New Handbook Tackles Workplace Violence Prevention in Healthcare

By Matt Phillion

Workplace violence in healthcare is its own epidemic: one that survey data puts some hard numbers on. According to a 2021 survey of nurses by Hospital IQ, 90% of respondents were considering leaving the profession in the next year, and 72% said they were experiencing burnout long before the COVID-19 pandemic.

To address this, the Crisis Prevention Institute (CPI) has published the Workplace Violence Prevention Handbook, a free resource detailing recommendations and strategies to help healthcare professionals across the board improve their organizations’ workplace violence prevention programming.

“We know that staff and providers are under a great deal of stress,” says AlGene P. Caraulia, vice president of integration and sustainability with CPI. “I’d consider workplace violence an epidemic within the healthcare arena.”

The problem of workplace violence is not news to the industry overall, says Caraulia. But things have changed. “We’ve known this has been an issue for over 40 years. In the old days, there was an attitude that it just comes with the territory: Grow a thick skin, and if you can’t handle it, you don’t belong in healthcare. That’s evolved for the better, but now people are saying, ‘There’s no reason I should go into work afraid,’ ” says Caraulia. “That was the first component that brought this book forward.”

Breaking the silos

CPI talked with healthcare professionals using focus groups and other avenues to look for ways the industry can do better. Those interactions were the genesis for the handbook’s development.

“In some of our sessions, it was like someone dropped a ton of bricks on us. They’re looking for guidance, [but] not just for what to do about workplace violence or how to respond to violent events,” he says. “This has to be a much broader discussion in nature. Organizations need to be able to not just address violent events but understand how to create comprehensive programs around this.”

By comprehensive, that means getting outside of the silos that are common in healthcare. “This program can’t just focus on a specific department. It’s not just security,” says Caraulia. “How do you address it across the board?” A strong workplace violence prevention program benefits not just the staff, but also patients, their families, and beyond, and it takes the entire village to solve this problem.

In developing the book, CPI also discovered a great deal of acknowledgment about the industry’s challenges related to violence prevention. One that rose to the top: ownership. “We talked a lot about executive ownership, which is a very interesting phrase,” says Caraulia. “Most of the time we talk about executive leadership, but when we talk about executive ownership, that’s someone at the executive level who is going to own the program. It can’t be someone like a CEO or CNO saying, ‘OK, I’ll develop the team and you’ll report back to me.’ When you have executive ownership, the dynamic changes significantly.”

Executives can lower barriers and come up with solutions, and focusing on ownership over leadership opens up buy-in from employees. “It also gives the opportunity for executives to significantly impact it for the better,” says Caraulia. “To hear executive ownership discussed wasn’t so much a surprise as a reaction of, ‘Wow, someone is saying it out loud.’ More ownership instead of just plain leadership.”

Balancing advocacy and staff support

When people discuss workplace violence, they often focus on the individual who is distressed, disruptive, or violent. “All the onus and responsibility for what’s taking place is there, but there’s a balancing act that needs to take place,” says Caraulia.

In North America, the concept of zero-tolerance policies for violence has grown more common. “And it’s true, no one should go into work and expect to be assaulted,” he says. “But there’s an interesting dynamic when we say zero tolerance: All of a sudden if someone is in distress—be it emotional, physical, psychological—and there’s a zero-tolerance policy in place, the person is kicked off campus and they’re not treated. You need to find a balance. We have to say no one should be assaulted, verbally or physically, but concurrently we know that people coming to us are in distress.”

A workplace violence prevention program has to simultaneously balance protecting staff and patients while also recognizing and minimizing the distress in the facility’s visitors. Unfortunately, programs must walk this tightrope at a time when the tenor of healthcare is decidedly worse: The pandemic has caused staff shortages, resource shortages, and a lack of time and money, all of which puts pressure on the system overall. The growing problem of violence has worsened those staffing shortages.

“Without question, it’s driving people out of the profession,” says Caraulia. “Everyone knows healthcare runs on what nurses are able to do, and when you have fewer of them or less experienced staff, that’s a huge issue.” Violent events make headlines all the time, in hospital workplaces and out, so the issue is top of mind for many professionals.

“If I’m afraid that workplace violence is going to impact my ability to provide the quality of care I’ve dedicated myself to, introducing an element of hesitation or second guessing, [then] we’ve got to enable staff members with the right tools and give them [the] ability to recognize these moments of crisis before they become moments of violence,” says Caraulia, “as well as how they can become more effective when they have to deal with a crisis.” The book is positioned to meet organizations where they are in their workplace violence prevention process, whether they’re just beginning to develop a program or expanding on one they already have.

Data also comes into play; with the right methods, capturing data can create a holistic picture of the culture around workplace violence prevention. Again, removing silos in an organization is key. It’s easy to look at security for this topic, or even risk management. But everyone is part of the care team, Caraulia notes—from nurses and physicians to executives and facilities staff.

“One of the most important first steps is building a program that is much more comprehensive, and executive ownership can drive that so it touches all elements within the organization, not just clinicians but environmental safety, nutrition workers, security staff,” he says. “Everyone has skin in the game and the ability to contribute to that culture, and you can’t have a culture that is compartmentalized.”

Compartmentalization is a problem related not just to people’s job responsibilities, but also to technology. If incident reporting involves the electronic health record (EHR), for example, but a nutrition service worker is the person threatened by a patient or family member, they don’t have access to the EHR to report that problem. Alternately, if security and clinicians use different forms for tracking incident reports, their facility can’t carry that data across departmental lines to get a comprehensive picture of what’s happening.

“These reports are rarely being merged or combined,” says Caraulia. “Or the nomenclature differs from the [EHR] to the security report. How do you compile all that data and make sure apples are compared to apples? That’s where executive ownership is key. They have the ability to expand across multiple domains.”

Shared reporting and nomenclature allows the accurate sharing of data with other environments. For example, if a patient who was involved in an incident moves from a hospital to an ambulatory site, the new location would have a full, clear picture of past events to help prevent or alleviate future incidents.

“We’re giving the book for free because we think it’s the right thing to do. Everyone is at a different place in their journey for workplace violence prevention,” says Caraulia. “And because of that, you can’t just say, ‘This is where you must start.’ We want to make sure it’s designed to enhance their journey and their current efforts, and expand them. At the end of the day, we’re here to make the workplace safer for staff, patients, and their families.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at