Part 1: The State of Healthcare Workplace Violence, De-Escalation Techniques, and Policy Must-Haves

While hospital violence remains high, this threat management expert believes there is hope on the horizon due to new violence prevention standards.

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In “Part 2: Behavioral Threat Assessments, Safety-Conscious Students Critical to School Violence Prevention,” Dr. Marissa Randazzo answers similar questions regarding school violence prevention.

The worst of the COVID-19 pandemic may be over but many industries are still dealing with its continued impact on human behavior — especially healthcare.

An Aug. 2022 study conducted by the Minnesota Nurses Association (MNA) found in the last two years, 75% of its nurses had observed or experienced physical violence at work. Furthermore, 97% observed violence or harassment. An analysis of Press Ganey’s National Database of Nursing Quality Indicators (NDNQI) showed more than 5,200 nursing personnel were assaulted — largely by patients — in the second quarter of 2022. This equates to two assaults per hour, 57 per day, and 1,739 per month.

“The peak that started to occur during the pandemic has remained high even though pandemic conditions have really started to abate,” Ontic’s Executive Director of Threat Management Dr. Marisa Randazzo told Campus Safety (6:28). “While healthwise we’re able to go out and about in the world and have been for a while, the residual impact of financial uncertainty, living and working and schooling at home, having to care for young kids who are unvaccinated or at risk, having to protect the health of elderly family members that we’re interacting with, having to worry about if you’ll still have a job — all of those things have had some residual impact on individuals.

“It [has translated] into less of an ability to be civil right each other: quicker tempers [and] more likelihood of interactions becoming combative and hostile. Whereas pre-pandemic, that same interaction might have been a disagreement but didn’t escalate into a shouting match and become a physical altercation. Our ability to tolerate things when we’re in conflict with someone else is pretty short-circuited right now for so many of us carrying that load from the pandemic. It isn’t the pandemic itself but the aftermath of having to live through that for as long as we have.”

This dramatic increase in overall threatening behavior from coworkers, patients, and patients’ families is creating a lot of fear and in turn leading to significant employee turnover in healthcare settings.

“We’ve got attrition of institutional knowledge and expertise, and new healthcare personnel coming on board — which is wonderful — but they’re trying to get up to speed with an increasingly stressed patient population and patients’ family members who are trying to advocate on their behalf,” said Randazzo. “I hate to use the term ‘perfect storm’ but we’re still seeing a perfect storm of contributing factors making violence and threats in the healthcare industry a continued front and center concern.”

Recognizing the concerning increase in violent and harassing behaviors, effective Jan. 1, 2022, the Joint Commission released new and revised workplace violence prevention standards that apply to all Joint Commission-accredited hospitals. The new guidelines “provide a framework to guide hospitals in developing effective workplace violence prevention systems, including leadership oversight, policies and procedures, reporting systems, data collection and analysis, post-incident strategies, training, and education to decrease workplace violence.”

Tracking incidents is critical when it comes to violence prevention in healthcare. Historically, however, healthcare violence is dramatically underreported. The aforementioned MNA study found nearly half of the victims didn’t report what happened to them. The Joint Commission now requires hospitals to provide staff with ways to document threats or assaults in a timely manner.

“There’s a new sort of recognition that it is important to report everything so hospitals can truly get a handle on what is going on in healthcare, really knows how many we’re talking about,” said Randazzo. “In order for a facility to be able to take meaningful action to try to prevent, they really need to know how much is going on. Is it in the overnight shift? Is it during shift change? The more that facilities and security for hospitals and healthcare know about it, the more they can actually take action. ‘Alright, that’s the time of day we want our security personnel doing rounds.’ To just have a sense of where and when gives so much ability and visibility for security professionals to then take action to try and prevent.”

Although the past few years have been extremely difficult for healthcare professionals, both emotionally and physically, Randazzo believes the future is promising due to these newly-implemented requirements (21:45).

“While healthcare providers are really in the thick of it right now in terms of workplace violence, I’m starting to see an impact from the Joint Commission requirements. As hospitals are fully implementing those requirements and other guidances like from the American Hospital Association, it takes a while but they are starting to see the beneficial impact of having these programs in place and having these trained teams to respond to incidents as they occur,” said Randazzo. “While the number of threats may continue to remain high, what I’m seeing improvements in is the ability of hospitals and healthcare facilities to respond appropriately and figure out where we need to actually intervene to mitigate risk.”

“I feel there’s absolutely hope on the horizon,” she added.

During our interview, Randazzo also shared:

  • Steps healthcare workers can take when they are confronted with a combative person (9:51)
  • Free de-escalation resources (12:38)
  • What technologies and tools are available to support healthcare workers in combatting workplace violence (13:50)
  • Must-haves in workplace violence prevention policies (19:13)

Watch the full interview here or listen on the go on Apple or Spotify.


If you haven’t seen “Part 2: Behavioral Threat Assessments, Safety-Conscious Students Critical to School Violence Prevention,” Dr. Marissa Randazzo answers similar questions regarding school violence prevention.

As Executive Director of Threat Management at Ontic, Dr. Marisa Randazzo provides strategic consulting, program development, and training services in behavioral threat assessment, threat management, and violence prevention for safety and security professionals at major corporations, educational institutions and government agencies. Prior to Ontic, Dr. Randazzo was the Chief Executive Officer and founder of SIGMA Threat Management Associates LLC, acquired by Ontic in September 2021.

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About the Author


Amy is Campus Safety’s Executive Editor. Prior to joining the editorial team in 2017, she worked in both events and digital marketing.

Amy has many close relatives and friends who are teachers, motivating her to learn and share as much as she can about campus security. She has a minor in education and has worked with children in several capacities, further deepening her passion for keeping students safe.

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