violence consists of physically and psychologically damaging actions that occur
in the workplace or while on duty (National Institute for Occupational Safety
and Health [NIOSH], 2002). The Bureau of Labor Statistics releases an annual
report about injuries and illnesses resulting in time away from work in the United
States. In the health care and social assistance sectors, 13% of days away from
work were the result of violence in 2013, and this rate has increased in recent
years (U.S. Department of Labor [DOL], Bureau of Labor Statistics, 2014). Examples of workplace violence include direct
physical assaults (with or without weapons), written or verbal threats,
physical or verbal harassment, and homicide (Occupational Safety and Health
Administration OSHA, 2015).
classifies workplace violence into four basic types. Types II and III are the
most common in the health care industry. (Types I and IV are not addressed in
this position statement.)
Type I involves “criminal intent.” In this type of workplace violence,
“individuals with criminal intent
have no relationship to the business or its employees.”
Type II involves a customer, client, or patient. In this type, an “individual
has a relationship with the
business and becomes violent while receiving services.”
Type III violence involves a “worker-on-worker” relationship and includes
“employees who attack or
threaten another employee.”
Type IV violence involves personal relationships. It includes “individuals who
have interpersonal relationships
with the intended target but no relationship to the business” (Iowa Prevention Research Center,
2001; NIOSH, 2006, 2013).
At this time, OSHA does not require employers to implement workplace
violence prevention programs, but it provides voluntary guidelines and may cite
employers for failing to provide a workplace free from recognized serious
hazards. Some states have legislated that employers develop a program
while the majority of states have advanced laws that amend existing statute for
assaults of first responders by adding nurses and /or increasing the penalty associated
with such behavior. There is variation between states as to which settings the
- Requires employer run workplace violence programs; CA, CT, IL, MD, MN, NJ, OR. NY is limited to public employers only.
- Reporting of incidents: WA.
Only those state with laws designating penalties for assaults that include "nurses" are reflected below:
- Establish or increase penalties for assault of "nurses": AL, AK, AR, AZ, CA, CO, CT, DE, FL, GA, HI, ID, IL, IA, KS, KY, LA, MA, MI, MS, MO, MT, NE, NV, NJ, NM, NY, NV, NC, OH, OK, OR, RI, SC, SD, TN, TX, UT, VT, VA, WV and WY.
Some of the states are setting specific - the law applies only to the emergency department personnel or mental health / psych. FL, GA, HI, SC, SD, KY, OK apply to emergency departments only;
mental health personnel (KS); public health personnel (MS);
- OH also authorizes hospitals to post warnings regarding violent behaviors.
- HI passed a resolution urging employers to develop and implement standards of conduct and policies for managers and employees to reduce workplace bullying and promote healthful and safe work environments.
Joint Commission Standard LD.03.01.01 Leaders create and maintain a culture of safety and quality throughout the (orgnaization).
A4. Leaders develop a code of conduct that defines acceptable behavior and behaviors that undermine a culture of safety.
A5. Leaders create and implement a process for managing behaviors that undermine a culture of safety.
(Applicable to ambulatory care, critical access hospital, home care, hospital, laboratory, long term care, Medicare-Medicaid, certification-based long term care, and office-based surgery programs and behavioral health care programs.)
Learn more about workplace violence
All efforts to capture state laws have been made, but exclusions are possible.
Last updated 01/ 2017