An Assessment for Securing Hospital Staff and Nurses

March 7, 2022
In times of crisis healthcare, security leaders must seek innovative solutions to address workplace violence

Many people are fortunate enough to not have to worry about their safety as they start their workday. Unfortunately, if you work in healthcare, this is not the case. Those in the industry know that violence committed against healthcare workers is not just pervasive, it’s on the rise. The Occupational Safety and Health Administration (OSHA) recognizes violence as an occupational hazard. According to OSHA, approximately 75% of the 25,000 assaults and other acts of workplace violence that are reported annually, are directed against healthcare workers. Despite this staggering number, healthcare security professionals believe the number is low, with only 26% of physicians and 30% of nurses reporting incidents of workplace violence. All of this makes healthcare facilities one of the most violent and challenging environments to protect.

In 2015, OSHA officially announced a new and stricter enforcement policy for the healthcare industry, promising to address the most common hazards in hospitals, nursing homes, residential care facilities, and other healthcare facilities. The new enforcement policy, which OSHA expected the States to also adopt, required that OSHA inspection of healthcare facilities focus on five major hazard areas, regardless of the original reason for the inspection. Workplace violence was one of these top five hazards.

The Causes

The causes of this increased level of violence are many and varied, but below is a list of some of the generally recognized factors that contribute to violent incidents in what can already be a stressful, healthcare setting.

  • Providing a poor prognosis, imposing physical limitations, or giving other “bad news” to emotionally unstable patients or those who lack sufficient coping mechanisms.
  • Dealing with patients, visitors, or family members who suffer from behavioral disorders or are under the influence of alcohol or controlled substances.
  • Denying narcotics or other controlled substances or refusing to categorize a patient’s diagnosis to meet disability claims, insurance reimbursement, or other illegitimate purposes.
  • Misplaced blame for a financial situation resulting from charges incurred from medical treatment/related services.
  • Reduced inpatient behavioral health beds for high acuity patients. (As funding dwindles for outpatient programs, many with behavioral health issues end up going without care and end up in the criminal justice system.)
  • Increased use of hospitals by some law enforcement agencies for the care of acutely disturbed, violent individuals, as alternates to overcrowded jails, or avoiding financial responsibility for medical bills by “unarresting” a patient until they are medically cleared.
  • Isolation of those working with patients during examinations, especially in a home health setting.
  • Lack of staff training in the recognition of and management of escalating and assaultive behaviors.
  • Increased wait times in emergency departments.

The Effects

Violence committed against healthcare workers negatively affects the delivery, quality, and accessibility of healthcare. It’s not only detrimental to the healthcare workers that are victimized but impacts the entire healthcare system as well. Healthcare workers that are assaulted can not only suffer from physical injuries and psychological trauma, but these assaults can also lead to decreased job satisfaction, cynicism, burnout, and caregivers leaving the industry. In addition to leading to fewer healthcare resources being available in our communities, this can lead to increased costs for organizations. These costs can come in the form of paying overtime to fill open positions, paying for staffing services, or increased costs associated with recruiting. According to the 2021 National Healthcare Retention & RN Staffing Report, “the average cost of turnover for a bedside RN is $40,038 and ranges from $28,400 to $51,700 resulting in the average hospital losing between $3.6 million to $6.5 million per year. Each percentage change in RN turnover will cost/save the average hospital an additional $270.800 per year.” Regardless of the size of an organization, this represents real money that could be used elsewhere.

Mitigation and Prevention Strategies

As we know, workplace violence is a complicated issue, but one that we as healthcare security professionals must work diligently to address. Although not all-inclusive, here are some of the ways we can positively affect the number of incidents.

  • Planning: Every healthcare organization, regardless of its size, should have a workplace violence prevention plan. This is not only in the best interest of the organization and the employees but also a regulatory and accreditation requirement. All plans should be unit-specific and continually reviewed to ensure their effectiveness.
  • Training: The single greatest tool we can employ is by requiring all employees to attend de-escalation training that focuses on recognizing and responding to agitated and abusive patients and family members. If we can teach them to recognize early warning signs such as a raised voice, pacing, or clenched fists, the employee can start trying to de-escalate the situation by asking calmly about their concerns and seeking a solution. Additionally, training should be easy to learn and support the retention of physical techniques in avoiding or disengaging when grabbed or choked.
  • Early warning: Implement a “flagging system” in the EMR, or Electronic Medical Record, that alerts triage staff and other healthcare workers about a patient’s history of violence and potentially some of their triggers. This ensures they are better prepared to respond to difficult situations and can take positive measures to eliminate potential violence.
  • Technology: Ensure the presence of sufficient security technologies, including panic buttons that can be worn by employees or downloaded onto mobile devices or desktop computers are some of the newest tools healthcare security departments are using to reduce workplace violence. Some of these downloadable panic alarms can also be used to warn employees to avoid areas during security incidents such as active shooter events. Just like cameras, panic buttons must be monitored to be effective.
  • ·Data: Mandatory reporting of workplace violence is another way for healthcare administrators to gain a truer understanding of the scope of the problem in their organizations. A study by the American Journal of Managed Care stated that although three-quarters of workplace violence incidents reported are occurring in healthcare, only 30% of nurses and 26% of emergency department physicians report violence. This suggests the situation is far more prevalent than we know. One reason for this is a belief by some healthcare workers that violence is simply part of the job. Accurate reporting is critical in that it allows hospital administrators and security directors to see when, where, and how incidents are occurring, and by reviewing this data, mitigation plans can be formulated and implemented. This means having a clear and consistent process to report incidents of workplace violence and encouraging staff to press charges as appropriate.
  • ·Legislation: Currently, 38 states have passed laws specifically designed to protect healthcare workers from assault. However, the laws in most of these states narrowly define healthcare workers into small sectors, such as emergency department workers, mental health workers or emergency medical technicians. Another legal consideration that applies to healthcare workers is EMTALA, or the Emergency Medical Treatment and Labor Act of 1986, which states that emergency departments must treat all patients seeking care, regardless of their abusiveness. This means that providers must medically clear these abusive patients before they can discharge them.


To reduce healthcare violence, protect our employees and better serve our communities, we as healthcare security leaders must seek innovative, evidence-based solutions to address the issue of workplace violence.

About the author: Eric Sean Clay, MSc, CHPA, CPP, PCI, currently serves as the Vice President of Security Services for a major healthcare system, providing security leadership for 450 security and law enforcement officers at the System’s seventeen hospitals and 250 care sites. He previously served as a homeland security advisor to Missouri's Governor and worked overseas as a security consultant, traveling to over 35 countries, and providing services to a diverse group of clients.