Workplace Violence in Healthcare Organizations

Workplace violence can be prevented by creating a workplace environment and organizational culture that prevents the problem, protects employees, and pursues strategies for change. The presence of official policies or codes of ethics in the workplace is not enough on its own. Those policies must also be strictly enforced, so that all employees as well as patients feel safe and supported. The United States Department of Labor and OSHA (2016) define workplace violence as "any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site." Moreover, the Department of Labor (2016) reports that almost 20% of the 11,370 reported incidents in one year occurred in nursing and residential care facilities. Healthcare workers are five times more likely to experience assault or violence than workers in any other sector (Thompson, 2015). Henry & Ginn (2014) claim that these incidences cannot be tolerated, and that effective leadership styles and strategies are the most important and effective tools in preventing workplace violence in the healthcare sector. Effective leadership will determine the need for changes in human resources, as well as administrative efforts including risk assessments and total quality management.

The most effective leadership style to address concerns of workplace violence is engaged leadership because there is "a direct connection between engaged leadership, workplace security and organizational success," (Whitmore, 2012, p. 1). An engaged leader cares about both patients and employees in meaningful ways, taking all concerns and complaints seriously. Moreover, an engaged leader cares about the organization itself and is committed to creating an organizational culture free from violence and where violence is not tolerated. Preventing violence might entail deep changes to organizational policy and procedures, including shifts in scheduling, in hiring and employee training practices, and in treatment delivery. As Trotto (2014) points out, patient violence against healthcare workers can be triggered by long wait times in emergency rooms, when patients are suffering and their pain is taken out on employees. Minimizing wait times or better addressing the needs of patients who have long waits would be one way of reducing the potential for violent outbursts. Similarly, violence occurs in situations involving psychiatric patients who are not being properly cared for (Trotto, 2014). Administrators and human resources management can work harder to train employees in how to identify patients who may potentially become violent. Finally, patients who are known to be violent can be handled in ways that reduce the potential for violent behavior. Each of these changes to organizational procedure starts at the level of leadership and management, creating a safer workplace environment.

Simply increasing penalties for violence in the healthcare environment is not enough (Henry & Ginn, 2014). Leaders in healthcare need to focus attention on prevention. To do so, an engaged leader would solicit input from employees to determine the needs specific to the organization and its patient population. Evidence-based practice can inform new policies and procedures. As Henry & Ginn (2014) point out, engaged leaders attack the problem of workplace violence holistically through the use of diverse tactics like risk assessments, total quality management, training, and the development of written plans of action. The strengths of the engaged leadership style is that all employees take part in the decision-making process, and feel comfortable reporting incidents that would otherwise be ignored or dismissed as being part of the job duty (Thompson, 2015). Engaging with employees, leaders can dramatically shift the organizational culture within a relatively short time frame to reduce incidences of violence and improve responses to violence.

In addition to preventing incidences of violence, healthcare leaders must also be committed to following through with the appropriate action. Responding to violence may mean utilizing the law. Many cases of violence in the healthcare environment are felonies; healthcare leaders need to take their employees' sides when encouraging full prosecution. Some administrators might feel that a drawback of an engaged leadership style would be costs to the organization: financial and public relations costs. Yet the financial losses due to workplace violence far outstrip those that would be devoted toward legal protections. According to one assessment, "staff turnover associated with bullying and sickness can cost between $60,000 and $100,000 for RN replacement," (Thompson, 2015). Costs may increase if an issue is left unaddressed or ignored. This is particularly true in cases where the workplace violence is directed at patients. As Thompson (2015) points out, the healthcare leader should be fully engaged in keeping a workplace free of violence and abuse because malpractice, negligence, and other legal concerns could plague the institution. Patients who are victims of violence might also incur additional costs related to length of stay in the institution and subsequently, reduced reputation of the organization, and reduced patient satisfaction overall (Thompson, 2015). Involving law enforcement may seem distasteful to any leader fearful of preserving the reputation of the institution, but allowing justice to be served preserves the integrity of the healthcare organization in the long run. Engaged leadership has a long-term vision that creates a culture of nonviolence.

Some administrators might also claim that an engaged leadership style would be too costly in terms of requiring additional training for employees. Yet in some states, like California, employee safety training and violence prevention have become mandatory by law (Thompson, 2015). Trotto (2014) notes that the American Nurses Association has been lobbying Congress for federal laws that change workplace training to address the issue of violence. The training programs would aid in the process of changing organizational culture, but strong and engaged leadership is still necessary in seeing to it that the training is implemented at every level of the workplace. Supervisors need to also be trained into how to recognize early warning signs, and to offer ongoing assistance to employees who might be experiencing undue levels of stress or who are reporting abuse. Additional costs incurred from addressing the problem of workplace violence include the installation of surveillance and monitoring equipment that would help all employees work together to prevent all types of violence. An engaged leader understands that creating a culture of nonviolence means that each employee is made personally responsible and accountable not only for their actions, but also for the actions they observe in their coworkers.