Addressing Workplace Violence in Post-Acute Care

Workplace violence is a widespread problem in the healthcare industry, affecting the safety and well-being of nurses. A new survey conducted by Nurse.com for the 2024 Nurse Salary and Job Satisfaction Report revealed a concerning trend in workplace violence in post-acute care settings. Nurses shared information about experiencing workplace violence that included verbal abuse, intimidation, physical assaults or abuse, and sexual assault or abuse not only by their patients or the patient’s family members but also by their colleagues (lateral violence).

The incidents were not isolated, with 9% of nurses in skilled nursing experiencing workplace violence every week, 6% in long-term care, 3% in home health, 2% in assisted living, and 2% in hospice care. Nurses shared that workplace violence negatively impacted their mental health and well-being.

The survey includes 1,635 nurses (45% of 3,662 respondents) from post-acute care settings: long-term care, skilled nursing, assisted living, hospice, home health, rehabilitation, and occupational health.

Below are some findings from the survey.

Violence by a patient or the patient family member

• 63% of nurses in skilled nursing reported verbal abuse, and 20% reported physical assault by a patient or the patient’s family member.
• 59% of nurses in home health experienced verbal abuse, and 16% experienced physical assault or abuse.
• 59% of nurses in long-term care experienced verbal abuse, and 24% experienced physical assault or abuse.
• 53% of nurses in assisted living reported verbal abuse, and 20% reported physical assault or abuse.
• 51% of nurses in hospice care reported verbal abuse, and 14% reported physical assault or abuse.

Lateral violence

• 59% of nurses in home health experienced verbal abuse, and 16% experienced physical assault or abuse.
• 59% of nurses in long-term care experienced verbal abuse, and 24% experienced physical assault or abuse.
• 53% of nurses in assisted living reported verbal abuse, and 20% reported physical abuse.
• 51% of nurses in hospice care reported verbal abuse, and 14% reported physical assault or abuse.
• 29% of nurses in skilled nursing reported verbal abuse, and 3% reported physical assault by their colleagues.

Impact on mental health and well-being

Among the aspects of work that negatively affected their mental health and well-being, nurses reported negative interactions with patients and families, being a witness to or a victim of workplace violence, negative or nonexistent relationships with colleagues, and a lack of responsive leadership. The highest rates of adverse mental health impacts came from the assisted living sector and the home health sector.

• 70% of nurses in assisted living were negatively affected by the lack of responsive leadership.
• 50% of nurses in home health were affected by negative interactions with patients and families.
• 48% of nurses in assisted living were impacted by negative or nonexistent relationships with colleagues
• 28% of nurses in home health were affected by being a witness to or a victim of workplace violence.

Most of the nurses responded that they were “somewhat satisfied” with the level of support their organization provides for their mental health and well-being:

• 45% of nurses in assisted living
• 40% in hospice care
• 37% in long-term care
• 37% in skilled nursing
• 35% in home health

“Workplace violence in post-acute care settings is a multifaceted issue that requires a comprehensive approach, said Vince Baiera, BSN, Post-Acute Care Partner at Relias. “Organizations must invest in robust training programs, implement advanced security measures, and foster a supportive environment to mitigate these risks. Only through a concerted effort can we ensure the safety and well-being of our healthcare professionals. By addressing the root causes and providing the necessary resources, we can create a safer and more supportive workplace for all healthcare workers.”

Strategies for preventing workplace violence

Reducing workplace violence in the post-acute care sector is crucial for ensuring the safety and well-being of both staff and patients. “Healthcare organizations should prioritize the physical and psychological safety of their healthcare teams,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality at Relias. “Healthcare leaders must scrutinize their current workplace violence prevention processes and establish policies that ensure safe and supportive employment environments. Beyond zero-tolerance policies and encouraging communication about workplace violence, the most effective strategy for preventing harmful occurrences is to predict future instances using data-driven insights.”

Sadler suggests a few steps healthcare organizations should take to reduce workplace violence.

1. Conduct routine risk assessments

Early detection of risk through methods like mental health screenings of patients can prevent workplace violence. By identifying historical incidents and prior violent tendencies, employees can proactively address problems before they arise. Risk assessment tools like the Brøset Violence Checklist (BVC) are vital for predicting and reducing violent incidents. The BVC is a violence prediction screening tool that evaluates imminent violent behavior by identifying behavioral patterns and has the highest efficacy for anticipating workplace violence. Such tools can help healthcare professionals spot warning signs, determine the risk of violence, and take the necessary steps to reduce it.

2. Create a safe environment for training

Violence often occurs in high-risk healthcare areas. In post-acute care, dementia care units, home health settings, and elderly/long-term care facilities are at risk for violence. It is vital to provide education to staff in key areas such as threat recognition, de-escalation, and crisis prevention. Using virtual reality (VR) technology for simulation can help practitioners develop these skills in a risk-free environment. VR can improve learning retention rates by up to 75% and reduce skill fade by 52%.

3. Enhance the implementation of security and reporting technologies

For nurses and other healthcare workers in isolated settings like home health, increased surveillance and rapid reporting technologies are essential for immediate support during violent situations. Continuous communication with security personnel ensures employees’ safety and helps prevent violence.

Workplace violence is a serious issue that requires attention and action from all parties involved. Your organization must implement comprehensive strategies to prevent and address workplace violence. This includes proactive risk management, specialized training, and robust security measures to support healthcare workers and reduce workplace violence.