Experts Shed Light on Workplace Violence in Health Care Settings

Halfpoint/AdobeStock

CONFERENCE REPORTER

Workplace violence is on the rise in all health care settings, Laura T. Safar, MD, told attendees at the 2024 American Psychiatric Association Annual Meeting.¹ According to Safar between 50% and 90% of health care workers have been exposed to workplace violence, which includes verbal violence, and 40% of psychiatrists reported physical assault in psychiatry settings (more often in inpatient settings as opposed to outpatient settings).

Safar, vice chair of psychiatry and director of the Neuropsychiatry and Behavioral Neurology Fellowship, Lahey Hospital and Medical Center at Harvard University, explained the various classification and types of workplace violence. First, it can be categorized as verbal vs physical,she said. The majority of incidents of workplace violence in health care settings are verbal, which include verbal abuse, bullying, and threats. Assault, battery, domestic violence, stalking, sexual harassment and assault, and homicide are examples of physical workplace violence. Safar shared data from a 2014 survey of workplace violence, which found:²

• 66.8% was verbal
• 20.8% was physical
• 10.5% was sexual harassment

Violence can also be classified based on the type of perpetrator. Safar said there are 4 types:

I. Perpetrator has no association with the workplace or employees

II. Perpetrator is a customer/patient of the workplace or employees

III. Perpetrator is a current or former employee of the workplace

IV. Perpetrator has a personal relationship with an employee, not with the workplace.

In health care settings, type II perpetrators are the most common, with the patient or visitor becoming verbally or physically violent, Safar reported. The same survey² found 75% of aggravated assaults and 93% of all assaults were classified as type II, she added.

Not surprisingly, nurses have the highest rate of experiencing workplace violence due to their increased patient contact time. Emergency department physicians also have high rates of victimization, with 78% reporting being a target the previous year, Safar told attendees. The majority of those incidents were cases of verbal violence (75%); physical assault (21%), confrontation outside of the workplace (5%), and stalking (2%) also occurred.²

Although prevention in the traditional sense may not always be possible for myriad reasons, Safar said the goal is to “identify patients at high risk, to implement safeguards, and prevent violent events/injury.” The first step is understanding the factors that might contribute to or increase the likelihood of workplace violence.

Traits intrinsic to health care settings can have a negative influence, including things like night work, high stress work, and inadequate workplace safety, she said. That is especially true for emergency departments, with their long wait times, crowding, and low socioeconomic status of patrons. Although altered mental status due to delirium, dementia, substance use (eg, intoxication, withdrawal) and decompensated psychiatric illness, Safar cautioned attendees from relying on diagnosis for predicting violence. “This can be inaccurate and lead to discrimination,” she said. Safar referred to Ghosh³ for a list and discussion of violence risk assessment tools.

Safar explained a one size fits all approach to prevention and interventions are not effective, because there are many variables. For instance, although perpetrator types II and III are most common, perpetrators may be an outsider to the health care system. Similarly, the settings and clinical variables can be different. Thus, she advocates for a “general framework combined with site-specific measures,” adding interventions should be multifaceted and multidisciplinary in nature.

“A strong violence prevention climate as been shown to be a protective factor against workplace violence in hospital settings,” Safar told attendees. A safety culture across the institution should include an institutional policy for workplace violence prevention, continuous monitoring, education and training on safety measures and de-escalation strategies, and incident reporting systems.

Have you experienced violence in the health care workplace? Share your experiences and lessons learned via email to PTEditor@mmgroup.com

References

1. Safar LT. Violent events in the health care environment. Presented at: 2024 American Psychiatric Association Annual Meeting; May 6, 2024; New York City, New York.

2. Phillips JP. Workplace Violence against Health Care Workers in the United States. N Engl J Med. 2016;374(17):1661-1669.

3. Ghosh M, Twigg D, Kutzer Y, Towell-Barnard A, De Jong G, Dodds M. The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review. Int J Ment Health Nurs. 2019;28(6):1248-1267.