Workplace Violence and Corporate Policy for Health Care Settings

Paul T. Clements; Joseph T. DeRanieri; Kathleen Clark; Martin S. Manno; Douglas Wolcik Kuhn


Nurs Econ. 2005;23(3):119-124. 

In This Article

Incidence of Violence in the Workplace

Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace. According to estimates of the Bureau of Labor Statistics, 2,637 nonfatal assaults on hospital workers occurred in 1999 (8.3 assaults per 10,000 workers). This rate is much higher than the rate of nonfatal assaults for all private-sector industries, which is 2 per 10,000 workers (USDHHS, 2002).

In 2001, the American Nurses Association released its Bill of Rights for Registered Nurses, which set forth the tenet that nurses have the right to work in an environment that is safe for themselves and their patients. However, studies have shown that between 35% and 80% of hospital staff have been physically assaulted at least once and that nurses are at great risk for violence while on duty (Arnetz & Arnetz, 2001; Bruser, 1998; Kinross, 1992; Lanza, 1996; Shepard, 1996; Whitehorn & Nowland, 1997; Williams & Robertson, 1997). Workplace violence in health care settings is not limited to physical assault. NIOSH (2003) has defined workplace violence as any physical assault, threatening behavior, or verbal abuse occurring in the workplace. The definition includes, but is not limited to, such events as beatings, shootings, rape, suicide or suicide attempts, and psychological traumas, such as threats to harm, obscene phone calls (also known as scatalogia), intimidation, or harassment, including being followed or sworn at.

Chavez (2003) reports that workplace violence continues because some employers simply fail to adequately address the problem. He posits:


This has not been purposeful but instead rather to a lack of awareness of the problem coupled with everyday workplace and industry pressures. It is conceivable that workplace violence prevention has not been given the priority it rates. This has resulted in employers being oblivious to some of the most obvious organizational factors that have contributed to scenes of unimaginable horror across the country. Some of those factors include:

  • A weak or nonexistent policy against all forms of violence within the organization;

  • Inadequate employee ac quisition, supervision, and retention practices;

  • Inadequate training on violence prevention at all levels;

  • No clearly defined rules of conduct;

  • Failure to introduce em ployees to antiviolence policies and prevention strategies;

  • Inability of managers and supervisors to adequately assess threats;

  • A nonexistent or weak mechanism for reporting violent or threatening be havior;

  • Failure to take immediate action against those who have threatened or committed acts of violence (p. 1).


The frequency and severity of aggressive incidents have not been well documented in the past. The stigma of victimization, such as shame, isolation, fear, or threat of further violence, has often deterred victims from reporting violent behavior (Hoff, 1992). Other variables, including underreporting of violent events, are correlated with lack of support from administration and management or the fear of reprisal, poor reporting mechanisms, excessive paperwork, and poor documentation and/or followup by hospitals (Arnetz & Arnetz, 2001; Kinross, 1992).


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