Statistics You Should Know: Workplace Violence in Healthcare

As most people who work in the healthcare industry know, healthcare workers are at an increased risk for workplace violence.

Data released May 21 at the IAHSS 51^st Annual Conference and Exhibition in Orlando found the assault rate against healthcare workers increased from 9.3 incidents in 2016 to 11.7 in 2018 — the highest rate that IAHSS has ever recorded since it began collecting crime data in 2012.

Of the workplace violence incidents reported, 85% were categorized as, “Violence directed at employees by customers, clients, patients, students, inmates or any others for who an organization provides services.” Approximately 46% of those incidents took place in emergency departments.

From 2002 to 2013, incidents of serious workplace violence (those requiring days off for the injured) were four times more common in healthcare than in the overall private industry, according to 2013 U.S. Bureau of Labor Statistics.

Before we dive into more statistics, let’s take a look at why healthcare workers are at an increased risk.

While it varies depending on the healthcare setting, OSHA’s 2015 “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” gives 15 workplace violence risk factors for healthcare employees:

1. Working with people who have a history of violence or who may be delirious or under the influence of drugs
2. Lifting, moving and transporting patients
3. Working alone
4. Poor environmental design that may block vision or escape routes
5. Poor lighting in hallways or exterior areas
6. Lack of means of emergency communication
7. Presence of firearms
8. Working in neighborhoods with high crime rates
9. Lack of training and policies for staff
10. Understaffing in general, especially during meal times and visiting hours
11. High worker turnover
12. Inadequate security staff
13. Long wait times and overcrowded waiting rooms
14. Unrestricted public access
15. The perception that violence is tolerated and reporting incidents will have no effect

Who Are the Assaulters and Who is Being Assaulted?

In 2013, patients were the largest source of violence in healthcare, making up 80% of all serious workplace violence incidents. Other incidents were caused by visitors, coworkers or other people.

See Chart 1 in the slideshow for a complete breakdown from the Bureau of Labor Statistics.

Within healthcare, hospitals are particularly susceptible to workplace violence. In 2015, the U.S. Bureau of Labor Statistics found medical and surgical hospitals, nursing and residential care facilities and ambulatory healthcare settings were among the industries with the highest prevalence of nonfatal occupational violence, with respective incidence rates of 6.0, 6.8 and 2.4 per 100 full-time workers.

Psychiatric aides experienced the highest rate of violent injuries at an estimated 590 injuries per 10,000 full-time employees — 10 times more than nursing assistants who experienced approximately 55 injuries per 10,000 full-time employees. Registered nurses experienced about 14 incidents per 10,000 full-time employees.

The most common types of violence against healthcare employees were hitting, kicking, beating and/or shoving.

See Chart 2 in the slideshow for a breakdown of violent incidents by both occupation and violence type.

Hospital Shooting Statistics

While much of the country’s focus has been on active shooters on K-12 or college campuses, active shooter events are affecting healthcare organizations as well.

A 2012 study published in the Annals of Emergency Medicine looked at all U.S. hospital shootings between 2000 and 2011 in which at least one person was injured. It identified 154 incidents in 40 states causing death or injury to 235 people.

See Chart 3 in the slideshow for a complete distribution of hospital-based shootings by year.

Here are more significant findings from the study:

• 59% of hospital-based shootings were inside the hospital while 41% were outside on hospital grounds
• 91% of perpetrators were men
• 29% occurred in emergency departments, 23% in parking lots and 19% in patient rooms
  • 23% of shootings within the ED occurred after a security officer’s gun was taken by the perpetrator
• Reasons/motives for the shootings included a grudge (23%); suicide (21%); “euthanizing” an ill relative (14%); prisoner escape (11%); ambient society violence (9%); mentally unstable patients (4%)
• Hospital employees made up 20% of victims
• Shooting fatality inside the hospital was significantly lower in the ED setting (19%) compared to other sites (73%)
• Southern states experienced the most events (44%), followed by Western states (21%), Midwestern states (20%) and Northeastern states (15%)
• 5 states (Florida, California, Texas, Ohio and North Carolina) accounted for more than a third of the events

See Chart 4 for a further breakdown of hospital characteristics of shooting events occurring in U.S. hospitals.

While the study acknowledges that this type of workplace violence is rare compared to others, it also acknowledges the fact that the “unpredictable nature of this type of event represents a significant challenge to hospital security and effective deterrence practices because most perpetrators proved determined and a significant number of shootings occur outside the hospital building.”

Here are some ways to effectively respond to active shooters in healthcare facilities.

Workplace Violence in Healthcare is Underreported, Costly

While the above statistics are shocking, even more shocking is the fact that many incidents go unreported. The Joint Commission’s 2018 Sentinel Event Alert Issue 59 found while 75% of nearly 25,000 workplace assaults occur annually in healthcare settings, only 30% of nurses and 26% of physicians have reported workplace violence incidents.

Reasons for underreporting can include a lack of reporting policy, lack of faith in the reporting system and fear of retaliation.

OSHA also lists the following reasons for the lack of reporting:

• Many healthcare workers take into consideration their ethical duty to “do no harm” to patients
• Some simply consider violence to be part of the job
• Many recognize that some of their injuries are not intentional
• More mentally ill patients who are prone to violence are increasingly using emergency departments instead of specialized facilities due to reduced funding for mental health services

Workplace violence in healthcare is also extremely costly. A 2017 report commissioned by the American Hospital Association (AHA) found hospitals spent an estimated $1.1 billion in security and training costs to prevent violence within their facilities and $429 million in medical care, staffing, indemnity and other costs resulting from violence against hospital workers.

7 Ways to Prevent Workplace Violence in Healthcare

To combat the violence and associated costs, in 2018, the Joint Commission urged hospitals to address workplace violence in healthcare by looking beyond added security measures.

The commission recommended several policies and initiatives hospitals can adopt to create a safer work environment. Here are seven of its recommendations:

1. Clearly define workplace violence and put systems in place across the organization that enable staff to report workplace violence instances, including verbal abuse
2. Capture, track and trend all reports of workplace violence in healthcare including verbal abuse and attempted assaults
3. Provide appropriate follow-up and support to witnesses and others affected by workplace violence
4. Review each case of workplace violence and analyze workplace violence data to determine contributing factors and opportunities for intervention
5. Develop quality improvement initiatives to reduce incidents of workplace violence in healthcare
6. Train all staff members in de-escalation, self-defense and response to emergency codes
7. Evaluate workplace violence prevention and reduction initiatives

For more details on these recommendations, click here.

Here are some additional workplace violence prevention resources:

• Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers
• Preventing Workplace Violence: A Road Map for Healthcare Facilities
• Workplace Violence Prevention and Related Goals: The Big Picture

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