Workplace violence in healthcare settings and challenging behavior are critical issues that impact the well-being of both staff and patients. Healthcare professionals often find themselves on the front lines, dealing with heightened stress, emotional distress, and sometimes aggressive behaviour from patients, families, or even colleagues in some instances. These incidents not only risk the safety and mental health of workers but can also hinder the quality of care provided to patients. In this blog, we will explore the various forms of workplace violence and challenging behaviour in healthcare environments, the underlying causes, and the steps that can be taken to address and mitigate these challenges, ensuring a safer and more supportive environment for both staff and patients alike.
Scope of Workplace Violence in Healthcare
Workplace violence in healthcare is a prevalent issue that takes many forms, from verbal abuse and intimidation to physical assaults. Healthcare workers are particularly vulnerable because they often interact with individuals who may be in acute distress or experiencing mental health crises. According to studies, healthcare workers are four times more likely to be assaulted than employees in other sectors, with nurses and emergency department staff particularly at risk. Source: US Bureau of Labor Statistics (BLS)
The UK’s National Health Service (NHS) reports revealed that healthcare staff in the UK, particularly in accident and emergency departments, were highly vulnerable to physical and verbal abuse. More recent statistics indicate that 13.7% of NHS staff reported experiencing at least one incident of physical violence from patients, service users, relatives, or the public in the past year. Additionally, statistics indicated that 1 in 10 NHS staff were subject to some form of physical violence during their work, and the overall rate of violence in the NHS was substantially higher than in many other industries. For example, it was reported that in 2015-2016, there were more than 60,000 incidents of violence reported against NHS workers in England, many of which involved physical assaults. Source: UK National Health Service (NHS)
The types of violence range from verbal threats and insults to physical attacks, such as hitting, biting, scratching or even using weapons. While the immediate impact of such incidents can be physically and emotionally damaging, the long-term consequences can be even more profound, contributing to burnout, anxiety, depression, and high staff turnover. This can lead to a vicious cycle where the healthcare environment becomes increasingly unsafe, affecting both staff morale and patient care.
Causes of Challenging Behaviour
Challenging behaviour in healthcare settings can manifest in various ways, including aggression, non-cooperation, and disruptive actions. While many of these behaviours are a direct response to patients' medical conditions or mental health struggles, they can also be exacerbated by external factors such as environmental stressors, long waiting times, alcohol or substance misuse, and overcrowding.
Some of the most common causes of challenging behaviour include:
- Mental Health Issues or Development Disorders: Patients with dementia, delirium, schizophrenia and autism, may display aggression or confusion that can lead to violent outbursts.
- Pain and Discomfort: Chronic pain, illness, or the stress of being in a hospital environment can provoke patients to act out or become hostile.
- Communication Barriers: For patients who are non-verbal or have difficulty expressing their needs, frustration can escalate into challenging behaviour if they feel misunderstood or neglected.
- Staff Shortages and Workload Pressures: Overworked staff are more likely to experience burnout and may be less able to respond to patient needs effectively, which can heighten tensions on both sides.
- Substance and Alcohol Misuse: Are significant contributors to challenging behaviour in healthcare settings. They can lead to aggression, confusion, cognitive impairment, and non-compliance, all of which can complicate patient care.
While some challenging behaviours are inevitable, understanding the underlying factors can help healthcare professionals address them more effectively.
Impact on Healthcare Professionals
The consequences of workplace violence and challenging behaviour extend beyond physical injury. For healthcare workers, repeated exposure to aggression and hostility can have profound psychological effects. The emotional toll of caring for patients in crisis, especially when faced with violent or disruptive behaviours, can lead to burnout, stress, and job dissatisfaction. According to reports, healthcare workers report higher rates of PTSD and depression due to their exposure to workplace violence than workers in other industries. Source: National Institute for Occupational Safety and Health (NIOSH)
Healthcare workers, particularly those in frontline roles such as nurses, paramedics, and emergency room staff, often feel powerless in the face of violent or disruptive incidents. The lack of adequate training or support to handle such situations can leave staff feeling isolated and unsupported, further exacerbating stress and contributing to high turnover rates.
Preventing and Addressing Workplace Violence
Reducing workplace violence and managing challenging behaviours requires a multifaceted approach that includes prevention, training, and support for healthcare workers. Here are several strategies that can help mitigate the impact:
- De-escalation Training: Providing staff with proper training in de-escalation techniques is crucial in preventing violence. This training focuses on non-confrontational methods to calm aggressive or distressed individuals, such as active listening, maintaining a calm demeanour, and using body language to reduce tension. When staff are equipped with the skills to handle difficult situations, they are better able to defuse potential conflicts before they escalate into violence.
- Improved Communication: Effective communication is key to managing challenging behaviours. Clear, respectful communication with patients and their families can prevent misunderstandings and reduce frustration. For patients with cognitive impairments, healthcare workers should use simple language, visual aids, and other methods to bridge communication gaps.
- Supportive Work Environment: A supportive workplace culture plays a significant role in managing violence. This includes promoting teamwork, offering emotional support through counselling services, and ensuring that staff feel valued and heard. Healthcare organizations must prioritize mental health resources for employees to mitigate the emotional toll of dealing with difficult situations.
- Security Measures: In some healthcare settings, particularly emergency departments or psychiatric units, the presence of security personnel can deter violent incidents. Additionally, installing panic buttons, surveillance systems, and ensuring that staff can quickly alert security when needed can create a safer working environment.
- Clear Reporting Protocols: Encouraging staff to report incidents of violence, no matter how minor, is crucial. A transparent reporting system allows healthcare organizations to track incidents, identify patterns, and implement targeted interventions. It also ensures that workers who experience violence or abuse receive appropriate care and support.
- Staffing Adequately: Ensuring sufficient staff levels is vital to both preventing challenging behaviour and managing it effectively when it occurs. Overworked staff are more prone to stress and burnout, which can create a cycle of poor patient outcomes and increased incidents of aggression. Adequate staffing allows workers to spend more time with patients, reducing frustration and the likelihood of disruptive behaviour.
Workplace violence and challenging behaviour in healthcare facilities are complex issues that require a comprehensive approach. By addressing the root causes, providing staff with training and products like ours, healthcare organisations can mitigate the risks associated with these behaviours. Ultimately, a more supportive and well-equipped workforce will lead to better outcomes for both healthcare professionals, their employers and most of all their patients.
If you or your team are experiencing violence in the workplace, it’s essential to prioritise safety. At BitePRO®, we offer protective clothing designed to help healthcare professionals reduce the risk of injuries from challenging behaviors. Contact us today to discuss how we can support your team.
About the Author
Richard Fox serves as the Director of Operations for BitePRO® and is a veteran of the UK Armed Forces, where he continues to serve as a Reservist. After transitioning from full-time military service, Richard worked extensively with education providers across Northern England, focusing on children displaying challenging behaviors and supporting students at risk of permanent exclusion.
