What Is Workplace Violence Prevention?

By Jackie Russell, RN JD

Nursing Practice and Regulatory Affairs Specialist

On the CDC website there is a Workplace Violence Prevention for Nurses Course (CDC Course No. WB2908–NIOSH Pub. No. 2013-155). It’s free. It’s interactive. (here’s the link to attend:  https://www.cdc.gov/niosh/topics/violence/training_nurses.html) It’s designed to “help healthcare workers better understand the scope and nature of violence in the workplace.” And it hasn’t been updated since 2016 (last reviewed, 2017).

If you take the course, you will learn the definition, types, and prevalence of violence; workplace violence consequences; risk factors for type II and III violence; prevention strategies for organizations; prevention strategies for nurses; and a post event response.

I took the course. Here’s a bit of what I’ve learned:

The course provides two definitions of workplace violence:

1. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “…any physical assault, threatening behavior, or verbal abuse occurring in the work setting,” and
2. The World Health Organization (WHO) and the International Council of Nurses (ICN) defines workplace violence as “… incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health.”

According to the CDC, occupational health researchers classify workplace violence by type, and they are:

Type I- Criminal Intent

Type II- Customer/Client

Type III- Worker-on-Worker

Type IV- Personal Relationship

According to the CDC (2002 and 2015 stats):

• 80% of nurses don’t feel safe at work.
• 82% of ED nurses had been physically assaulted at work in one year (2002). And that’s 17-years ago!
• 25% of psychiatric nurses experienced disabling injuries from patient assaults (2006).
• And 35-80% of hospital staff had been physically assaulted at least once during their career (2005).

These statistics are outdated but I list them here because even then, workplace violence against nurses was a significant issue, and we feel certain the issue has sharply increased with the opioid epidemic. And what has been done about it? Largely, nothing. If a significant number of auto workers get injured on the job, production stops and the problem gets resolved. But not in our hospitals.

Decades ago, workplace violence experts believed that the statistics were only the tip of the iceberg because many incidents didn’t get reported because:

• Workplace violence is “part of the job”,
• Poor or non-existent institutional policies, procedures, staff training or supports,
• Complex reporting procedures,
• Violence happens so frequently, it would be too time-consuming to report every incident,
• Some patients can’t be accountable for their violent actions. Yes, as nurses, we understand this better than most. Recent MNA testimony in support of Workplace Violence legislation got derailed this session by legislators and opponents over (in part) their concern mentally ill persons who have assaulted a nurse would face felony charges. No nurse would ever knowingly file charges against a mentally ill patient! Not to mention, there are stop gaps in the law. Legislators can and have created exceptions in criminal law that protect mentally ill persons. Also, law enforcement and prosecutors determine probable cause, the evidence, etc. before any allegation of assault becomes a formal criminal charge.

This is still true today. But today, there are other forces at work that keep some nurses from reporting, intimidation by law enforcement with the mere suggestion that “you know, this isn’t going to go anywhere.”

So, while it may be interesting that workplace violence has more than one definition and has several classifications, it doesn’t matter because in the state of Minnesota, assault and battery is a crime. If you have been verbally or physically assaulted, you are a victim of a crime. It is unacceptable that when nurses are assaulted their complaints go largely unacknowledged by hospital management and often by law enforcement. As a victim of a crime, you have a right to report. It’s not the officer’s ultimate decision whether a case “goes anywhere”. No officer should ever suggest to the victim of a crime their complaint isn’t going to go anywhere. In fact, if this happens to you, report the officer to your local law enforcement agency and/or to the Union.

Violent crime is like a disease rotting our society, and our hospitals. To stop or prevent the spread of this disease, workplace violence must be taken seriously by law enforcement, hospital administrators, and our legislators. And if you are the victim of a crime, you have rights. Report and get the help you need and rightfully deserve.