical assault than nearly every other profession. And the rate of workplace violence against all healthcare workers more than doubled from 2010 to 2020, according to data from the Hospital and Health System Association of Pennsylvania.

Related: Healthcare facilities should be places for healing, not violence

At our own Allegheny Health Network, based in Western Pennsylvania, 89% of emergency department physicians reported being threatened by a patient or visitor over the previous year, and almost half of our nurses have been physically assaulted by someone in their care during their careers.

There are few hospitals that haven’t reported a serious escalation in violence against caregivers in the COVID-19 era. In fact, a March survey from ECRI–an independent group that tracks healthcare safety and quality trends–identified “verbal and physical abuse against healthcare workers” as the industry’s No. 2 concern for 2023, topped only by the pediatric mental health crisis.

Those who don’t work in a hospital setting might find this information shocking. Those who do, however, know the reality of it all too well: Biting, punching, kicking and verbal assaults have become common hazards for healthcare providers.

It’s unacceptable, and it must end.

Zero tolerance for violence

Violence against hospital caregivers is at such epidemic levels The Joint Commission last year implemented new violence-prevention standards for all commission-accredited hospitals. The updated protocols include new guidelines related to reporting and data collection, post-incident analysis, de-escalation training and establishing a culture of safety.

That last item might be the most important one. As healthcare leaders, we must understand that patients and their families often come to our facilities at their lowest point, on the most difficult days of their lives. Emotions and tempers often run high, especially in emergency departments and critical care settings.

But that sensitivity must have limits, particularly when violence–or even the threat of violence–arises. We owe it to our nurses, physicians and other frontline staff to have their backs in such situations, and to do whatever is necessary to ensure their safety.

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While there’s no silver bullet that will curb the violence in healthcare settings, it starts with a zero-tolerance policy for violent or abusive behavior. In healthcare, that kind of mindset requires a substantial cultural shift.

For too long, violence has been expected–even tolerated, to a degree–in our EDs. Experienced caregivers tell younger ones that occasional assaults are inevitable, and as a result it can be perceived as a natural part of the workday. When that attitude prevails, “minor” incidents may be overlooked and go unreported to leadership.

Fortunately, that is starting to change. At AHN and hospitals across the country, violence against caregivers is promptly addressed and reported, and patients and visitors are advised–through signage, counseling and other means–that there is zero tolerance for such behavior and that assaults will be prosecuted.

It starts at the top

Violence against caregivers can’t be viewed as just an emergency department issue or a security issue–it’s a problem for all to solve and must be a priority for the entire organization, starting at the top.

Preparing for, responding to and mitigating against violence requires a comprehensive strategy that includes input and buy-in from hospital leadership, security, human resources, patient-safety officers, clinician wellness leaders, behavioral health specialists and others.

The best way to combat violence in hospitals, of course, is to stop it before it starts.

That means investing in conflict-de-escalation training for caregivers and other staff and putting tools and protocols in place that allow staff and security to quickly intervene when patients or family members become combative and before a situation becomes volatile.

And while violence is never an appropriate response to long wait times, we must recognize our own role in creating stressful situations–not just in the ED but also in common areas where tempers might flare. Easing that stress means circulating clinical staff into the waiting areas to provide more frequent patient updates, investing in patient-flow coordinators who can help triage more efficiently and taking proactive steps to reduce ED traffic by steering care elsewhere when clinically appropriate.

Violence, of course, may also have roots in stressors that occur outside of the hospital, such as housing instability, food insecurity, substance misuse or mental health issues, which is another reason for health systems and other organizations to prioritize strategies focused on social factors that affects wellness.

Caring for the caregivers

We recognize that even with the best of efforts and programs, caregivers will always face some level of risk. That’s why it is so important to wrap our team members in all the support they need. When incidents occur, we provide therapy to help our employees recover from the trauma of the experience. We conduct debriefs, collect data, flag repeat offenders and pursue criminal charges when merited.

Our actions must be immediate and purposeful. Nothing is more discouraging to team members than feeling like there’s an insufficient response to, or consequence for, violent acts against them.

To be the best we can be for our patients, healthcare providers must create the safest working environments for those who choose these healing professions and who help us each day to deliver on our promise of building safer, healthier communities.

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