Assessment of Workplace Violence in Healthcare

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By Eugene Schmuckler PhD, MBA CTA

By Dr. David E. Marcinko MBA

Chapter 07: Workplace Violence

NOTE: The ME-P can only speculate how this healthcare workplace violence information from a public safety expert, applies to the recent spate of national violence – regardless of venue – or how any lessons learned are applicable in this case; or not.

1. What Is Workplace Violence?

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence. The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes:

  • threatening behavior — such as shaking fists, destroying property, or throwing objects;
  • verbal or written threats — any expression of intent to inflict harm;
  • harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;
  • verbal abuse — swearing, insults, or condescending language;
  • muggings — aggravated assaults, usually conducted by surprise with intent to rob; or
  • physical attacks — hitting, shoving, pushing, or kicking.

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger.  The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.

  • Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.
  • Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.
  • Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.
  • Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

2. Effects of Workplace Violence

The healthcare sector continues to lead all other industry sectors in incidents of non-fatal workplace assaults. In 2000, 48% of all non-fatal injuries from violent acts against workers occurred in the healthcare sector. Nurses, nurses’ aides, and orderlies suffer the highest proportion of these injuries. Non-fatal assaults on healthcare workers include assaults, bruises, lacerations, broken bones, and concussions. These reported incidents include only injuries severe enough to result in lost time from work. Of significance is that the median time away from work as a result of an assault or other violent act is 5 days. Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite costly to the facility as well as to the victim.

A study undertaken in Canada found that 46% of 8,780 staff nurses experienced one or more types of violence in the last five shifts worked. Physical assault was defined as being spit on, bitten, hit, or pushed.

Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical assaults in intensive care, emergency departments, and general wards. A study in Florida reported that 100% of emergency department nurses experience verbal threats and 82% reported being physically assaulted. Similar results were found in a study undertaken in a Canadian hospital. Possible reasons for the high incidence of violence in emergency departments include presence of weapons, frustration with long waits for medical care, dissatisfaction with hospital policies, and the levels of violence in the community served by the emergency department.

Similar findings have been reported in studies of mental health professionals, nursing home and long-term care employees, as well as providers of service in home and community health.

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all healthcare providers. Personnel working in large medical practices fall into this category as well. Although no area is totally immune from acts of violence it most frequently occurs in psychiatric wards, emergency rooms, waiting rooms, and geriatric settings.

Many medical facilities mistakenly focus on systems, operations, infrastructure, and public relations when planning for crisis management and emergency response: they tend to overlook the people. Obviously, no medical facility can operate without employees who are healthy enough to return to work and to be productive. Individuals who have been exposed to a violent incident need to be assured of their safety.

The costs associated with workplace violence crises are not limited to healthcare dollars, absenteeism rates, legal battles, or increased insurance rates. If mishandled, traumatic events can severely impair trust between patients, employees, their peers, and their managers. Without proper planning, an act of violence can disrupt normal group processes, interfere with the delivery of crucial information, and temporarily impair management effectiveness. It may also lead to other negative outcomes such as low employee morale, increased job stress, increased work turnover, reduced trust of management and co-workers, and a hostile working environment.

Data collected by the U.S. Department of Justice shows workplace violence to be the fastest growing category of murder in the country. Homicide, including domestic homicides, is the leading cause of on-the-job death for women, and is the second leading cause for men. The National Institute of Occupational Safety and Health (NIOSH) found that an average of 20 workers is murdered each week in the U.S. In addition, an estimated 1 million workers — 28,000 per week — are victims of non-fatal workplace assaults each year. Workplace attacks, threats, or harassment can include the following monetary costs:

  • $13.5 billion in medical costs per year;
  • 500,000 employees missing 1,750,000 days of work per year; with a 41% increase in stress levels with the concomitant related costs!


More links: 

Racism in Medicine:

MORE: Work Violence


About the Author

Dr. Eugene Schmuckler was Coordinator of Behavioral Sciences at a Public Training Center before accepting his current position as Academic Dean for iMBA, Inc. He is an international expert on personal re-engineering and coaching whose publications have been translated into Dutch and Russian. He now focuses on career development, change management, coaching and stress reduction for physicians and financial professionals. Behavioral finance, life planning and economic risk tolerance assessments are additional areas of focus. Formerly, Dr. Schmuckler was a senior adjunct faculty member at the Keller Graduate School of Management, Atlanta. He taught courses in Organizational Behavior and Leadership, Strategic Staffing, Training and Development, and the capstone course in human resources management. He is a member of a number of professional organizations including the American Psychological Association, the Academy of Management, and the Society for Human Resource Management. A native of Brooklyn New York, he received his BS degree in Psychology from Brooklyn College. He earned his MBA and PhD degrees in Industrial and Organizational Psychology from Louisiana State University. Currently, he serves on the executive BOD for:  and is the Dean of Admissions for


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16 Responses

  1. Assessment of Workplace Violence in Healthcare

    As a risk-manager and nurse – this was a chilling and timely ME-P.



  2. Doctor Killed In Office
    [Shot To Death Newport Beach Exam Room]

    A doctor was killed yesterday in California, found dead of gunshot wounds in an office in Newport Beach.

    As of now, the doctor has not been formally identified by police, but some reports have indicated he may have been targeted by a former patient, 70.

    Dr. David Edward Marcinko MBA


  3. Russian Doctor Punches Heart Surgery Patient In Chest

    This video shows a top anaesthesiologist – who says he “got carried away” – hitting the man while he was strapped to a hospital bed.

    Ann Miller RN MHA


  4. Fired doctor arrested on suspicion of four slayings

    Authorities just arrested an Indiana doctor on suspicion of carrying out two attacks in Omaha over the past five years in which four people were killed who had ties to a local university medical school that fired him in 2001.

    Hope R. Hetico RN MHA


  5. Healthcare Workplace Violence

    Psychiatric Ward, emergency rooms, acute care settings, and critical care units are the most frequent sites of reported violent incidents.

    In fact, NIOSH confirmed that (Arpil 2002) health care workers reported over 4 times of nonfatal assults over the private sector workers. And, a Floridian report has shown that over 82% of nurses suffered from physical assult while working in an emergency room of a hospital and all of them had reported experience verbal threats.

    My past experience working in a regional medical hospital in US confirms that emergency room is the most dangerous department in a hospital along with the psychiatric ward if the facility do not have precautionary measures built in to the operation flow to counter it.

    Many newer facilities now have more stringent security measures designed into the space to mitigate violence.

    Ken Yeung MBA
    Certified Medical Planner™ candidate


  6. Man shot by police at hospital had 2 guns

    A man was shot four times by police inside a northern Utah hospital emergency room after he made demands and pulled out two guns, according to authorities.



  7. Myth vs. Fact: Violence and Mental Health

    A Q&A with a psychiatrist who studies the relationship between mental illness and violence.

    Gene Schmuckler PhD MBA


  8. Medical Complex Shooting

    Police in Washington state say a gunman just fatally shot his wife before turning the weapon on himself at a downtown Spokane medical center.

    Dr. Theo


  9. Fatal Stabbings Prompt Indiana Hospital Lockdown

    Methodist Hospital in Merrillville, Indiana, was just placed on lockdown after an elderly patient was fatally stabbed and another body was discovered at a nearby home in Gary.



  10. WIHI: Workplace Violence in Health Care Can’t Be the Norm

    We are glad this topic is getting some needed attention. And, the ME-P has been advocating for more R&D for the last decade.'t-Be-the-Norm.aspx

    Dr. David Marcinko MBA


  11. Joint Commission issues Sentinel Event Alert on violence toward health care workers

    The Joint Commission has issued a Sentinel Event Alert in an effort to help prevent physical and verbal violence against health care workers. Facility professionals sometimes face verbal aggression on the job and should be aware of the alert. It promotes a cultural change in health care to stress a healthy and safe environment for all, and that workplace violence of any kind is not permitted.


    We have been in this space for the last two decades.

    Dr. David Edward Marcinko MBA


  12. Creighton University School of Medicine

    A former doctor was sentenced to death for the revenge killings of four people connected to a Nebraska medical school, including the 11-year-old son of a physician who helped fire the man from a residency program nearly two decades ago.



  13. 13.6% of Internal Medicine Residents Experienced Bullying

    JAMA Network recently published a research letter on perceived bullying among internal medicine residents. Here are some key findings:

    • 13.6% of internal medicine residents reported experiencing bullying during their residency.
    • Of residents who reported bullying, 80% said they experienced verbal harassment.
    • 3.6% of residents who reported bullying said they experienced sexual harassment.
    • Of those who felt bullied, 31% sought help to deal with it.

    Source: JAMA Network, August 13, 2019


  14. Medical Workplace Violence

    When reading the details of this article, and the comments, it seems like a much larger issue than one would think.
    What I mean is that you certainly don’t hear about the risks physicians are facing on the mainstream news that often.

    Some of these stats are eye popping!



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