Workplace Violence Against Healthcare Practitioners


Incidents of Workplace Violence Against Healthcare Practitioners are extremely common in the United States. Moreover, it is observed that US hospital employees are at a higher risk of injury due to violence than employees in other industries (Arnetz et al., 2017). Considering that workplace violence threatens the health and psychological well-being of employees; decreases their morale, productivity, job commitment, and satisfaction; and results in poorer quality of care and increased staff turnover, it is essential to address this problem as promptly and as effectively as possible.

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Researchers distinguish four types of workplace violence, and the most common of one among them is type 2 assault, referring to “a situation in which the perpetrator has a legitimate relationship with the business and becomes violent while being served by the business” (Phillips, 2016, p. 1661). In other words, the majority of all violence cases are initiated by patients. As stated by Phillips (2016), “type II workplace violence accounted for 75% of aggravated assaults and 93% of all assaults against employees” in 2014 and, as it was already mentioned previously, the highest number of those instances were directed against healthcare practitioners (p. 1661). It is worth noting that even though the cases of fatal violence against employed adults are rather rare, nevertheless, they and in 25% of cases occur at the workplace (Phillips, 2016).

Besides threatening one’s health and life, any type of workplace violence has an extensive negative impact on a person and their performance. Exposure to workplace assaults adversely influences a practitioner’s professional quality of life by causing burnout (Itzhaki et al., 2018). Additionally, workplace violence significantly reduces practitioners’ job satisfaction and increases their intention to leave the profession (Zhao et al., 2018). Due to adverse effects of workplace violence on the level of work-related stress and healthcare providers’ commitment to their work, it is valid to presume that in hospitals where the rates of assault and harassment are high, the quality of care can suffer.

Ways to Minimize the Risk of Violence

It is impossible to eliminate violent episodes in healthcare, yet some measures may be undertaken to minimize their occurrence. According to the SIA Health Care Security Interest Group (SIA) and the International Association for Healthcare Security and Safety Foundation (IAHSSF) (2017), the process of security strengthening should start with the development of leadership/management commitment, design of HR strategies aimed to prevent and respond to violence, personnel education on relevant security issues, security staff empowerment, and establishment of partnerships with law enforcement personnel.

The SIA & IAHSSF (2017) also recommend utilizing advanced technologies, including surveillance systems, staff duress alarms, and mass notification systems, to monitor the workplace situation, identify risks, and take appropriate steps timely.

However, the use and enhancement of procedures aimed to curb workplace violence are regarded as the most important step by many professional organizations, including the ECRI Institute and the American Nursing Association (ANA). They emphasize the significance of enforcing the policies, standards, and organization-wide violence prevention systems and programs aimed to protect hospital employees and facilitate the creation of an-anti violence, preventive hospital cultures (ECRI Institute, 2017; ANA, 2019). Since HR 5223 requires employers “to adopt a comprehensive plan for protecting health care workers and other personnel from workplace violence,” its passage will substantially support the endeavors targeted at minimization of the incidence of workplace assault episodes in hospitals (“H.R.5223,” n.d.).

Theoretical/Regulatory Model Applicable to HR 5223

The passage and implementation of HR 5223 can be evaluated from multiple theoretical and regulatory perspectives. However, when it comes to abovementioned HR 5223 purposes and goals, they can be explained by applying the Ottawa Model of Implementation Leadership (O-MILe). Based on this model, to attain any improvement and cultural/organizational change, it is essential to develop core knowledge and skills needed to initiate interventions and implement right leadership behaviors aimed at creating a supportive climate (Gifford, Graham, Ehrhart, Davies, & Aarons, 2017).

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After that, leaders must influence organizational structures and processes through evidence-based practices, evaluate the impacts of those practices, and make appropriate corrections if needed (Gifford et al., 2017). Overall, HR 5223 emphasizes the role of employers/leaders in fostering the desired changes in hospitals in terms of workplace violence, whereas the O-MILe explains specific processes that hospitals’ administrative personnel and leadership may employ to adopt comprehensive violence prevention and response plans.


The major stakeholder group that would benefit from the passage of HR 5223 is comprised of healthcare practitioners. As the previously introduced research findings indicate, physicians, nurses, and other members of hospital teams who interact with patients daily face an increased risk of violence-related injuries and death. The adaptation of comprehensive plans as per HR 5223 may thus allow reducing this risk significantly, while also decreasing burnout rates among staff members, fostering greater job satisfaction and work commitment in them. As the risk of burnout will decline, multiple aspects of practitioners’ lives will be protected better because burnout is frequently manifested in poor overall health, insomnia, such psychological problems as depression and anxiety, relationship problems, substance abuse, and so forth (Salyers et al., 2017).

As workplace-related security threats are minimized and a safer employee environment is established, a chance to improve the quality of care appears since practitioners’ performance is directly affected the level of their burnout and overall well-being (Salyers et al., 2017). Therefore, two other stakeholder groups that would benefit from the passage of HR 5223 include patients and hospitals. As a result of better protection of hospital personnel against workplace violence, patients will have a greater chance to enjoy all potential favorable outcomes of patient-centered care: higher quality of interaction with practitioners, better adherence to interventions, improved health outcomes, and greater overall satisfaction with rendered services (Salyers et al., 2017).

It is also worth mentioning that along with excess staff turnover, poor patient safety is associated with substantial expenses because medical errors, which occur in unfavorable work environments more frequently, induce various preventable adverse events, prolonged hospital stays, and rehospitalizations (Khammarnia, Ravangard, Barfar, & Setoodehzadeh, 2015). Thus, by improving workplace security, HR 5223 may also lead to greater service cost-efficiency and cost-effectiveness, which is important for hospitals and the US healthcare system, in general.

Potential Barriers to HR 5223 Passage

As it was demonstrated in this presentation, the passage of HR 5223 can have a plethora of favorable impacts on various stakeholder groups and the US healthcare system, in general. Nevertheless, the passage may be hindered due to obstacles inherent in the legislative process. Firstly, legislators may vote against the act if they do not comprehend the urgency of the need to handle the situation with workplace violence in hospitals and the scope of detrimental effects of this problem on healthcare in the country.

Secondly, the assessment of the financial impact of the legislation may reveal that the implementation of HR 5223 can be too costly and economically infeasible, which, in turn, may convince legislators to vote against the act. Thirdly, there may be conflicts in interests between legislators and advocates. However, all three of these barriers can be overcome through efforts aimed to raise public awareness of the workplace violence against hospital employees, research and reporting on the matter of interest, advocacy, and active and respectful communication between medical practitioners and legislators.


American Nursing Association. (2019). Workplace violence. Web.

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Arnetz, J. E., Hamblin, L., Russell, J., Upfal, M. J., Luborsky, M., Janisse, J., & Essenmacher, L. (2017). Preventing patient-to-worker violence in hospitals: Outcome of a randomized controlled intervention. Journal of Occupational and Environmental Medicine, 59(1), 18-27.

ECRI Institute. (2017). Violence in healthcare facilities. Healthcare Risk Control. Web.

Gifford, W., Graham, I., Ehrhart, M. G., Davies, B., & Aarons, G. (2017). Ottawa Model of Implementation Leadership and Implementation Leadership Scale: Mapping concepts for developing and evaluating theory-based leadership interventions. Journal of Healthcare Leadership, 2017(9), 15-23.

H.R.5223 – Health Care Workplace Violence Prevention Act. (n.d.). Web.

Itzhaki, M., Bluvstein, I., Peles Bortz, A., Kostistky, H., Bar Noy, D., Filshtinsky, V., & Theilla, M. (2018). Mental health nurse’s exposure to workplace violence leads to job stress, which leads to reduced professional quality of life. Frontiers in Psychiatry, 9(59), 1-6.

Khammarnia, M., Ravangard, R., Barfar, E., & Setoodehzadeh, F. (2015). Medical errors and barriers to reporting in ten hospitals in Southern Iran. The Malaysian Journal of Medical Sciences, 22(4), 57–63.

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374(17), 1661-1669.

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Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475-482.

SIA Health Care Security Interest Group, & International Association for Healthcare Security and Safety Foundation. (2017). Mitigating the risk of workplace violence in health care settings. Web.

Zhao, S., Shi, Y., Sun, Z., Xie, F., Wang, J., Zhang, S.,… Fan, L. (2018). Impact of workplace violence against nurses’ thriving at work, job satisfaction and turnover intention: A cross-sectional study. Journal of Clinical Nursing, 27(13-14), 2620-2632.

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