As I developed a training program on violence prevention, I reflected on a scenario I’ve witnessed many times in my career. A resident who had been physically aggressive toward aides and nurses got sent to the hospital only after he hit the attending physician.

Situations like this send the message to nursing department staff that they aren’t important, and that violence is just part of the job. That attitude explains why nurses are estimated to report violent behaviors just 30% of the time1.

Instead of accepting aggressive behaviors as normal, facilities would be wise to approach then as anomalies that can and should be addressed. As research indicates,2 aggression toward workers decreases staff satisfaction and increases burnout. Violence prevention efforts reduce turnover costs and improve morale, and result in fewer lawsuits and a reduction in worker’s compensation claims.

Violence prevention programs

According to the Occupational Safety and Health Administration, a violence prevention program has several key elements:

  • Management commitment and employee involvement
  • Worksite analysis
  • Hazard prevention and control
  • Training and education
  • Record-keeping and evaluation of program

The thrust of such programs is to support and encourage staff to report events so that there can be an accurate evaluation of the circumstances contributing to violence. Using the information gleaned from this analysis, adjustments are made to the environment and workers are trained to handle aggressive behaviors. These steps are followed by reevaluation and readjustment as needed.

The efforts can be remarkably effective. In one hospital-based program,3 Operation Safe Workplace, the incidence of violent behaviors was reduced by 55%! While hospitals have different factors contributing to these problems, such as a younger, more physically able population, there are many aspects of a long-term care environment that could be adjusted to reduce the likelihood of aggressive behaviors.

The institutional risk factors most associated with healthcare violence are:

  • Low staffing
  • Solo work with no easy access to backup
  • Lack of a coordinated program to address violence
  • Lack of training in de-escalation procedures

Low staffing is an obvious contributor to resident agitation, as well as to a host of other problems. Those who doubt the research4 should spend some time incognito in the day room of their facility and observe.

Employees who are easily able to contact coworkers for assistance through call systems are in a better position to prevent problems than those who have to shout down the hall for help. Nursing homes with staff members who are trained in de-escalation techniques will have fewer incidents of violence, especially in a facility where aggression isn’t considered the norm.

The hospital prevention program mentioned above offered additional insights. One of the “hot spots” for violence in a hospital is the waiting area. Similarly, times when nursing home residents are waiting for care can be problematic. Long periods of enforced togetherness with minimal personal engagement, especially in a loud, crowded environment with poor temperature control, can be a recipe for agitation.

Other parallels between hospitals and nursing homes include the need for increased collaboration between departments, enhanced understanding of violence prevention reporting and procedures, and the establishment of expectations for a generally respectful environment.

Many workers and facilities are resigned to accepting aggression from residents. Programs such as Operation Safe Workplace show that with management support, it’s possible to significantly reduce these incidents, saving money and improving the quality of life of residents and employees.

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 Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at