Healthcare workers, especially nurses, are at a high risk of violence, largely at the hands of patients. Research shows that healthcare workers are at greater risk from violence than almost every other worker, and the problem is on the rise.1,2

“Over the last decade, healthcare workers have accounted for approximately two-thirds of the nonfatal workplace violence injuries involving days away from work,” according to John Howard, MD, director of the National Institute for Occupational Safety and Health, writing for the CDC.

Recognizing the risk, healthcare organizations are developing and sharing resources to help mitigate workplace violence. This is why The Joint Commission decided in 2018 to release Sentinel Event Alert #59, which was about physical and verbal violence against healthcare workers.

Government statistics show that healthcare workers are much more likely to be victims of violent acts than workers in most other occupations, says Coleen Smith, MBA, MSN, RN, director of High Reliability Initiatives at The Joint Commission Center for Transforming Healthcare. From 2002 to 2013, there were four times as many incidents of serious workplace violence among healthcare workers than there were among workers in private industry, according to the Occupational Safety and Health Administration (Read more at: The Joint Commission’s Sentinel Event Alert advises hospitals to monitor, report internally, and investigate these acts of workplace violence:

  • Injuries to patients or others;
  • Occupational injuries and illnesses;
  • Property damage;
  • Security incidents;
  • Hazardous material spills and exposures;
  • Fire safety management problems and failures;
  • Medical or laboratory equipment problems and failures;
  • Utility systems management problems and failures.

Ambulatory surgery centers (ASCs) and other healthcare sites also could follow these guidelines. The Joint Commission offers a public workplace violence prevention portal that provides specific examples of how healthcare organizations have addressed workplace violence.

It is important for healthcare organizations to create policies and procedures about workplace violence because of the way the subject often is misunderstood or unacknowledged.

“For many healthcare providers, being hit or assaulted by a patient they’re trying to help causes a kind of disconnect,” says Judy Arnetz, PhD, MPH, PT, professor and associate chair for research in the department of family medicine at Michigan State University.

Healthcare employees often feel guilty when a patient assaults them, and this is why they often do not want to report the incident, Arnetz explains. Healthcare organizations should make it clear that every incident should be reported. Staff might suffer from short- and long-term repercussions after an act of violence. In some cases, workers might leave their jobs or even their professions after experiencing violence in the workplace.

“We definitely have seen in our research that it leads to burnout, feelings of not enjoying your work any longer, and some studies saw that victims of violence physically distanced themselves from patients out of fear,” Arnetz says. “Even if it’s a patient with a psychiatric disorder or an older person with dementia, it can leave its mark psychologically.”

These all are reasons why healthcare organizations need to pay close attention to the potential for workplace violence and address these occurrences directly.

ASCs and other healthcare organizations should create an effective reporting culture to show staff that workplace violence is not tolerated, no matter who is the perpetrator. The Joint Commission’s focus on this issue is intended to address barriers to effective reporting of incidents of violence.

“The biggest barriers that healthcare organizations experience, inclusive of ambulatory surgery centers, are fear of punishment and the failure of leadership to let ‘reporters’ know what was done with their reports,” Smith says. “In the case of fear of punishment, this relates to the days when mistakes were cause for an entry in someone’s personnel record or even disciplinary action up to and including firing. As healthcare has moved toward safer practices, including establishing a strong patient safety culture, leaders have realized that errors and mistakes are the cost of being human, and most often these are the results of faulty systems and processes.”

Despite this, healthcare employees remain hesitant about reporting acts of violence. A prevention strategy could focus on education, communication, and creating a culture in which employees feel safe to report incidents.


  1. Havaei F, Macphee M, Lee SE. The effect of violence prevention strategies on perceptions of workplace safety: A study of medical-surgical and mental health nurses. J Adv Nurs 2019; Jan 15. doi: 10.1111/jan.13950. [Epub ahead of print].
  2. Larson LA, Finley JL, Gross TL, et al. Using a potentially aggressive/violent patient huddle to improve health care safety. Jt Comm J Qual Patient Saf 2019; Jan 9. pii: S1553-7250(18)30103-X. doi: 10.1016/j.jcjq.2018.08.011. [Epub ahead of print].