In 2012, the Healthcare and Social Assistance (HCSA) sector was amongst the largest industry sectors in the U.S. employing an estimated 19.4 million workers (13.5% of the total workforce)[1]. On average, over the last decade, U.S. healthcare workers have accounted for two-thirds of the nonfatal workplace violence injuries in all industries involving days away from work [2].  Healthcare workers face the risk of both physical violence and non-physical violence, such as verbal abuse, on the job.  These numbers represent only the assaults that resulted in time away from work and not the less severe physical injuries or the psychological trauma that HCSA workers experience from workplace violence. Additionally, these data only capture the reported incidents.  The literature suggests that the number of assaults reported by healthcare workers is greatly underreported.

Employers seeking to establish an effective workplace violence prevention program in the healthcare industry should incorporate prevention strategies that focus on risk factors from several perspectives including: clinical (patients under the influence of drugs or alcohol) [3,4,5]; environmental (physical layout, design, and contents of the workplace); organizational (policies, procedures, and culture) [3]; and social and economic (distraught family members and challenging economic circumstances) [3].  The 2002 NIOSH publication “Violence: Occupational Hazards in Hospitals” discusses prevention strategies in terms of environmental (installing security devices), administrative (staffing patterns), and behavioral (training).

NIOSH and its partners recognized the lack of workplace violence prevention training available to nurses and other healthcare workers. To address this need, NIOSH and healthcare stakeholders, including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. developed a new free on-line course aimed at training nurses in recognizing and preventing workplace violence.  The course also encourages nurses to become proactive in working with their employers to prevent violence in the healthcare setting.  The multi-media training incorporates text, videos depicting workplace violence incidents, testimonials from real nurses, and module quizzes. Nurses can also receive free continuing education credits for completing the online course.

The course has 13 units that take approximately 15 minutes each to complete and includes   “resume-where-you-left-off” technology.  This feature allows the user to complete any portion of the course, leave to do something, and return where they left off.

Focus groups provided input during the development of the training materials.  Additionally, the course was evaluated by 204 members of the American Nurses Association (ANA).  Here is what some reviewers said about the training.

“It’s a nice learning tool for both those new to the profession and for those with seniority.”

“We really liked the ‘resume-where-you left off’ technology.”

“The on-line course is an effective training tool for hospitals that wish to improve nursing staff’s ability to prevent, assess, and appropriately intervene in incidents of violence in the workplace.”

The course is available on the NIOSH website. It is explained in detail on the YouTube video Workplace Violence Prevention for Nurses Training. Please help us get the word out about this training and provide us with contact information for any organizations that you feel we should reach out to regarding the course.  For more information about NIOSH’s research and recommendations on workplace violence, visit http://www.cdc.gov/niosh/topics/violence/.

Dan Hartley, EdD; Marilyn Ridenour, BSN, MPH

Dr. Hartley is the NIOSH Workplace Violence Prevention Coordinator in the Division of Safety Research.

Ms.  Ridenour is a nurse epidemiologist in the NIOSH Division of Safety Research. 

1. NIOSH Division of Safety Research [2013].  Unpublished analyses of 2012 Current Population Survey micro data files.  Morgantown, WV: National Institute for Occupational Safety and Health,  Division of Safety Research.

2. Bureau of Labor Statistics (BLS). 2011. Employed persons by detailed industry, sex, race, and Hispanic or Latino ethnicity. http://www.bls.gov/cps/cpsaat18.pdf Accessed: August 28, 2012.

3. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care and social service workers. OSHA Publication No. 3148-01R 2004.

4.  Friedman RA. (2006) Violence and Mental Illness — How Strong is the Link? New England Journal of Medicine, 355, 2064-2066.

5. Gillespie GL, Gates DM, Miller M, Howard PK. Workplace violence in Healthcare Settings: Risk Factors and Protective Strategies. Rehabilitation Nursing. 2010; 35(5):177184.