Workplace Violence in Health Care

A recent review article (JP Phillips. NEJM 2016; 374: 1661-9) discusses the topic of workplace violence against health care workers in the U.S.  Fortunately, this is a topic of which I do not have any expertise. But, on reading, I was fascinated how common this occurs despite a high likelihood of being underreported and largely ignored.

For starters, there are four types of workplace violence.   Type II, in which the perpetrator is a customer or patient of the workplace is thought to be most common.  In hospitals, one survey indicated that this accounted for 93% of all assaults.  Other types of violence include perpetrator who has no association to workplace/employee (type 1), perpetrator who is a current or former employee (type III), or a perpetrator with a personal relationship with employee, such as ex-husband (type IV).

Two areas in medicine experience the highest rates of violence: the emergency room and the psychiatry ward.  In both situations, mental illness, narcotic-seeking behavior, and intoxication may play a role.


  • Nurses and nursing aides are victimized at the highest rates, likely due to increased contact time.  In the Minnesota Nurses’ Study, the annual incidence of verbal and physical assaults was 39% and 13% respectively.
  • ER nurses had a 100% reporting verbal assault and 82.1% reporting physical assault during the previous year.
  • Physicians: one-quarter of ER physicians reported being the targets of physical assault in the previous year.  A much higher rate of verbal threats were noted within the previous 12 months: 75%.
  • Weapons are used in <1% of type II episodes of violence in the health care workplace.


  • There are no clear solutions.
  • The author advocates not overlooking verbal threats.  “The ‘broken windows’ principle, a criminal-justice theory that apathy toward low-level crimes creates a neighborhood conducive to more serious crime, also applies to workplace violence.”  Addressing verbal threats may prevent escalation.
  • To ensure a safe environment, more reporting on this problem is needed along with investigations of potential mitigating strategies.

My take: I have had been yelled at before and I was quite shocked.  This is a topic that is not discussed widely in training and probably should be.

Gibbs Gardens

Gibbs Gardens


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