Violence: Not in My Job Description

Laura A. Stokowski, RN, MS


August 23, 2010

In This Article

Risk Factors for Workplace Violence

In general, nurses are respected by patients and families. It is a minority of individuals who take their frustrations out on the people who are trying to help them. Unfortunately, however, violence against nurses in the course of their duties is increasing, and the reasons are varied and complex. The following might also be viewed as the risk factors for violence in healthcare settings, many of which also offer opportunities for prevention[1,3,9]:

  • Increasing number of handguns and other weapons carried by individuals;

  • Use of hospitals by police for criminal holds and care of acutely disturbed, violent individuals;

  • Increasing diagnosis of dementia and Alzheimer's disease among the general population and among hospital patients;

  • Caring for psychiatric patients in the ED;

  • Increased physical patient contact;

  • Trend of releasing acute and chronic mentally ill patients from facilities without adequate follow-up;

  • Perceived availability of drugs or money at hospitals;

  • Unrestricted movement of the public in hospitals;

  • Lack of or poorly controlled visitor policies;

  • Long waits in EDs or clinics and crowded, uncomfortable waiting rooms with no smoking permitted;

  • High numbers of drug or alcohol abusers, gang members, and trauma victims;

  • Distraught family members;

  • Misperceptions by patients or visitors of staff behavior (eg, laughter);

  • Holding or boarding patients in the ED;

  • Low staffing levels at certain times (eg, mealtimes), and inadequate staff in general;

  • Isolated work with patients in examination or treatment rooms;

  • Working alone in areas of hospital without backup or alarm systems;

  • Poorly lit parking areas and long walks to parking areas; and

  • Lack of staff training in recognizing and managing escalating hostile behavior.

In a sentinel event alert issued in June 2010, the Joint Commission noted that a factor in the increasing violence in hospitals is the fact that hospitals are open to the public around the clock every day of the year, so securing the building and grounds presents challenges.[3]It would be nearly impossible to thoroughly screen every person entering every facility. Areas where high traffic is coupled with high stress, such as the ED, are typically the hardest areas to secure.


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