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Violence Prevention

Health-care environments present inherent risks of workplace violence, including aggression from patients, families, or visitors. Preventing such incidents is essential to ensure the safety of both staff and patients. By fostering collaboration among health-care leaders, front-line workers, and patients and families, we can create safer, healthier health-care environments.

Understanding Workplace Violence in Health Care

Violence in hospitals and health facilities is a complex issue, often stemming from the stress and emotional intensity of the setting. Patients and families may act out due to fear, frustration, or uncertainty during medical emergencies. Workplace violence in health-care environments can take many forms, from verbal threats to physical aggression.

Workplace violence is defined by The Occupational Health and Safety Act as:

  • The exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker,
  • An attempt to exercise physical force against a worker, in a workplace, that causes or could cause physical injury to the worker,
  • A statement or behavior that is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace that could cause physical injury to the worker.

Types of Workplace Violence

  1. Type I – External Perpetrator: The violent person has no relationship to the worker.
  2. Type II – Client/Customer: The violent person is a client or their family at the workplace who becomes violent towards a worker or another client.
  3. Type III – Employment Related: The violent person is a worker or has had some type of job-related involvement with the workplace.
  4. Type IV – Domestic Violence: The violent person has a personal relationship with an employee or client.

Examples of workplace violence may include: Punching, hitting, shaking fists, groping, pinching, biting, choking, spitting, shoving, pushing, stabbing, kicking, throwing object, sexual assault, and threats of assault.

Impact of Workplace Violence

Workplace violence in health care has far-reaching and often devastating effects, not only on individual employees but also on the broader health-care system. These incidents affect not only the workers involved but also their coworkers and the quality of care patients receive. The consequences can be physical, psychological, and organizational, creating ripple effects that harm both workers and the patients they care for.

Effects on Health-Care Workers

Workplace violence can seriously harm health-care workers, causing injuries that need medical care and time off work. For many health-care professionals, experiencing workplace violence may have a psychological and emotional toll, including:

  • Stress and Fear: Repeated exposure to violence fosters a culture of fear and hypervigilance, making workers anxious about their safety. This can lead to burnout, diminished morale, and challenges in maintaining focus during patient care.
  • Psychological Trauma: Verbal abuse, threats, and physical assaults can result in conditions such as post-traumatic stress disorder (PTSD), anxiety, and depression, severely impacting an individual’s mental well-being.
  • Low Productivity and Performance: Fearful or traumatized workers often struggle with concentration, leading to errors in care delivery and reduced efficiency. Over time, this negatively impacts the quality of patient outcomes and increases staff turnover.
  • Fatalities: In some cases, workplace violence has led to the tragic loss of health-care workers’ lives, underscoring the critical need for preventive measures.

Impact on Co-Workers and Team Dynamics

Workplace violence affects more than just the direct victim. When an incident occurs, the entire team feels the repercussions:

  • Reduced Team Cohesion: Witnessing or hearing about violence can cause stress among co-workers, leading to fear, resentment, or feelings of helplessness. This can erode trust and collaboration within teams.
  • Distraction and Low Morale: Violence creates an unsafe work environment that distracts staff from their primary focus—patient care. Team members may feel unsupported, especially if incidents are not addressed effectively by leadership.
  • Increased Workload: If a colleague is injured or unable to work due to violence, others may need to take on additional responsibilities, leading to overwork and further stress.

Repercussions for Patient Care and Systemic Quality

The effects of workplace violence extend beyond staff to the very core of health-care delivery:

  • Compromised Care Quality: Stress and fear reduce health-care workers’ ability to provide compassionate, attentive, and high-quality care. Patients may sense the tension, potentially eroding their trust in the system.
  • Interruptions in Service: Violent incidents can disrupt hospital operations, delay treatments, and lead to the temporary unavailability of essential staff.
  • Staff Turnover and Retention Challenges: Health-care workers may leave the profession due to repeated exposure to violence, exacerbating staffing shortages and increasing recruitment and training costs for organizations.

Legislation Support a Violence-Free Workplace

Laws are in place to protect health-care workers and ensure workplaces are safe and free from violence. These regulations hold employers, supervisors, and workers accountable for preventing and addressing violent incidents.

  • Workplace Safety & Health Act: The Workplace Safety & Health Act and Regulations (WSHA) requires employers to take every reasonable precaution to protect workers from violence and harassment in the workplace. The WSHA emphasizes that intent does not matter when violence occurs—whether intentional or not, the focus is on its impact and prevention. Key responsibilities include:
    • Developing and implementing workplace violence and harassment policies.
    • Providing staff with training on recognizing, preventing, and responding to violence.
    • Ensuring workers report all violent incidents and that appropriate actions are taken to address risks.
  • The Criminal Code of Canada: The Criminal Code applies to violent behavior in hospitals, just as it does in any other setting. Assault, threats, and other forms of violence are criminal offenses and can lead to legal consequences. These laws reinforce the idea that violence is unacceptable in health-care settings and provide legal avenues to hold offenders accountable. For example:
    • Assault: Any attempt or act of physical harm, including actions like hitting, spitting, or threatening harm.
    • Harassment: Repeated unwelcome behaviors, such as verbal abuse or intimidation.
  • Regional Health Authority Policies: Each Service Delivery Organization (SDO) has policies and procedures to report violent incidents and support staff available internally on the staff intranets.

Additional Resources

References

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