The violent workplace

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Dr. Eleanor Barbera
Dr. Eleanor Barbera

Last week a nurse, aide and police chief were killed at an Ohio nursing home, along with the gunman, who died of a self-inflicted gunshot wound. While it's impossible to prevent all tragic events, especially those involving an armed assailant entering the building despite an order of protection against him, there are ways to reduce the likelihood of workplace violence.

According to a 2014 Scientific American article, “Health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S., according to data from the Bureau of Labor Statistics.”

The article goes on to discuss the institutional acceptance of violence against nurses, the lack of violence prevention training and the implication from management that the employees were responsible for the assaults against them.

While the Scientific American article focused on nurses in a hospital setting, a 2016 study of nursing staff in long-term care facilities finds that “65% of the participants had experienced workplace violence while 41% believed that management shows little or no concern for their safety.”

I'm reminded of the many times over the years that residents have hit, spit on and otherwise abused nursing staff, and a team meeting was convened or a resident transferred to the psych hospital only after assaulting the doctor. If we want to retain staff, we need to convey that the safety of each individual is important regardless of their stature within the organization.

We also might hypothesize that people who have grown up in homes without violence are unlikely to stay in positions where they feel endangered; similarly, the staff members who stay have some level of comfort with aggressive behavior, perhaps due to exposure to domestic violence as children.  Research on the “cycle of violence” indicates that childhood exposure increases the likelihood of violent relationships as an adult.

If that hypothesis is true, it becomes even more crucial for the facility to set the standard that violence is not “normal” and that the safety of those in their community is paramount.

Reducing violence at all levels

To begin addressing the problem, training and procedures within the organization should be reviewed. The Joint Commission offers a number of recommendations to prevent workplace violence, including the following (see here for more):

•  Work with the security department to audit the risk of violence and to identify strengths and weaknesses.

•  Make improvements to the facility's violence prevention program.

•  Conduct thorough background checks of prospective employees.

•  Train human resource staff to ensure that the procedures used for disciplining and firing employees minimize the chance of provoking a violent reaction.

•  Train appropriate staff members in techniques to handle agitated and potentially violent family members.

•  Train supervisors to recognize signs of possible domestic violence in staff members and residents.

•  Ensure that there are counseling programs in place for those who become survivors of workplace violence.

The Occupational Safety and Health Administration (OSHA) has guidelines for preventing workplace violence specifically for healthcare and social service workers, including long-term care facilities. The document is an excellent resource and provides specific actions and details on how to evaluate facilities and revamp procedures.

It's also worthwhile to assess how instances of resident-to-resident and resident-to-staff aggression are handled because they are frequent and they set the tone for the work environment. Staff members need to know how to reduce agitation and handle combative residents and to be able to rely on the administration to assist them with difficult situations.

We live in a world of unpredictable violence and we count on those governing us to keep us as safe as possible. Similarly, direct care workers are relying on their management team to take steps to ensure their safety on the job. Using the resources listed above is a good beginning.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medal blogger in the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with more than 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at


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