Top 2023 Patient Safety Concerns: Physical and Verbal Violence Against Healthcare Staff

By Tammie Smeltz

Physical and verbal violence against healthcare staff is ECRI’s No. 2 concern for patient safety in 2023. MLMIC recognizes the seriousness of workplace violence in the healthcare setting and has identified this as a critical concern for our insureds. Following, we’ll take a deeper look at the issue.

What Is Workplace Violence?

Workplace violence can emanate from anywhere and can affect anyone. Violence against healthcare workers can come from patients, family members or staff. It can be in the form of physical or verbal abuse and, in most circumstances, stems from aggressive behaviors. Characteristics of aggressive behavior can include inappropriate comments, intimidation, bullying, lack of cooperation, threats and profanity, as well as verbal or physical attacks. Violence against healthcare workers not only affects their psychological and physical well-being, but it also can lead to a lack of job motivation, compromised quality of care, increased risk for malpractice claims and burn-out.

Workplace Violence in the Healthcare Setting

Violence against healthcare workers has been on the rise over the last five years. The World Health Organization found that nurses, emergency room staff and paramedics are at the highest risk for violence. According to a new survey from the American College of Emergency Physicians, more than eight in ten emergency room physicians believe the rate of violence in the emergency department has increased, with 45% saying it has greatly increased over the last five years. A recent survey of registered nurses revealed that 44% experienced physical violence and 68% experienced verbal abuse during the pandemic.

Risk Management Strategies to Protect Healthcare Workers from Violence

We have developed several risk management strategies to address this issue. The following are a few ideas to keep in mind to protect you and your staff from both physical and verbal violence in the office setting:

  1. Recognize the early signs of aggression. It is imperative to educate staff to recognize the early signs of behavioral health needs in a nonjudgmental way. Healthcare providers should be mindful of cognitive bias, which can occur when operating in the mode of “intuitive or fast thinking.” Analytical or mindful thinking is a slower process used to make decisions and is recommended because it is conscious, deliberate and generally reliable. Healthcare workers should identify patients at risk for aggression, keeping in mind that not every aggressive patient has a mental illness and that not every behavioral health patient is violent.
  1. Obtain a complete history and assessment. A comprehensive assessment should be conducted on all patients, and the practitioner should provide clear, concise documentation in the medical record including a clinical rationale for treatment.

The assessment should contain a detailed family history regarding mental illness, depression and alcohol/drug dependency. Major life events, such as a death in the family, job loss, relocation or divorce, should be documented in the social history. Also, it is important to engage patients as active participants in their healthcare and especially when taking a history.

When coordinating care with specialists, keep a clear line of communication and document all discussions in the medical record.

  1. Develop policies and procedures. Create a plan for violence reduction and response that is personalized to your office environment. Establish a multidisciplinary group for violence prevention and clearly define unacceptable behavior. All staff should be trained on de-escalation techniques and panic buttons should be installed. Depending on your patient population and office location, you may want to hire security staff and have a plan in place with local emergency and law enforcement agencies.
  2. Consider the backgrounds and needs of healthcare staff. It is prudent to conduct pre-employment background checks on any potential employee to investigate a history of violence. You can also provide accommodations for employees with difficult situations outside of the workplace. This could include offering remote work where feasible, alteration of work hours/tasks or providing an escort to the parking lot.

Additional Information

In addition to the above, we recommend implementing a Zero-Tolerance Policy not only for staff but also patients, visitors and vendors.

Currently, there are no federal laws to protect healthcare workers from violence. The Safety From Violence for Healthcare Employees Act (H.R. 7961) would make assaulting or intimidating healthcare workers on the job a federal offense. This bill is still pending and would establish a new grant program that would encourage hospitals to update their security systems, as well as professionally train staff to respond to violent incidents and coordinate with local law enforcement.

To curtail the amount of workplace violence against healthcare workers, MLMIC Insurance Company offers a variety of educational programs focusing on this issue. Our programs include strategies for addressing the disruptive patient, managing aggressive behaviors, discharging a patient from practice, and healthcare providers’ responsibilities under New York’s Safe Act. All of these programs can be tailored to your office practice, emergency department or in-patient setting and are offered at no additional cost to our insureds or any of our endorsed partners. To schedule a program, contact Matthew Lamb, Esq. at 518-786-2762.

MLMIC policyholders can reach our 24/7 emergency support services for questions regarding workplace violence by calling (844) MMS-LAW1. You can also submit a specific question by sending an email request here.