violence at the workplace presentation

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• Health Topics A-Z

About Workplace Violence

• Workplace violence can happen to any type of worker in any work setting, though some workers have a higher risk.
• Workplace violence can cause long-term effects, both physical and psychological.
• NIOSH funds, conducts, and publishes research to reduce workplace violence.

Workplace violence is the act or threat of violence. It ranges from verbal abuse to physical assaults directed toward people at work or on duty. Violence can occur in any workplace and among any type of worker.

The impact of workplace violence can range from psychological issues to physical injury, or even death.

The risk for fatal violence is greater for workers in sales, protective services, and transportation. The risk for nonfatal violence resulting in days away from work is greatest for healthcare and social assistance workers.

Workplace violence prevention course for nurses‎

Quick facts and stats.

According to the Bureau of Labor Statistics, 20,050 workers in the private industry experienced trauma from nonfatal workplace violence in 2020. These incidents required days away from work. 1

Of those victims who experienced trauma from workplace violence:

• 73% were female
• 62% were aged 25-54
• 76% worked in the healthcare and social assistance industry
• 22% required 31 or more days away from work to recover
• 22% involved 3-5 days away from work

According to the Bureau of Labor Statistics, 392 U.S. workers died from workplace homicide in 2020. 2

Of those victims who died from homicide:

• 81% were men
• 44% were aged 25-44
• 28% were Black
• 18% were Hispanic
• 30% performed retail-related tasks (e.g., waiting on customers)

Programs and initiatives

NIOSH funds, conducts, and publishes research focused on risk factors and prevention strategies for workplace violence.

Employers, occupational safety and health professionals, and workers can use the following resources to reduce occupational violence.

• Indicators of Workplace Violence, 2019 NIOSH Publication No. 2022-124
• Basic dos and don’ts for employees to prevent workplace violence NIOSH Infographic (2020)
• Violence on the Job NIOSH Publication No. 2004-100D
• Online Workplace Violence Prevention Course for Nurses NIOSH Publication No. 2013-155
• Emergency Medical Services Workers: How Employers Can Prevent Injuries and Exposures NIOSH Publication No. 2017-194
• Violence: Occupational Hazards in Hospitals NIOSH Publication No. 2002-101 En español
• Help for the Holidays: Preventing Fatigue, Violence, and Stress in Retail NIOSH Blog: December, 2023
• Reducing Workplace Violence in Gasoline Stations and Convenience Stores NIOSH Publication No. 2023-121
• NIOSH Fast Facts Taxi Drivers How to Prevent Robbery and Violence NIOSH Publication No. 2020-100 Revised

Journal articles

• Trends in workplace homicides in the U.S., 1994–2021: An end to years of decline American Journal of Industrial Medicine: April, 2024 / 67(6):562-571
• Workplace violence against healthcare workers using nationally representative estimates of emergency department data, 2015-2017 American Journal of Industrial Medicine: April, 2023 / 66(4):333-338
• Occurrences of workplace violence related to the COVID-19 pandemic, United States, March 2020 to August 2021 International Journal of Environmental Research and Public Health: November, 2022 / 19(21):14387
• Workplace violence and the mental health of public health workers during COVID-19 American Journal of Preventive Medicine: March, 2023 / 64(3):315-325
• Workplace violence during the COVID-19 pandemic: March-October, 2020, United States Journal of Safety Research: September 22, 2022 / 82:376-384
• Symptoms of depression, anxiety, post-traumatic stress disorder, and suicidal ideation among state, tribal, local, and territorial public health workers during the COVID-19 pandemic — United States, March–April 2021 Morbidity and Mortality Weekly Report: July 2, 2021 / 70(26):947-952
• Impact of a crime prevention ordinance for small retail establishments American Journal of Industrial Medicine: June 2021 / 64(6):488-495

More on workplace violence‎

• Bureau of Labor Statistics (2020). TABLE R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury or illness, private industry, 2020 .
• Bureau of Labor Statistics (2020). Fatal occupational injuries by selected worker characteristics and selected event or exposure, All U.S., all ownerships, 2020.

National Institute for Occupational Safety and Health (NIOSH)

The Occupational Safety and Health Act of 1970 established NIOSH as a research agency focused on the study of worker safety and health, and empowering employers and workers to create safe and healthy workplaces.

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Workplace Violence Training for Supervisors

This is a sample presentation intended for delivery to supervisors and other individuals who manage employees. It is designed to be presented by an individual who is knowledgeable in both employee relations and managing workplace violence. This is a sample presentation that must be customized to include and match the employer’s own policies and practices. 

For the best experience, download this presentation using Google Chrome.

Workplace Violence Training for Supervisors  (PPT)

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Workplace Violence Prevention Resources

This page provides links to materials developed by The Joint Commission as well as government resources and those from professional associations (such as the American Nurses Association and the American Hospital Association) and related organizations. The tabs below organize the resources according to source: From The Joint Commission, Federal Resources, State Resources, Professional Associations, and Other Resources. We encourage healthcare organizations to share their experience under the heading of “From the Field” and welcome suggestions for improvement.

This website is not intended to serve as an exhaustive or exclusive repository of publicly available resources related to Workplace Violence Prevention. Nor does it offer any endorsement of the source nor of any particular product, health care organization, or service, nor should it be construed as a statement that the source, health care organization, or its products or services, are superior to those of other source or company. Many of these resources were not developed or validated by The Joint Commission. Approaches utilized by organizations spotlighted in this website are not inclusive of all organizational approaches that may be successful in addressing workplace violence prevention, and strategies may need to be tailored by organizations to meet the unique needs of their setting and patient population. By accessing and using website resources, website users agree to make no claim of any kind against The Joint Commission for any and all damages that result from use or implementation of any website content. Some items included on these pages (such as Joint Commission monographs) were developed several years ago. While much of the content remains relevant, users should be aware that the information has not been updated.

Workplace Violence Prevention Compendium of Resources

This document was created as a resource to assist Joint Commission-accredited hospitals and critical access hospitals in preparation for the new requirements that became effective on 1/1/2022.

Information on Joint Commission Standards

The joint commission defines workplace violence as:.

An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.

The Hospital Workplace Violence Prevention standards are effective as of January 1, 2022. The new standards can be reviewed via the R3 document by clicking on the button below.

View the Hospital R3 Report

The Behavioral Health & Human Services Workplace Violence Prevention standards are effective as of July 1, 2024. The new standards can be reviewed via the R3 document by clicking on the button below.

View the Behavioral Health & Human Services R3 Report

More information on revised requirements and webinar.

View the webinar

To submit a question related to the standards.

Submit a standards question

• From the Field

File a Patient Safety Complaint

From the joint commission.

• Sentinel Event Alerts and Quick Safety Newsletters
• Presentations
• Take 5 Podcast: Workplace Violence  
• Emergency Management Portal
• Joint Commission Resources Newsletters
• Joint Commission Resources and OSHA Alliance

Federal Resources

• CMS Center for Clinical Standards and Quality Memo Workplace Violence-Hospitals (November 28, 2022)
• Agency for Healthcare Research and Quality (AHRQ)
• CDC/National Institute of Occupational Safety and Health (NIOSH)
• Occupational Safety and Health Administration (OSHA)
• U.S. Department of Homeland Security (DHS)
• Federal Bureau of Investigation (FBI)
• U.S. Government Accountability Office (GAO)
• Office of the Assistant Secretary for Preparedness and Response (ASPR)
• U.S. Department of Veterans Affairs (VHA)

State Resources

• OSHA State of Oregon: Violence Prevention Program online course (March 2023)
• Massachusetts Department of Mental Health
• Minnesota Department of Health
• Washington State Department of Labor & Industries

Professional Associations

• Society of Hospital Medicine (March 2023)
• American Hospital Association (AHA)
• American Nurses Association (ANA)
• American Psychiatric Association (APA)
• American Psychiatric Nurses Association (APNA)
• Emergency Nurses Association (ENA)
• International Association for Healthcare Security and Safety (IAHSS)
• Oregon Association of Hospitals & Health Systems (OAHHS)

Used with permission.

Other Resources

• Article in Workplace Safety and Health titled “Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout” (March 2023)
• ECRI Institute
• Canadian Centre for Occupational Health and Safety
• Crisis Prevention Institute
• Depression and Bipolar Support Alliance (DBSA)
• Institute for Healthcare Improvement (IHI)
• i Advance Senior Care
• National Safety Council
• Ontario Safety Association for Community and Healthcare
• Willis Towers Watson (for senior living communities)
• Joint Commission Blog Posts
• Joint Commission Podcasts
• Joint Commission Presentations
• Joint Commission Research Resources
• Agency for Healthcare Research and Quality
• American Hospital Association
• American Nurses Association
• American Psychiatric Association
• American Society for Healthcare Risk Management
• CDC/National Institute of Occupational Safety and Health
• Compendium of Resources
• Depression and Bipolar Support Alliance
• Emergency Nurses Association
• Federal Bureau of Investigation
• Government Accountability Office
• DHS/Healthcare and Public Health Sector Coordinating Council
• iAdvance Senior Care
• Implementing Strategies for Safer Healthcare Organizations Webinar
• Institute for Healthcare Improvement
• International Association for Healthcare Security and Safety
• Occupational Safety and Health Administration
• Office of the Assistant Secretary for Preparedness and Response
• Oregon Association of Hospitals & Health Systems
• Sentinel Event Alert and Quick Safety newsletters
• U.S. Department of Veterans Affairs
• Willis Towers Watson

Prioritizing our Healthcare Workers: The Importance of Addressing the Intersection of Workplace Violence and Mental Health and Wellbeing

Workplace violence impacts the mental health and wellbeing of the healthcare workforce. The negative outcomes not only affect the healthcare worker but can trickle down to patient safety and satisfaction. It is important that healthcare institutions implement workplace violence prevention programs that benefit the entire healthcare workforce. This blog post highlights current efforts across government and industry to address this critical issue.

The Healthcare Workforce

There are roughly 15 million healthcare workers employed in the United States. This includes home health aides and nursing assistants, physicians, nurses and nurse practitioners, mental health counselors, massage therapists, and pharmacy and emergency medical technicians. Current Population Survey estimates for 2022 reveal women make up 85% of the almost 5 million employed as healthcare support workers (e.g., home health aides, nursing assistants, psychiatric aides) and 50% of physicians and dentists. Nearly 25% of healthcare support workers are Black, compared with less than 10% of physicians and dentists. A large proportion of healthcare workers are between 25 and 34 years old and 28% were born outside of the United States. It is important that workplace violence prevention programs benefit the entire health workforce, including all ages, genders, and racial and ethnic backgrounds, and those who come to the U.S. to provide patient care.

Workplace Violence and Healthcare

Workplace violence is the act or threat of violence, ranging from verbal abuse and threats to physical assaults directed toward persons at work or on duty. Workplace violence has even occurred offsite when perpetrators stalk victims in anger and revenge. The two types of violence that most often lead to nonfatal injuries in the healthcare industry are:

• violence that is directed at a healthcare worker from the patient, patient’s family member, or visitors, and
• violence that is directed at a healthcare worker from a colleague, supervisor, or other co-worker.

Another type of violence that can occur in the healthcare industry is:

• violence that is directed at a healthcare worker from someone they have a personal relationship with, such as an intimate partner or family member.

Workplace violence in the healthcare industry accounted for a rate of 14 nonfatal injuries involving days away from work per 10,000 full-time equivalents (FTEs) in 2021-2022 (BLS, 2023a). This is more than triple the overall rate for all industries combined (4.3 per 10,000 FTE) (BLS, 2023a). While healthcare workers make up 10% of the workforce , they experience 48% of the nonfatal injuries due to workplace violence (BLS, 2023b). Healthcare workers experiencing workplace violence may experience suicidal ideation, posttraumatic stress disorder, depression, anxiety, burnout, and continue to feel anger and fear and other emotions (Nigam et al, 2023; Lanctot & Guay, 2014). In addition to understanding the perpetrator’s relationship to the healthcare worker, it is also critical to identify the triggers and the goals of the violence (i.e., determining if it is reactive or predatory) to prevent recurrence.

In addition to the various health issues that can result from workplace violence, there are many costs associated with workplace violence in healthcare. Workers’ compensation insurance will typically pay the cost of a workplace injury in treatment and lost wages (OSHA, 2015), with other costs including the replacement of a healthcare worker, lower patient satisfaction (McHugh et al, 2011), and reduced patient safety (e.g., medication errors, patient infections) (Hall et al, 2016).

The Impact of Workplace Violence on Mental Health and Wellbeing

According to a 2023 CDC Vital Signs report, more than double the number of healthcare workers reported harassment at work in 2022 than in 2018 – rising from 6% in 2018 to 13% in 2022. The impact of this harassment on healthcare worker mental health is substantial. Workers who experienced harassment at work were more likely to report feelings of anxiety, depression, and burnout.

NIOSH launched the Impact Wellbeing campaign in October 2023 to provide hospital leaders evidence-informed solutions to reduce healthcare worker burnout, sustain wellbeing, and build a system where healthcare workers thrive. In March 2024, NIOSH released the Impact Wellbeing Guide , a tested tool designed to help hospital leaders and executives accelerate or supplement professional wellbeing work in their hospitals at the operational level. This includes fostering a safe work environment .

The Impact of Workplace Violence on Patient Safety

In 2023, the Agency for Healthcare Research and Quality (AHRQ) convened a subcommittee of its National Advisory Council to establish goals for the National Action Alliance for Patient and Workforce Safety . The first aim of the Alliance is to facilitate healthcare systems’ commitment to performing safety self-assessments , including assessing their approaches to support workforce safety.  The subcommittee noted early in its discussions that patient and healthcare worker safety are intrinsically linked. This conclusion is supported by recent research that has reported on the intersection of patient safety culture, healthcare worker burnout and workplace violence (Kim et al, 2022; Kim et al, 2023). Kim et al found that in most instances, a positive patient safety culture was associated with lower workplace violence and lower workforce burnout scores (Kim et al, 2022), and a culture of reporting workplace violence—when it occurs—may reduce the effect of burnout on patient safety (Kim et al, 2023). The AHRQ’s Surveys on Patient Safety Culture TM (SOPS © ) include the Workplace Safety Supplement Item Set , which measures items describing healthcare workers’ perceptions of workforce safety (Zebrak K et al, 2022). Topics of emphasis include:

• Workplace hazards
• Moving, transferring, or lifting patients
• Addressing workplace aggression from patients or visitors
• Workplace aggression policies, procedures, and training
• Addressing verbal aggression from providers or staff
• Supervisor, manager, or clinical leader support
• Hospital management support
• Workplace safety and reporting
• Work stress/burnout

Risk Factors for Workplace Violence in Healthcare Settings

In 2013 NIOSH released a free, interactive online course designed to help healthcare workers better understand the scope and nature of violence in the workplace. According to the Workplace Violence Prevention for Nurses online training , the following are some of the risk factors for patient-based workplace violence:

• Substance use or misuse
• Patients who are in pain
• History of violence by the patient
• Cognitive impairment
• Accessibility to healthcare workers
• Increased stress (such as confusing signage or disturbing noise levels in the facility)
• Security measures that limit staff’s ability to respond appropriately to violent incidents
• Complacent attitudes towards workplace violence prevention
• Inadequate security procedures and protocols
• Lack of staff training and preparedness

See Unit 3 of the training to learn more about risk factors for patient-based violence.

The following are some of the risk factors for co-worker-based workplace violence:

• Stressful and emotional work
• Inadequate interpersonal, coping or conflict management skills
• Productivity demands
• Cost containment requirements
• Embedded hierarchies
• Changing professional roles
• Staff and schedule changes

See Unit 4 of the training and publications cited above for more risk factors and details.

What Employers Can Do

Employers in the healthcare industry can take steps to prevent workplace violence including:

• Engaging employees in efforts to promote a safe workplace
• Implementing violence prevention programs using guidelines established by OSHA
• Providing training in workplace violence such as the NIOSH free online training
• Meeting standards for workplace violence prevention set forth by The Joint Commission
• Collaborating with other institutions, organizations, and other beneficiaries to implement best practices for workplace violence prevention in the healthcare industry
• Creating a formal system for threat assessment after a first incident, to understand the drivers for the assault
• Incorporating tracking systems in the clinical chart/records management system

What Hospitals Are Doing to Mitigate Workplace Violence

Hospitals and health systems report that workplace violence and intimidation make it more difficult for staff to provide quality patient care. Nurses, physicians, and allied health professionals cannot provide attentive care when they are afraid for their personal safety, distracted by disruptive patients or family members, or traumatized from prior attacks. The American Hospital Association (AHA) prioritizes addressing workplace violence and its impact on health worker wellbeing. Guided by its Task Force on Workforce, the AHA has issued a report on strategies and resources for supporting the health and well-being of healthcare workers.

Further, the AHA’s Hospitals Against Violence (HAV) initiative shares examples and best practices about workplace and community violence prevention. The Building a Safer Workplace and Community framework guides health care leaders through building a culture of safety, mitigating risk, violence intervention strategies, and trauma support. The framework also highlights the critical components for success in designing a violence mitigation strategy, including data collection, accountability, and training and education at all levels of the organization.

This year, on June 7, AHA is hosting the eighth annual #HAVhope Friday , a national day of awareness to highlight how America’s hospitals and health systems combat violence in health care settings and in communities. AHA invites all interested parties to join #HAVhope Friday to see how hospitals and health systems use partnerships, innovations and creative thinking to foster peace and make a safer environment for workers and patients.

Government Efforts to Mitigate Workplace Violence

The Occupational Safety and Health Administration provided a Road Map in 2013 for safety and health management systems in hospitals that is still relevant today. It provides 6 core elements:

• Management leadership
• Employee participation
• Hazard identification and assessment
• Hazard prevention and control
• Education and training
• System evaluation and improvement

The Road Map defines the core elements, justifies their importance, describes what is needed to incorporate them, and offers best practices and examples. These safety and health management system principles are also expanded upon even more specifically with regard to addressing workplace violence in OSHA’s 2015 Guidelines for Prevention of Workplace Violence for Healthcare and Social Service Workers (OSHA Publication 3148).

OSHA staff also collaborated with NIOSH, the Veterans Health Administration (VHA), and private sector researchers to develop a checklist with criteria statements to support internal audits of institutional programs. These criteria statements provide straight-forward approaches to evaluating whether a program contains critical elements. The checklist follows the general structure of the OSHA Guidelines for Preventing Workplace Violence for Healthcare and Social Services Workers. Other OSHA efforts include:

• A request for information (RFI) on Prevention of Workplace Violence in Healthcare and Social Assistance industry sectors in 2016.
• A public meeting on workplace violence prevention in healthcare and social assistance industries in 2017.
• A potential rule to address Prevention of Workplace Violence in Healthcare and Social Assistance is on OSHA’s regulatory agenda .
• Under the requirements of the Small Business Regulatory and Enforcement Fairness Act (SBREFA), OSHA engaged with a diverse set of representatives from small businesses and non-profit entities in healthcare and social assistance industry sectors in Spring of 2023 to receive input on the potential impacts of a workplace violence prevention regulation .
• In addition to guidance, OSHA has developed Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence , which provides guidance and procedures to be followed when conducting inspections and issuing citations related to occupational exposure to workplace violence.

The Joint Commission

The Joint Commission published a report that crosswalks each workplace violence prevention standard with the supporting requirements, rationale, and references (The Joint Commission, 2021). The report contains important statements on program completeness. Recently, an update was published for behavioral healthcare and human services organizations (The Joint Commission, 2023). In addition, the Joint Commission recently developed an overview tool for de-escalation, with practical summaries for implementation through the Quick Safety 47: De-escalation in Healthcare (The Joint Commission, 2019).

In addition to the online training and the Impact Wellbeing campaign mentioned above, NIOSH researchers continue to conduct research on workplace violence . NIOSH supports health worker wellbeing through the Total Worker Health Program® , Healthcare and Social Assistance Program and the Traumatic Injury Prevention Program .

In addition to helping lead the National Action Alliance for Patient and Workforce Safety on behalf of HHS, AHRQ is supporting a new funding opportunity to address to explore systems-based approaches to improve patient safety by improving healthcare worker safety and well-being.

Workplace Violence Prevention Matters

Efforts to address the mental health and wellbeing of our nation’s workforce must include the prevention of workplace violence. Share with us in the comment section below how your workplace has addressed violence against health workers.

Cammie Chaumont Menendez, MS, MPH, PhD, Research Epidemiologist with the Division of Safety Research, National Institute for Occupational Safety and Health

Elisa Arespacochaga, MBA, Vice President, Clinical Affairs and Workforce, American Hospital Association

Robyn Begley, DNP, RN, NEA-BC, FAAN, Chief Executive Officer and Chief Nursing Officer, American Hospital Association

Melissa Bhatnagar, PharmD, MPA, Senior Staff Service Fellow with the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality

Priscilla Ross, Executive Director, Executive Branch Relations, Senior Director, Federal Relations, American Hospital Association

Megan E. Schaefer, Group Vice President, Governance, American Hospital Association

Christina Spring, MA, Associate Director for the Office of Communications, National Institute for Occupational Safety and Health

The Agency for Healthcare Research and Quality and the Occupational Safety and Health Administration also contributed to this blog.

Arbury S, Collins NR, Magtahas J, Holmes M, Hodgson MJ.  OSHA Workplace Violence Enforcement. .J Occup Environ Med. 2022 Apr 1;64(4):e211-e216. doi: 10.1097/JOM.0000000000002482. Epub 2022 Jan 11.PMID: 35019893

Bureau of Labor Statistics. 2023a. Table R8. Annualized incidence rates for nonfatal occupational injuries and illnesses involving days away from work, restricted activity, or job transfer (DSR), days away from work (DAFW), and days of restricted work activity, or job transfer (DJTR) by industry and selected events or exposures leading to injury or illness, private industry, 2021-2022. Accessed online 2.21.24 at https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.bls.gov%2Fiif%2Fnonfatal-injuries-and-illnesses-tables%2Fcase-and-demographic-characteristics-table-r8-2021-2022.xlsx&wdOrigin=BROWSELINK .

Bureau of Labor Statistics. 2023b. Table R12. Number of nonfatal occupational injuries and illnesses involving days away from work, restricted activity, or job transfer (DART), days away from work (DAFW), and days of restricted work activity, or job transfer (DJTR) by occupation and selected events or exposures leading to injury or illness, private industry, 2021-2022. Available at: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.bls.gov%2Fiif%2Fnonfatal-injuries-and-illnesses-tables%2Fcase-and-demographic-characteristics-table-r12-2021-2022.xlsx&wdOrigin=BROWSELINK .

Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. 2016. Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One, 11(7):e0159015. Doi: 10.1371/journal.pone.0159015.

Kim S, Kitzmiller R, Baernholdt M, Lynn MR, Jones CB. 2022. Patient safety culture: The impact on workplace violence and health worker burnout. American Association of Occupational Health Nurses. 71(2). https://doi.org/10.1177/21650799221126364

Kim S, Lynn MR, Baernholdt M, Kitzmiller R, Jones, CB. 2023. How does workplace violence-reporting culture affect workplace violence, nurse burnout, and patient safety? Journal of Nursing Care Quality. 38(1):11-18. https://doi.org/10.1097/NCQ.0000000000000641

Lanctôt N & Guay S. 2014.  The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and Violent Behavior, 19(5):492-501. https://doi.org/10.1016/j.avb.2014.07.010

McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. 2011. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2):202-210.

Nigam JAS, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. 2023. Vital Signs: Health worker-perceived working conditions and symptoms of poor mental health — Quality of Worklife Survey, United States, 2018–2022. MMWR, 72(44):1197-1205. https://www.cdc.gov/mmwr/volumes/72/wr/mm7244e1.htm .

NIOSH. 2013. Workplace Violence Prevention for Nurses. 2013-155. Available at: https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit4_6 .

Nowrouzi-Kia et al. 2019. Antecedent factors in different types of workplace violence against nurses: A systematic review. Aggression and Violent Behavior. 44:1-7.

Occupational Safety and Health Administration. 2015. Workplace violence in healthcare: Understanding the Challenge. No. 3826. https://www.osha.gov/sites/default/files/OSHA3826.pdf .

The Joint Commission Division of Healthcare Improvement. Quick Safety: De-escalation in healthcare . Issue 47, January 29, 2019.

The Joint Commission, Sentinel Event Alert. June 18, 2021 update. Available at: https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea-40-intimidating-disruptive-behaviors-final2.pdf

The Joint Commission. R 3 Report/ Requirement, Rationale, Reference. Workplace Violence Prevention Standards. Issue 30, June 18, 2021. https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3_20210618.pdf.

The Joint Commission. R 3 Report/ Requirement, Rationale, Reference. Workplace Violence Prevention in Behavioral Health Care and Human Services. Issue 42, December 20, 2023.  https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpv-for-bhc-r3.pdf.

Zebrak K, Yount N, Sorra J, Famolaro T, Gray L, Carpenter D, Caporaso A. 2022. Development, pilot study, and psychometric analysis of the AHRQ Surveys on Patient Safety Culture TM (SOPS © ) workplace safety supplemental items for hospitals. International Journal of Environmental Research and Public Health. 19(11):6815. https://doi.org/10.3390/ijerph19116815

2 comments on “Prioritizing our Healthcare Workers: The Importance of Addressing the Intersection of Workplace Violence and Mental Health and Wellbeing”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy » .

“EMT life: saving lives, racing against time, and maybe grabbing a coffee in between.” Thank you [Rohit Sen]

Prioritizing the mental health and wellbeing of healthcare workers is crucial, especially considering the intersection of workplace violence. It’s imperative to address this issue to ensure a safe and supportive environment for those who dedicate their lives to caring for others.

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Free White Paper: Workplace Violence Prevention for California Employers

California employers have long been required to provide a healthful and safe environment for their employees — not just related to workplace injuries and illnesses, but also in reducing the risk of workplace violence. Overall, employers haven’t had any specific requirements around workplace violence other than to generally prevent and mitigate it — but that changed when California Senate Bill (SB) 553 was signed into law on September 30, 2023, establishing new workplace violence prevention standards .

Beginning July 1, 2024, nearly all California employers must comply with the state’s general industry workplace violence prevention standards — and CalChamber’s free Workplace Violence Prevention for California Employers white paper covers what employers should know about these new requirements.

New obligations under the law include:

• Developing and implementing a workplace violence prevention plan;
• Training employees on the plan;
• Identifying, evaluating and correcting workplace violence hazards;
• Creating workplace violence incident logs; and
• Various recordkeeping requirements. 

The Workplace Violence Prevention for California Employers white paper answers several important questions for employers, including:

• Which employers are covered?
• What qualifies as workplace violence?
• What is a workplace violence prevention plan?
• What type of training is required?
• How do employers identify workplace violence hazards?
• How do employers respond to workplace violence incidents? 
• What documentation is required?

Because there is no “one-size-fits-all” solution for employers that must create and implement a workplace violence prevention program that fulfills all obligations under the law — each employer’s program must be uniquely tailored to the specific conditions of their worksites and operations — this white paper also lists resources available to help employers better understand and complete these obligations.

Workplace Violence Prevention for California Employers  is now available for nonmembers. CalChamber members can  access the white paper here .

At CalChamber, we’re all about helping California businesses do business. We provide expert guidance and advocacy for California employers so businesses like yours can comply with frequently changing labor laws and thrive in a heavily regulated environment. Not a CalChamber member? Learn more about  how HRCalifornia can help you .

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Updates on workplace violence prevention, AI rules, right to disconnect

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Here’s a mid-year update of topics addressed in earlier columns.

Workplace violence prevention plan July 1 deadline

My Jan. 1 column addressed new Labor Code section 6401.9 that requires California employers to establish a workplace violence prevention plan by July 1.

The plan must include, among other things:

• The names or job titles of those responsible for implementing the plan;
• How employees may help identify, evaluate and correct workplace violence hazards;
• How the employer will process reports of workplace violence;
• How employees may report a workplace violence incident to the employer or law enforcement without retaliation; and
• How employees will be alerted to the presence, location, and nature of actual or potential workplace violence emergencies, plus evacuation and sheltering plans as appropriate.

Cal-OSHA has posted a customizable model plan . Employers may choose instead to adopt their own plan, either as a standalone plan or as part of their existing injury Illness and Prevention Program.

Workplaces where fewer than 10 employees are working at any time and that are inaccessible to the public are exempt from the new law. That means a publicly accessible workplace with fewer than 10 employees present must comply, as must a publicly inaccessible workplace with more than 10 employees present at any time.

Covered employers must provide employee training about their plan by July 1. There is no grace period according to the posted frequently asked questions . The training must include, among other things:

• The employer’s plan, how to access it, and how to participate in developing and implementing it;
• How to report workplace violence incidents;
• Workplace violence hazards specific to the employees’ jobs; and
• An interactive Q&A with someone knowledgeable about the plan.

Adoption of AI regulations imminent

Last August, this column alerted employers to draft artificial intelligence regulations concerning workplace decision-making being considered by the California Civil Rights Council, the rule-making arm of the Civil Rights Department.

The council probably will adopt the new rules when it meets July 18. If adopted, the rules will, among other things, prohibit employers from using any automated decision-making system to evaluate applicant or employee skills, target job advertisements, or measure aptitude, attitude or cultural fit that would have an adverse impact on a protected class. The regulations also will prohibit any third party, such as a vendor, from designing, selling, or using an automated decision-making system that facilitates unlawful discrimination.

An employer will be able to defend its use of an automated decision-making system that has a discriminatory effect by showing using the system “is job-related for the position in question and consistent with business necessity and there is no less discriminatory policy or practice” that would accomplish the employer’s goals.

The new rules highlight the risk of impermissibly using AI-generated tests in hiring. Labor Code section 12940(e) generally prohibits an employer from making a pre-offer “medical or psychological inquiry of an applicant.” Once an offer has been made, but before employment begins, an employer generally may make such an inquiry evenhandedly if the inquiry “is job-related and consistent with job necessity.”

The new rules identify tests commonly used in automated decision-making systems that may constitute an unlawful inquiry, including (1) personality-based questions that test for personal or emotional stability and (2) puzzles or games that evaluate physical or mental abilities.

In its statement of the rule’s rationale , the council says “a test measuring reaction time could screen out people with disabilities affecting their processing speed,” for example. Results from these tests may not reflect whether someone can perform a particular position with or without accommodations. Therefore, any test not demonstrably job-related could constitute an impermissible medical or psychological inquiry.

“Right to disconnect” bill shelved

In April, I wrote about AB 2751 , which would have given virtually all California employees a “right to disconnect” from their employers outside their scheduled working hours. The bill failed to advance in the Assembly; it is dead at least for this year.

My column identified some of the measure’s many flaws. But if providing employees with a right to disconnect would be bad law, it may be good management. That judgment, however, should rest with each employer.

Eaton is a partner with the San Diego law firm of Seltzer Caplan McMahon Vitek where his practice focuses on defending and advising employers. He also is an instructor at the San Diego State University Fowler College of Business where he teaches classes in business ethics and employment law. He may be reached at [email protected] .

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How we’re implementing the National Plan to End Gender-Based Violence

The Women’s Bureau co-led the shaping of the Plan’s economic security and housing stability pillar, which aims to change harmful work cultures, address the root causes of gender-based violence in the world of work, and improve economic security for workers and survivors experiencing gender-based violence and harassment. Many of the actions outlined in this pillar drew inspiration from the International Labour Organization's (ILO) Convention on Violence and Harassment (Convention 190) . While the U.S. has not ratified Convention 190 and it is not binding on U.S. employers, it is the first international treaty to recognize the right to a world of work free of violence and harassment. 

Here are four key actions the Women’s Bureau has taken to implement the Plan:

In September 2023, the Women’s Bureau awarded the first Department of Labor grants exclusively focused on ending gender-based violence and harassment in the world of work . Over $1.5 million was awarded to five community organizations working across 14 states to build awareness of gender-based violence and harassment in the world of work, connect workers and survivors to their workplace rights and benefits, and implement worker- and survivor-driven strategies to shift workplace norms and culture. The grant program, Fostering Access, Rights and Equity (FARE), is now accepting Fiscal Year 2024 applications through May 28, 2024 .

Shortly after the Plan was released, the Women’s Bureau  signed a memorandum of understanding with the ILO Office for the U.S. and Canada to engage in joint events and activities concerning gender-based violence and harassment, including uplifting the principles of Convention 190 in U.S. policies, programs and practice. Together we are engaging stakeholders around the country and across sectors to discuss effective worker- and survivor-driven solutions to eliminate gender-based violence and harassment in the world of work. Since announcing our partnership, the Women’s Bureau has held about 40 regional convenings that have brought together workers, employers, unions, worker advocates, government representatives and others.

The Women’s Bureau also partnered with the Department of Labor's Occupational Safety and Health Administration on a webinar series that emphasized that gender-based violence and harassment is a workplace safety and health issue that has psychological and physical impacts on workers. The series featured discussions with workers, worker advocates, employers, and representatives from unions and the Equal Employment Opportunity Commission.

Finally, the Women's Bureau created a webpage on gender-based violence and harassment and published fact sheets, issue briefs and blogs throughout the year. Our fact sheet on gender-based violence and harassment in the world of work discusses key terminology, lists examples and outlines the key initiatives in this space. It is available in English and  Spanish . 

Carrying out the vision of the National Plan will take continued effort, action and coordination for many years to come. We all have an active role to play in making our world of work, and our society as a whole, safer and more equitable. The Women’s Bureau is committed to implementing this vision by engaging with survivors, workers, unions, employers and government agencies to address and prevent gender-based violence and harassment in the world of work. 

Amy Dalrymple and Kate Miceli are Policy Analysts at the Women’s Bureau. Katrin Schulz is the Branch Chief of Grants, Communications & Planning at the Women’s Bureau.

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