Workplace 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).
NIOSH 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 health care providers / nurses and / or increasing the penalty associated with such behavior. There is variation between states as to which settings the law applies. Those states which require employer run workplace violence prevention programs include: CA, CT, IL, MD, MN, NJ, OR, WA.
NY is limited to public employers.
A MD ID Tag and Badges law has added staff protections by relaxing the requirement of using full names.
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, IN, IL, IA, KS, LA, MS, MO, NE, NV, NM, NY, NC, OH, OK, OR, PA, RI, SD, TN, TX, UT, VT, VA, WA, WV, and WI.
- MO went a step further with a law that establishes a penalty of a Class D for first offense and Class C for second or subsequent offense when creating a disturbance inside a healthcare facility or if interfering with an ambulance service.
Some of the penalties apply to specific healthcare workers / settings: only to emergency department personnel GA, HI, NC, SC, SD, OK; (KS) mental health personnel in select facilities; (MS) emergency and public health personnel.
- 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 (organization).
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 March 2021
- Incivility, Bullying, and Workplace Violence
ANA Position Statement - Approved 7/22/15
- The Violence Prevention in Health Care Facilities Act
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