Magnitude of Violence in the Healthcare Workplace
Violence against healthcare workers is a recognized, but difficult to quantify, problem in the United States. Many studies have concluded that underreporting, different methodologies, and varied source data (eg, occupation classification and injury severity level) are responsible for the wide range of national estimates of violence against healthcare workers.[1,2,3,4,5] The variation in survey instruments and research designs also compounds the difficulty in making meaningful comparisons among studies. Three diverse data sets will be presented in this article, each using a different measure to report workplace violence against healthcare personnel. Although each of these data sets examines a different level of injury severity, all demonstrate that workplace violence is prevalent in healthcare and that prevention strategies must be in place at all healthcare facilities.
National Electronic Injury Surveillance System (NEISS-Work Follow-Back Study)
In an effort to collect data specific to circumstances of workplace violence against healthcare workers, the National Institute for Occupational Safety and Health (NIOSH) and the Consumer Product Safety Commission (CPSC) partnered to use the CPSC's NEISS occupational supplement, NEISS-Work (which records only work-related injuries), to conduct a follow-back survey of victims of workplace violence who presented at NEISS-Work hospitals from December 2002 through mid-August 2003 and November 2003 through June 2004. Approximately 700 individuals from various industries were interviewed, 53% of whom worked in the healthcare industry. For this 15-month follow-back study period, the national estimate of assaulted workers for the healthcare service industry, using the Bureau of Census 2000 industry code structure (which includes non-direct care occupations, such as security guards), was 81,000 (95% confidence interval [CI], 46,000-117,000). Assaults on healthcare workers in direct care occupations numbered 69,000 (95% CI, 37,000-100,000), with a rate of 0.64 (95% CI, 0.34-0.93) per 100 workers. Although the number of assaults reported by healthcare workers in this follow-back study was more than double that in the other reportable occupations, the rate for protective service workers of 1.54 (95% CI, 1.01-2.02) per 100 workers was almost 2.5 times greater than that for healthcare workers.
Bureau of Labor Statistics Data
In 2007, the Bureau of Labor Statistics (BLS) estimated that 9950 assaults on workers in the "healthcare and social assistance industry sector" were severe enough that time off from work was needed to recover from the injuries. This is 59% of the estimated overall private sector incidents (n = 16,840) for this severity of injury. That same year, the rate of assault on healthcare and social assistance workers requiring time off from work as reported by the BLS was 8.3 per 10,000 full-time workers, a rate that was 4.6 times greater than the overall private industry rate of 1.8 per 10,000 full-time workers. The BLS also conducted the Census of Fatal Occupational Fatalities, which recorded an annual average of 21 workplace homicides for the healthcare and social assistance industry sector during 2003 through 2009. These data indicate that although healthcare workers represent only 4% of fatal workplace assaults annually, they account for the majority of nonfatal workplace assaults (59%) in the private sector.
National Crime Victimization Survey
A 2001 report by the Bureau of Justice Statistics (BJS) using the National Crime Victimization Survey (NCVS) reported that nurses were victims of workplace violence more than 61,000 times per year during 1993 through 1999 (21.9 per 1000 workers). During this same period, physicians were victims more than 10,000 times per year (6.2 per 1000 workers). Medical technicians accounted for just under 14,000 incidents per year (12.7 per 1000 workers). A 2011 report released by BJS indicates that the overall rate of workplace violence decreased 62% between 1993 and 2002 and by another 35% between 2002 and 2009. The overall rate of workplace violence was 5.1 per 1,000 employed persons aged 16 years or older for 2005 through 2009. The estimated number and rate of workplace violence compared with those in different healthcare occupations (on the basis of NCVS data for 2005 through 2009) are presented in Table 1.
Table 1. Nonfatal Workplace Violence, 2005-2009a
Rate per 1000 Employed Persons Aged 16 Years or Older
|Custodial care||27,200||37.6 b|
|Other mental health occupations||69,200||20.3|
aSource: National Crime Victimization Survey 2005-2009 data.
bOn the basis of 10 or fewer sample cases.
Summary of Data
These NEISS follow-back and the BLS nonfatal injury data are nationally representative of the number of assaults on healthcare workers that required treatment in an emergency department and involved days away from work, respectively. These 2 databases represent the more severe cases that required medical treatment (cases that are typically reported). The NCVS numbers demonstrate that many assaults go unreported because they do not require treatment for an injury.
Public Information from NIOSH and Medscape
Cite this: Marilyn Ridenour. Workplace Violence in the Healthcare Setting - Medscape - Sep 13, 2011.