The 5 Types of Workplace Violence

4 min • April, 23 2024

Workplace violence (WPV) within healthcare and the nursing profession is a startling and somber reality that many are actively seeking to address. In fact, according to the U.S. Bureau of Labor Statistics (BLS), nurses are five times more likely to be the victim of violence on the job than the average private sector employee. But why exactly is WPV so prevalent? According to NIOSH, “staff shortages, increased patient morbidities, exposure to violent individuals, and the absence of strong workplace violence prevention programs and protective regulations” all contribute to WPV. NIOSH also reports that anyone working in health care may become a victim of violence, and nurses and aides who have the most direct contact with patients are at highest risk.OSHA goes into greater detail on the risk factors for WPV in its Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers . 

Categories of WPV

In the past, there were four general categories of workplace violence that were recognized by researchers and NIOSH, and nurses will experience or witness each during their career:

1. Criminal intent. In criminal intent workplace violence incidents, the perpetrator usually has no relationship with the establishment and the primary intent is theft. Violence is rarely the intent but will frequently occur when the perpetrator perceives a potential interference with their theft. Within the healthcare system, the pharmacy and the emergency department are the most likely targets for criminal intent due to the presence of drugs and cash.
2. Customer/client. In the customer or client type of workplace violence, the perpetrator is the customer or client of the victim. Violence often occurs in the course of the normal duties of the worker. This is, by far, the most common type of violence that nurses face. The high likelihood for violence in which the patient (or their family) is the perpetrator is, in part, due to the high stress environment that healthcare is for patients. Risk factors also include “(1) unpredictable behaviors of patients and families who are often under emotional stress, as well as (2) organizational and systemic factors such as high-stress work environments, staff shortages, lack of organizational policies and staff training ”. In addition, in many facilities, there is a culture that expects violence as part of the job and deters reporting or pressing charges. Taken together, these make nursing a profession at high risk for violence perpetrated by the very people we are trying to help.
3. Worker on worker. In this kind of violence, the perpetrator is a current or former employee or coworker. Violence may occur up (directed at a supervisor), across (directed at a peer), or down (directed at a supervisee) the chain of command. Interpersonal and organizational conflict is most often implicated in this type of violence. Within the healthcare system, worker to worker violence is commonly intensified in times of high workload and short staffing, and in units that have a culture of mistrust or “eating their young”. Violence from coworkers can be the most devastating because these are the people that should be “in our corner”, that should be supportive and safe. Violence from patients can be somewhat understood, but violence from a team member is a deep betrayal of trust.
4. Personal relationship. Domestic violence may enter the workplace when a spouse, partner, or someone with a relationship with the employee outside of work follows an employee to work. The perpetrator can take advantage of knowing exactly where the employee is likely to be during work hours.

Ideological Violence as the 5th Type of WPV

Ideological workplace violence, often motivated by violent extremism, is directed at an organization, a particular group of people within the organization, and/or its property for ideological, religious, or political reasons. Active shooter incidents (when not perpetrated by a patient or their family) are most often in this category. Ideological violence is on the rise. Issues like reproductive rights, access to gender-affirming healthcare, and ongoing divisions on past COVID protocols and vaccinations have accentuated social and political divisions, and stoked fears among some violent extremists. Being aware and prepared is essential for all healthcare facilities.
 

As you can see in these different types and scenarios, workplace violence within the nursing profession is a real and significant problem. Everyone has an important role to play in preventing and eliminating workplace violence . Find additional WPV resources here . If you would like to be part of the solution, you can take action now.    

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