According to the National Institute for Occupational Safety and Health, workplace violence includes any act or threat of violence directed toward people at work—from verbal abuse to physical assault. The Joint Commission expands this definition to include harassment, intimidation, bullying, sabotage, and sexual harassment. In healthcare, violence can come from patients, visitors, colleagues, or even spillover from personal relationships.
Healthcare professionals face an alarming share of this crisis. Between 2016 and 2020, the US Bureau of Labor Statistics reported 207 workplace violence-related deaths in healthcare and social services, alongside nearly 500,000 nonfatal assaults in 2020 alone. By 2021, healthcare workers were more than 6 times as likely to be injured by workplace violence compared to the average private industry worker.
Although headlines often highlight rare active shooter incidents, the more common and insidious threats are daily verbal abuse, bullying, and intimidation that erode morale and contribute to burnout. A recent study found that nearly 98% of healthcare professionals reported experiencing hostile patient behavior—yet fewer than half had received training in how to respond.
The causes are complex, ranging from patient behavioral health conditions and emotional distress to environmental stressors and staffing challenges. But the path forward is clear: healthcare organizations must invest in policies, training, and cultures of safety. Proactive communication, conflict resolution skills, and de-escalation training can empower staff, protect well-being, and ultimately improve patient care.
Strategies for Verbal De-Escalation
- Respect personal space; keep a safe distance
- Maintain a neutral, relaxed posture with arms at your sides
- Avoid sudden movements or rushing the patient
- Reduce environmental stressors (dim lights, lower noise, maintain comfortable temperature)
- Ignore inflammatory or challenging statements rather than engaging
- Use calm, respectful communication to defuse anger and build rapport
- If unsuccessful, follow institutional policy: notify staff, call security, consider restraints, and document
Recognizing Physical Violence Risks
- Be aware of environmental and social triggers (eg, long wait times, overcrowding, bad news, inadequate staffing, presence of weapons)
- Monitor for STAMP signs of escalating aggression:
- Staring/excessive eye contact
- Tone/volume of voice changes
- Anxiety (fidgeting, restlessness)
- Mumbling or repetitive speech
- Pacing/inability to sit still
- Consider validated assessment tools:
- Brøset Violence Checklist (BVC): Useful in ED, psychiatric, and medical-surgical settings (high specificity, moderate sensitivity)
- Aggressive Behavior Risk Assessment Tool (ABRAT): High sensitivity and specificity for ED patients
Strategies for Managing Threatening Behavior
- Stay Vigilant
- Continuously assess the environment for risks and changes in behavior
- Identify exits and hazards, and listen to intuition
- Position for Safety
- Keep an open path to the exit
- Avoid being cornered or trapped
- Know where emergency buttons, alarms, and communication systems are located
- Active Shooter Protocol: Run, Hide, Fight
- Run: Evacuate if safe, leave belongings, keep hands visible
- Hide: Lock/barricade doors, silence devices, disperse rather than huddle
- Fight (last resort): Use available objects to incapacitate the assailant; act decisively
This FBI video demonstrates the appropriate response to an active shooter. While we hope that you never need these skills, this video is an important resource that can prepare you should you ever find yourself in this situation.
Healthcare professionals are committed to caring for others, but personal safety must remain a top priority. By practicing de-escalation skills, recognizing early warning signs of violence, and knowing how to respond in threatening situations, clinicians can reduce risk for themselves, their colleagues, and their patients. Proactive training and situational awareness transform moments of vulnerability into opportunities for prevention and protection.
Want to discuss your specific risk challenges? Contact Catherine Mullaney, MHA at cbretz@med-iq.com.
