Workplace Violence: What Hospital Executives and Administrators Need to Know

Rumberger | Kirk

Rumberger | Kirk

In an article published by Healthcare Business & Technology on September 24, Suzanne Singer provides guidance for hospital executives and administrators to address and prevent workplace violence. The article is republished below with permission. 

In today’s world, hospitals have to be prepared for anything and everything, and not just medical emergencies. They have to be prepared to handle all types of workplace violence, from active shooters to abuse from patients. In this guest post, Suzanne Singer, a lawyer who specializes in all aspects of labor and employment law and is a partner in a Florida law firm, details the measures executives and administrators can take to reduce the likelihood of workplace violence and allow nurses, physicians and other healthcare professionals to do their jobs without stressing about protecting themselves.


911 Operator: “911, what’s your emergency?”

Caller: “Hi, I’m a, I’m a nurse here, they called a ‘code black’ over the um, intercom, and we called our chief officer of the hospital and they didn’t know about it being a drill.”

911 Operator: “What is a code black?”

Caller: “Code black means active shooter.”

911 Operator: “OK, I have police on the way.”

On Aug. 1, 2018, a nurse from inside Mercy Southwest Hospital in Bakersfield, CA, alerted police of an active shooter. Although a false alarm, staff and first responders followed their training and remained behind locked doors until an all-clear was issued hours later.

Others haven’t been so lucky.

This April, a nurse and family member were left in critical condition at a hospital in Orangeburg, SC, when a man fired several rounds of a .223-caliber assault rifle down the emergency room hallway. There were no protective barriers, armed security officers, metal detectors, bulletproof glass, nor panic buttons installed in what was “a critical artery between a community with high-crime areas and life-saving medical care,” leaving nurses at the Orangeburg facility on edge.

While a “code black” is a low-probability – but an extremely high risk – healthcare professionals put their safety in jeopardy on a daily basis: They’re kicked, shoved, spit on, threatened and harassed with unprecedented regularity. But too many healthcare workers think it’s part of the job – and that’s where hospital executives and administrators must step up to the plate.

Why are healthcare workers at an increased risk of workplace violence?

The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.” It goes without saying that workplace violence is a serious problem, and workers in hospitals and other healthcare settings face significantly greater risks of workplace violence than workers in any other industry. Why?

Simply put, there’s no specific diagnosis. Workplace violence comes from many sources and in varying degrees. The Occupational Safety and Health Administration (OSHA) put it succinctly:

“[P]ossible sources of violence include patients, visitors, intruders, and even coworkers. Examples include verbal threats or physical attacks by patients, a distraught family member who may be abusive or even become an active shooter, gang violence in the emergency department, a domestic dispute that spills over into the workplace, or coworker bullying.”

Pain, devastating prognoses, unfamiliar surroundings, mind-and-mood-altering medications and drugs, and disease progression can all cause agitation and violent behaviors.[1]

Yet other factors – like working in high crime neighborhoods, long-wait times for patients, understaffing and inadequate security – present high risks for hospital employees.

In a study conducted by the Bureau of Labor Statistics from 2002 to 2013, incidents of serious workplace violence (those requiring days off for the injured employee to recuperate) were four times greater in the healthcare industry than in the private industry. Not surprisingly, 80% of reported violent incidents can be traced back to interactions with patients.

An essential component for producing a successful workplace violence prevention program is understanding the specific risk factors that permeate your industry, and in turn, communicating that to your employees. Hospital leaders play a significant role in communicating to staff members potential hazards and how to protect themselves and their coworkers. While all potential risks of violence can’t be eliminated, hospital executives and administrators can manage and mitigate the risk of harm through three simple concepts: preventiontraining and response.

An ounce of prevention is worth a pound of cure

There is no guarantee against workplace violence, but employers can take measures to reduce the likelihood of such an occurrence so that nurses, physicians and other healthcare professionals can focus on saving lives – not stressing about protecting their own from both internal and external safety concerns.

Protect from the inside out. The HR department should spearhead workplace safety from the beginning by incorporating safe hiring practices. Hospitals that utilize sophisticated screening technology promote legal compliance and accuracy, and moreover, demonstrate their commitment to safety. Routine background investigations and social media monitoring are prominent examples. Tracking employee behavior can help employers and fellow employees spot red flags early on. Proactive monitoring gives employers an opportunity to correct suspect actions of an employee, and allows an employee the chance to adjust their behavior.

Encourage participation. Encourage your employees to share their workplace safety concerns with leadership personnel without fear of reprisal. It’s important that employees feel their voice matters. An atmosphere that promotes open lines of communication between staff and leadership can diminish the likelihood of incident underreporting and advance violence-free initiatives. For example, administering employee surveys and patient surveys provide an avenue for grievances to be addressed and remedied. Additionally, requiring no-fault reporting of all hospital incidents – whether caused by a patient, a visitor or a fellow employee – removes the “it’s just a part of the job” stigma of workplace violence in hospitals by standardizing reporting requirements.

Build and implement a comprehensive workplace violence program. Executives and administrators should incorporate a workplace violence prevention program into their employee handbooks and guidelines. To reduce violence in the workplace, OSHA has developed a comprehensive workplace violence prevention program that covers five core elements:

  1. Management commitment and employee participation
  2. Worksite analysis and hazard identification
  3. Hazard prevention and control
  4. Safety and health training, and
  5. Recordkeeping and program evaluation.

Incorporating safety protocol such as OSHA’s workplace violence prevention program into employee handbooks, manuals and guidelines is a vital starting point to preventing injuries in the workplace. It’s important that your employees have resources to refer to when needed.

Leverage technology. Consider using technology to recognize risks early on and respond to incidents faster. Some of the latest advances:

  • Social media scanning tools collect, analyze and synthesize intelligence from social media to identify possible threats that can then be addressed proactively
  • Mobile apps and platforms for real-time response management, including SOS buttons, video capabilities and staff communication tools, cut down response time to seconds instead of minutes
  • Remote access control technology automates locks, alarms and sensors on windows and doors that can be monitored and activated remotely
  • Panic buttons can be embedded on a wearable device or located in patient rooms
  • Digital floor plans – layouts on map-like grids – can assist emergency response teams navigate unfamiliar hospital premises quickly
  • Biometric devices – the latest in fingerprint identification, facial recognition and iris scan identification – can provide background checks on visitors in seconds.

Prepare for the unexpected

Workplace violence training isn’t required by law, but healthcare executives and administrators should be catalysts for incorporating precautionary programs intended to protect their employees from harm. It starts from the top: If leaders create and maintain a culture of safety and quality throughout the hospital, then employees will be encouraged to participate in safety-enhancing protocol. That is, setting guidelines, distributing manuals and implementing standard operating procedures are one piece of the puzzle. Successfully educating your staff on guidelines for handling violence in the workplace can only be achieved through consistent safety training and education.

Hospital executives and administrators can ensure their workers are well-equipped to prevent, address, and protect themselves from danger in many ways. Training and education can include:

  • Enact a zero-tolerance policy for workplace violence
  • Mandate annual “refresher” training on topics like recognizing assaultive behavior, rapid response and self-defense
  • Establish an easily accessible anonymous reporting system where employees can report threatening activity, no matter where it comes from (such as a mobile app)
  • Require employees to wear name badges with photo ID
  • Ensure locked doors remain locked and closed
  • Assign designated “safe rooms” where staff can find shelter from violent incidents
  • Install card or badge access readers that can be quickly programmed
  • Utilize a mass notification system that provides security alerts to all hospital employees in the event of a security threat
  • Perform regular safety drills such as lockdown procedures, emergency escape routes and evacuation protocols for varying degrees of safety threats
  • Create a violence/crime inspection committee to perform routine “checks” of potential security hazards
  • Instruct workers on de-escalation techniques, and
  • Install a “panic button” system throughout the hospital to improve rapid response to violent incidents by pinpointing the exact location of a rapidly evolving incident to local authorities and security personnel.

Investigate, review and improve

Responding to a violent occurrence is just as important as preparing for one. When an incident does occur, hospital executives should act immediately, but remain calm. Providing medical treatment to those in need and alerting local authorities are some of the first steps employers should take. Hospital executives should provide victims with post-incident assistance. As recognized by OSHA, some examples include trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs. In addition, employers may establish peer counseling and support groups.

Investigate and adjust. Once immediate concerns are taken care of, hospital executives should investigate the incident and involve staff. Provide uniform post-incident response forms to individuals involved in violent occurrences. This can help executives identify causes, track trends, extract lessons learned and ultimately contribute to better prevention strategies.

Workplace violence cannot be tackled in isolation. An involved, collaborative and hands-on approach is much more likely to prevail. Reid Hoffman, the co-founder and chairman of LinkedIn, put it best: “No matter how brilliant your mind or strategy, if you’re playing a solo game, you’ll always lose out to a team.” Involve your workers, update your systems, follow protocol and nurture a violence-free atmosphere. Hospitals are chaotic and each day is unpredictable. But the occurrence of workplace violence in healthcare settings isn’t only predictable but expected. Prevent, train and respond.


[1] Lawrence J. Fennelly & Marianna Perry, 150 Things You Should Know About Security, 72 (Butterworth-Heinemann, 2nd ed. 2017).

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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