Workplace violence in healthcare can include threats, verbal abuse, harassment, intimidation, and physical assault directed at workers while they are on duty. Incidents may involve patients, family members, visitors, or other people. The issue should be addressed as an occupational safety concern—not treated as an unavoidable part of nursing or as a personal failure by the worker or patient.
Distress, pain, confusion, cognitive changes, or other clinical circumstances can affect behavior, but they do not make threats or assault acceptable. A safe response protects staff while treating patients respectfully and seeking appropriate clinical support.
Why a prevention program matters
Workplace violence can cause physical injury, psychological harm, disrupted work, and concerns about returning to a unit or role. Underreporting makes it harder for organizations to understand patterns and reduce risk. OSHA’s healthcare guidance emphasizes a coordinated prevention program that includes management commitment and worker participation, hazard analysis, prevention and control, training, and recordkeeping and evaluation.
Risk factors differ by setting
Potential risks may relate to a specific patient situation, the physical environment, staffing and workflow, or organizational practices. Examples can include long waits or confusing processes, limited ways to call for help, isolated work, inadequate staffing, or a lack of clear response procedures. These are prompts for worksite assessment—not a checklist for labeling individual patients as dangerous.
Risk assessment should be individualized and clinically informed. Diagnosis, disability, substance-use history, race, or another identity should not be used as a proxy for dangerousness. Focus on observable behavior, the immediate circumstances, relevant history available to the care team, and the safety plan.
Prevention strategies for healthcare organizations
1. Involve workers in hazard assessment
Ask nurses, aides, clinicians, security, and support staff where incidents and near misses happen, what contributes to them, and whether staff can get help quickly. Include different shifts, units, and work settings in the review.
2. Make reporting simple and nonpunitive
Give workers a clear way to report threats, verbal abuse, physical incidents, and near misses. Explain what happens after a report and protect staff from retaliation for raising safety concerns. Review reports for patterns, not only severe injuries.
3. Improve environmental and operational controls
Consider visibility, exits, alarms or communication devices, visitor processes, waiting-area design, staffing, and access to trained responders. Controls should fit the setting and be evaluated for unintended effects on patient access and dignity.
4. Train staff and supervisors
Training can cover recognizing escalation, respectful communication, calling for help, leaving an unsafe situation, role-specific response, and reporting. De-escalation is not a substitute for adequate staffing, security measures, or the right to withdraw from imminent danger.
5. Create clear response and post-incident processes
Define who responds to a threat, who contacts security or emergency services, how clinical care continues, and how to document and report the event. After an incident, offer prompt medical evaluation and practical support, including debriefing or employee assistance where appropriate. Review what system changes could reduce the chance of recurrence.
What a nurse can do during an escalating encounter
Follow your facility’s training and emergency procedures. If it is safe to do so, use a calm voice, listen without arguing, acknowledge the person’s immediate concern, and explain what you can do next. Give simple choices when possible, preserve personal space, and avoid blocking exits. Call a colleague, supervisor, security, or emergency response when risk is rising.
If there is an immediate threat or assault, prioritize safety: move to a safer location, summon help, and follow emergency procedures. Do not remain alone or attempt physical intervention unless it is within your training, role, and established policy. After the situation is safe, report the incident and seek support.
