How hospitals can reduce the risks of violence

Doctors and nurses have repeatedly sought to call attention to the increased level of violence they are facing in hospitals.

Four people were killed in a shooting at a medical building on the campus of the Saint Francis Health System in Tulsa, Okla. in June. Two doctors, a receptionist and a patient lost their lives.

A nurse and a social worker were fatally shot in the maternity unit at Methodist Dallas Medical Center in Dallas, Texas in October. The suspect had been assaulting his girlfriend before shooting the healthcare workers, police said.

And on Saturday, a woman shot and killed her terminally ill husband inside AdventHealth Daytona Beach Hospital. No one else was injured, but the woman pointed her weapon at three other individuals, and she remained in the room for hours before a SWAT team took her into custody, police said.

Healthcare workers are dealing with enormous stress as they find themselves being assaulted by patients or family members, says Marisa Randazzo, executive director of threat management of Ontic, a security firm that works with health systems.

“They are continuing to experience a high level of violence, particularly patient-directed violence, but also family-directed violence targeting their healthcare providers, the nurses, the techs, the doctors,” Ranazzo told Chief Healthcare Executive.

In addition, healthcare workers are also dealing with increased violence, or at least hostility, from fellow co-workers, she says. After nearly three years of dealing with the COVID-19 pandemic and growing staff shortages, doctors, nurses and other healthcare workers have been pushed to the limit.

Hospital and healthcare executives can take important steps to improve the safety of their workplaces and at least reduce the risk of violent encounters, Randazzo says.

• Read more: Better communication can curb violence in hospitals

Healthcare leaders need to make sure employees know about those safety measures. And they need to be listening when doctors and nurses say they don’t feel safe at work.

“So much of good security and violence prevention work goes on without employees knowing it, but right now, hospitals and healthcare are facing a situation where so many employees feel unsupported, and therefore feel unsafe,” Randazzo said.

“It’s not enough to just do the work,” she said. “It’s really important to make sure that all employees at these hospitals and healthcare facilities know of all the violence prevention work that’s going on.” (See part of our conversation with Marisa Randazzo in this video. The story continues below.)

Ask staff questions

Doctors and nurses haven’t been shy about describing their frustrations with increasing violence in hospitals. Most emergency doctors said they have seen rising violence, and many said they are frustrated their organizations aren’t doing more to prevent it, according to a September survey by the American College of Emergency Physicians.

Doctors and staff at children’s hospitals have also faced threats and harassment for providing gender-affirming care.

Healthcare leaders can tackle one aspect of security by simply reaching out to employees and asking about their concerns, Randazzo says. Executives should consider taking surveys of staff to gauge their perceptions of safety and workplace violence.

Even if those surveys don’t offer good news, organizations would send a message to employees that their opinions matter.

“It can be tremendously helpful to do a survey of all of your staff around their current concerns,” Randazzo says. “How safe does this place feel? They may be scared or reluctant to do a survey like that, thinking the results are not going to be good.”

“If the results are not good, you can turn it into an opportunity,” she adds.

If healthcare workers don’t feel safe, then the hospital or health systems can start initiatives to improve safety.

Organizations that take such a step will also send a message that they are paying attention to their workers’ concerns. Nurses have frequently said they don’t think their hospitals care about their safety.

“The fact that you’re willing as an administration to ask for that input is very important and can really demonstrate care for your employees’ well-being and safety,” Randazzo says.

Healthcare leaders also must strive "to communicate effectively, and frequently, all the different things that the hospital or healthcare facility may be doing," she adds.

“Whatever you are already doing around workplace violence prevention, you may be doing a tremendous amount, but if it’s not known to the employees, it’s important to find ways to communicate those efforts,” Randazzo stresses.

Hospitals can include reminders about resources in company newsletters, or include signs in bathrooms or break rooms to indicate where employees can turn if they need assistance or to report aggressive behavior from patients, families, or fellow employees.

“The perception of safety is a really important component to workplace violence prevention,” she says.

Some doctors have said they are frustrated that the individuals attacking healthcare workers haven’t been prosecuted.

Organizations can be in a bind if law enforcement agencies or prosecutors opt against pressing charges, which commonly happens in incidents that don’t result in serious injuries, Randazzo says. A hospital does not decide if an assailant is prosecuted, but that doesn’t stem the bitter feelings of employees who have been attacked.

And that underscores why healthcare executives need to be talking regularly about safety and protecting workers.

“I think the perception that employers aren’t doing enough is very real,” Randazzo says.

Reducing risks

Health systems shouldn’t simply assume that violent incidents are going to happen and they can’t be avoided.

“A common misperception or misunderstanding within hospitals and healthcare is that there’s nothing you can do to prevent violence, particularly targeted violence,” Randazzo says.

In the spirit of busting myths, Randazzo also wants to address another commonly held view that violence prevention is the sole domain of security.

‘There is a mistaken belief that this is just a problem for their security departments and security personnel to solve,” she said. “The reality is workplace violence is minimized across different industries most effectively when it’s a multidisciplinary effort.”

“It’s security, it’s HR, it’s looking at your counseling services that may be available for employees,” she adds. “Getting input from front-line personnel in the emergency department, in accounts payable, in different departments that often get those more irate interactions.”

Health systems should also look at training of all healthcare workers, from clinicians to custodians, in de-escalating strategies. “Those are skills that all staff, including volunteers, can benefit from having,” she says.

Workers should be encouraged to take notice of patients or family members who may be upset, and to flag a nurse or supervisor to inform them about a potential problem, she said.

Hospitals need to track violent incidents so they can learn from them and also take additional steps to protect workers and patients, Randazzo says. Systems can learn if they need to add security or make other changes to improve working conditions.

“I can’t emphasize enough, this ability to capture and store incidents in a database or some sort of software format is vital for healthcare and hospitals,” Randazzo says.

Healthcare organizations can conduct periodic reviews of violent incidents to determine trends. Seeing data year over year can provide hospitals valuable insight.

“That can really help hospitals and healthcare facilities learn about where their high-risk areas are, or high-risk practices may be in place, and to help put mitigation measures around those as well,” Randazzo says.

‘Trauma-informed approach’

Health systems should take a “trauma-informed approach” to supporting employees, Randazzo says. Organizations can help workers who have been through trauma by providing more choices, she says.

Some companies outside of healthcare have tried to help workers by giving them more freedom to work remotely or to pick different shifts. Hospitals and health systems don’t necessarily have that luxury: most doctors and nurses can’t work remotely, for the most part.

But giving some choices, such as when they work, could help workers who are struggling with the stress after an attack, or simply dealing with the ongoing threat of violence.

“The flexibility over when, the flexibility to be able to exert some control over your preference, over aspects of your job, any ability to exert some control over their situation can really help people who have experienced trauma, and help them to return to more productive levels,” Randazzo says.

“The more that you can take as an employer a trauma-informed approach, the more you can increase the positive climate of the workplace, where employees feel like the employers care about their well-being and care about their safety.”