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Violence Against Healthcare Workers: Is Your Facility Equipped to Stop It?

Violence against healthcare workers is rampant, grievous, unacceptable – and you can prevent it.

If you work in a hospital or any healthcare setting, you’ve probably seen your share of workplace violence. You don’t need statistics to tell you what you know — that waiting rooms, emergency departments, behavioral health units, and just about any part of a facility can get intense, to say the least.

Healthcare settings are meant to be places of healing, and yet they’re way too often scenes of verbal abuse and violent acting out.

And of course, the data reflects this:

That’s just what’s reported. And we all know that most incidents go unreported. “It happens all the time” and “it’s part of the job” are phrases you might hear, or even say, every day.

From name-calling and insults — to threats to life and family — to being “bitten, kicked, punched, pushed, pinched, shoved, scratched, and spat upon,” as Lisa Tenney of the Maryland Emergency Nurses Association is quoted as saying in The Joint Commission report — healthcare workers truly have their work cut out for them.

And that’s just at one end of the spectrum — verbal assault and physical aggression. Take a look at our Workplace Violence Continuum of Behaviors for a breakdown of the other kinds of treatment you and your colleagues likely face even more often:

Workplace Violence Continuum of Behaviors

How do you provide quality care when your own safety is at risk?

It ain’t easy, but chances are you do it every day.

Yet you don’t have to.

We all know that workplace violence results in low staff morale, injuries, lawsuits, burnout, errors, and high staff turnover — to name a few of the many effects.

And none of that is conducive to care for anyone. So here’s what can help — starting with a few of the regulations and standards that are designed to support you in reducing violence.

If you need strategies you can start using immediately, I’ll also share some of our best tips for preventing violence against healthcare workers. And I’ll tell you exactly how to turn those effects of workplace violence around — into improved staff and patient satisfaction, into reduced injuries, and into a stronger culture of care for everyone.

OSHA regulations for hospitals

OSHA has Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, which CPI can help you fulfill in any state.

Cal-OSHA implemented a regulation called Workplace Violence Prevention in Health Care in 2017. If your facility is in California, you’ll be familiar with this regulation, as it requires all facilities in the state to provide training to address violence against healthcare workers. CPI sets the standard for achieving ROI with all-staff training in California.

(In fact, after workplace injuries were reduced to ZERO with Nonviolent Crisis Intervention® training, Kaiser Permanente leadership started automatically budgeting CPI training in.)

Other state-level OSHAs are following California's lead, requiring workplace violence prevention training for all healthcare workers. What’s especially important about this growing trend is that OSHAs are requiring training specifically for ALL staff — not just behavioral health or just emergency departments. As you likely know, and as you’ll see detailed below, stopping the violence really means going beyond piecemealing staff training to only those who are at a high risk for assault.

Efficacy and ROI come with every person in your setting being equipped with the right level of violence prevention training. OSHAs know this, more and more of their state regulations require this, and CPI continually develops deeper and better ways for you to meet the regulations with ease, flexibility, and return on investment.

State laws & requirements for hospitals

In addition to OSHA regulations for hospitals, more and more states are passing laws requiring health care settings to provide violence prevention training for every staff member. Legislation in Washington State, for example, even includes volunteers and contracted security personnel. Search for your state to see why CPI is the best choice to help you comply with the laws and regulations that apply to your setting.

Joint Commission’s recommended actions

In the Sentinel Event Alert I mentioned above, The Joint Commission suggests seven actions your facility can take to be ready when verbal or physical violence — or the potential for violence — strikes.

Here’s what they are, and how we’re the gold standard to help you every step of the way:

1. Clearly define workplace violence and put systems into place across the organization that enable staff to report workplace violence instances, including verbal abuse.

CPI can help you develop a definition of workplace violence that includes the full range of behaviors staff might encounter. Additionally, our Nonviolent Crisis Intervention® program gives you tools to train staff in documenting and reporting verbal (and physical) incidents as part of the debriefing process. We also offer troubleshooting guidance (one of our industry-leading supports that our customers love and use the most), plus reporting tools and supplemental training on incident reporting. 

violence against healthcare workers
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2. Recognizing that data come from several sources, capture, track and trend all reports of workplace violence – including verbal abuse and attempted assaults when no harm occurred.

CPI’s debriefing model and documentation tools can help you capture, track, and trend all incidents of workplace violence, including verbal abuse and physical aggression. Nonviolent Crisis Intervention® training also helps you use Postvention for prevention — meaning that what you discover in an incident review can guide you in making changes to prevent similar situations from happening again.

3. Provide appropriate follow-up and support to victims, witnesses, and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary.

We developed the CPI COPING Model℠ to guide you through the process of giving caring, constructive support to everyone involved in an incident — victims, witnesses, staff, patients, family members, visitors, everyone.

The core belief and teaching of Nonviolent Crisis Intervention® training is that everyone deserves to be treated with care and safety. And everyone can be empowered to provide that for themselves and others. As part of this, we’ll help you incorporate trauma-informed care best practices into your staff trainings, policies, and procedures.

4. Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence, and worksite conditions, to determine priority situations for intervention.

When you use CPI’s prevention, response, and debriefing protocols, you’ll find determining contributing factors to be one of your most crucial and effective tools.

Contributing factors can be personal, and teaching staff how to identify and handle them is not only fundamental, it's unforgettable.

Contributing factors can also be environmental. If you're looking to assess your worksite conditions, you’ll find our Environment of Care article helpful, and well as this facility walkthrough article. And our free eBook for hospitals has 8 environmental assessment questions you and your team should ask (and, of course, answer!).

5. Develop quality improvement initiatives to reduce incidents of workplace violence.

Facilities that work with CPI choose us because they want to create lasting, positive, ongoing change that pays off in terms of time, money, and people.

Listen in on the results of a quality improvement study conducted at an acute care facility that uses Nonviolent Crisis Intervention® training to reduce violence. Their quality improvement goal was to decrease code alerts, which they did — and they proved something about their investment in CPI in the process.

6. Train all staff, including security, in de-escalation, self-defense and response to emergency codes.

You know it: The Joint Commission recommends training all staff to handle and prevent violence against healthcare workers.

With CPI training for all staff, you can break the cycle of workplace violence. You’ll learn verbal de-escalation skills, how to block and move away from strikes and grabs, how to respond to and reduce emergency codes, and many more skills that can be life-saving at the most, and job-enhancing to say the least.

7. Evaluate workplace violence reduction initiatives.

CPI is always here to help you evaluate your initiatives and keep making improvements every day.

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More Joint Commission Standards

The Joint Commission also has several additional standards that CPI can help you meet. These include — to name just a few:


To effectively address violence against healthcare workers, it’s crucial to train ALL staff in de-escalation techniques.

As we’ve seen, more and more OSHA regulations and state laws are requiring training for all healthcare workers. This is because violence against healthcare workers is just that — it’s verbal and physical assaults against people who work in healthcare. Healthcare workers are, of course, nurses, doctors, aides, techs, social workers — people schooled in care, for sure.

Healthcare workers are also security, customer service, cafeteria, transportation, maintenance, finance, pharmacy, phone support staff... in short, everyone who works in healthcare can come into contact with a potentially violent person.

And everyone who works in your facility should be trained in best practices to prevent or de-escalate the violence.

That’s why The Joint Commission’s suggested action #6 specifies training ALL staff. 

osha regulations for hospitals
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This can look different for different kinds of staff. Some might need basic awareness training. Some might need to build on that with verbal intervention training. Some might need to build on that with skills for blocking and moving away from strikes and grabs. Some might need that, plus more tools for risk assessment and problem solving, and additional physical intervention options.

To get started on the process of helping every member of your team be safer, check out our Risk Stratification Matrix. It will help you visualize the degrees of risk that different departments face — from the emergency department, psych, and security to customer service, administrators, and everyone in between. And it will help you determine the best mix of training to make your hospital measurably safer from the many risks of violence.

osha regulations for hospitals
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Curious just how measurably safer your staff and patients can be?

Take a look at what healthcare settings like yours have accomplished. We’re talking 50 to 100% restraint reduction. Security alerts down by over 80%. Worker comp claims down by 82%. Liability reduced by $230,000. Injuries from patient violence down to ZERO. Stuff like that. There’s even a quality improvement study by a chief nursing officer who proved that CPI training reduces violence against healthcare workers.

Sally-Gillam-2.jpg“If someone needed a study to ascertain whether they want to invest in Nonviolent Crisis Intervention® training for their staff, this study proves that 2% of payroll reduces 23% of violence.”
—Dr. Sally Gillam, Chief Nursing Officer, St. David's South Austin Medical Center

De-escalation tips you can use immediately

One of the keys to preventing violence is using de-escalation techniques as soon as a person starts to show signs of agitation. The next time you see someone showing warning signs of potential violence, use these five tips to prevent the situation from spinning out of control. (You can also grab our top 10 tips below.)

And, of course, to thoroughly manage and prevent violence, your staff need to be equipped with the right level of violence prevention training. That’s when your setting will have the complete toolbox to decelerate all kinds of situations from minor to major... to safely manage situations that have already intensified... and to prevent behaviours from escalating in the first place.

1. Be empathic and nonjudgmental

Empathy — or at least compassion — is a basic part of providing care, so this might seem pretty obvious. But let’s face it: When you’re doing a thousand things, tension is mounting, and someone’s starting to lose control of their behavior, it’s not easy to keep control of your own. In the heat of the moment, it’s a lot more instinctive to think “this lady’s crazy” than to stop and realize she’s freaked out because her husband’s in the ED. But it pays — in time, money, and people — to remember to see things this way.

So when someone says or does something you perceive as weird or irrational, try not to judge or discount their feelings. Pay attention to them. Keep in mind that whatever that person is going through, it’s probably the most important thing in their life at the moment.

2. Don’t take it personally

It can feel impossible not to take things personally, especially when an upset person says nasty personal things. But it’s essential to do your best to remain calm and professional — at least on the outside. A rational response can go a long way toward influencing a person's behavior in a positive way.

3. Watch HOW you say what you say

Two identical statements can have opposite meanings — depending on the tone, volume, and cadence of your voice. Make sure your vocal inflection is consistent with the words you use. Saying “Come with me” can sound reassuring to someone who’s upset — or it can sound threatening. Controlling how you say things and how you respond to someone's behavior is one of the most crucial things you can do to prevent a situation from taking a downward spiral into violence.

4. Ignore challenging questions

When a person challenges your authority or an organizational policy, redirect their attention to the issue at hand. For example, say a visitor in a waiting area insists on entering the ED. You ask him to wait in the waiting area. He says, "Why should I listen to YOU? Who are you to tell me what to do?"

Answering this type of challenging question will only lead to a power struggle. It's better to ignore the challenge — but not the person — and restate your request in a calm, respectful tone of voice so you can keep the focus on resolving the problem.

5. Set clear, reasonable, and enforceable limits

Setting effective limits is one of the most powerful ways to steer a situation back on track. The trick is to offer the positive choice first. This is important because someone who’s upset is not likely to be able to focus on much of what you say. If you don’t offer the positive choice first, they might not even hear it.

So for example, you could say, “Please come back to the waiting area with me, and I’ll be sure the doctor speaks with you about your mom as soon as possible. If you try to enter the treatment room again, I’ll have to call security, and then it’ll be even longer before you can talk to the doctor.”

The Joint Commission recommends CPI’s Top 10 De-Escalation Tips

Among the many useful suggestions in their Sentinel Event Alert 59, The Joint Commission recommends training all staff, using de-escalation techniques as soon as threatening language and agitation are identified, and guiding staff with our Top 10 De-Escalation Tips.

This is our most popular free resource for a reason: It breaks down some of the most fundamental strategies from CPI training — giving staff simple techniques they can easily use when they need them.

Download our top 10 tips, print them out, share the link with your staff, put a hard copy in your break room — however you distribute them, get them in the hands of everyone who comes into contact with upset — or potentially upset — people. (That is, everyone.)

The reality is that, from time to time, we’re all one step away from “losing it” when we’re angry, scared, or in any heightened emotional state. (Think of how you would act — or have acted — and how you would want to be treated when something goes horribly wrong.)

Since none of us are strangers to crisis situations, we all deal with acting-out people from time to time — some more than others, depending on the nature of our jobs. And, as anyone who’s had CPI training will tell you, when you implement the program with fidelity, the strategies seriously work for de-escalating tough situations on the job — and in any part of life.

Don’t wait to implement comprehensive training!

If you’re ready to take the next step to reduce verbal and physical violence in your healthcare setting, it’s time to get trained as a Nonviolent Crisis Intervention® Certified Instructor. Get the tools now to start training staff — because violence does NOT have to be part of the job.