Workplace violence

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Nurses describe their experience as victims of, or as witnesses of, violence in the workplace
Deborah R. Collins, a survivor of workplace violence in the 1988 shooting at Electromagnetic System Labs, discusses the consequences of workplace violence. USMC-100910-M-9161A-001.jpg
Deborah R. Collins, a survivor of workplace violence in the 1988 shooting at Electromagnetic System Labs, discusses the consequences of workplace violence.

Workplace violence, [1] violence in the workplace, [2] or occupational violence refers to violence, usually in the form of physical abuse or threat, that creates a risk to the health and safety of an employee or multiple employees. [3] The National Institute for Occupational Safety and Health defines worker on worker, personal relationship, customer/client, and criminal intent all as categories of violence in the workplace. [4] These four categories are further broken down into three levels: Level one displays early warning signs of violence, Level two is slightly more violent, and level three is significantly violent. [5] Many workplaces have initiated programs and protocols to protect their workers as the Occupational Health Act of 1970 states that employers must provide an environment in which employees are free of harm or harmful conditions.

Contents

Epidemiology

According to data from the US Bureau of Labor Statistics, in 2011 violence and other injuries caused by persons or animals contributed to 17% of all US occupational fatalities, with homicides contributing to 10% of the total. [6] From 1992 to 2010, there were 13,827 reported workplace homicide victims, averaging over 700 victims per year, in the United States. [7] Examination of the 2011 data shows that while a majority of workplace fatalities occurred to males, workplace violence disproportionately affects females. Homicides contributed to 21% of all occupational fatalities for women, compared to 9% for men. [6] Of these homicides, relatives or domestic partners contributed to 39% of female homicide cases; male homicide cases were most likely to be perpetrated by robbers, contributing to 36% of male homicide cases. [6]

The Occupational Safety and Health Administration ("OSHA") a department of the United States Department of Labor defines workplace violence as "any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide." [8]

2,000,000 US workers per year report workplace violence [8]

Most cases of workplace violence are non-fatal. From 1993 to 1999, an average of about 1.7 million people reported occupational violence. [7] About 75% of these cases are considered simple assault, while 19% of cases are considered aggravated assault. [7]

Workplace violence is at epidemic proportions. "There used to be a time when an employee shooting someone in the workplace would be a shock. Now it's becoming common," states Kathleen M. Bonczyk, Esq. a researcher and expert on workplace violence prevention. [9]

Following a June 2017 shooting spree when a former employee returned to his Orlando, Florida workplace to murder five co-workers before committing suicide Kathleen M. Bonczyk, Esq. stated "You hear it again and again. People always say 'We didn't think it (workplace violence) would happen here,' but it can happen anywhere and anytime. It shouldn't be a question of if; employers should operate under the question of when." [10]

There are four categories used to classify workplace violence: worker on worker, personal relationship, customer/client, and criminal intent. [11] Worker on worker violence occurs when two people of the same occupation are violent towards one another, either physically, verbally or emotionally. A common example of this is when one worker has some sort of authority over another, such as a supervisor position over a supervisee. Personal relationship violence at the workplace occurs when an employee's personal relationship is brought into the workplace and causes disruption for the employee, his/her co-workers, and possibly the customers of that business. [12] Victims of personal relationship violence are typically women. Customer/client violence occurs when there is violence between a customer or client of a workplace and an employee. The violence could be performed by the customer onto the employee or vice versa. Finally, criminal intent violence in the workplace occurs when there is no relationship between the person committing the violent act and the workplace or its employees.

The four categories listed above are further classified into three levels, depending on the situation. Level one includes signs such as the person bullying others, being rude or abusive, and uncooperative. At this level, one should carefully take note of the behaviors and report them to a supervisor. The supervisor may want to meet with the potential perpetrator to discuss his/her behaviors. Level two includes the potentially violent subject stating that he feels victimized and verbalizing threats, verbalizing wanting to hurt others, frequently arguing with others, seeking revenge, and refusing to follow workplace policies. In response to this behavior one should document observed behaviors, directly contact a supervisor, ensure that one's own safety is put first, and, if needed, contact first responders. The third level of workplace violence are currently violent situations such as threatening to harm one's self or others by either physical means or using weapons, demonstration of extreme anger, or destruction of property. In case of level three violence, one should ensure the safety of themselves followed by the safety of others, stay calm, cooperate with law enforcement, and leave the situation if possible. [4]

In the case of personal relationship violence, it is often hard to recognize levels one and two of violence because they typically occur outside of the workplace. Most personal relationship violence situations occur at level three, in which case the level three approach for handling the situation should be in place. [4]

Perline and Goldschmidt [13] contend that the present definitions of workplace violence are simply descriptive and not based on motivation of the perpetrator. [13] Understanding the motivation underlying these crimes is important in developing preventative strategies. Perline & Goldschmidt define two types of workplace violence: 1) Object-focused workplace violence is violence that occurs to obtain some object, such as money, drugs, jewelry, etc., and 2) non-object-focused violence, which is emotionally based, and mostly associated with anger. Anger generally requires frustration and perceived injustice. Mitigating anger or perceived injustice will mitigate or prevent a violent episode, and people can be angry without perpetrating violence. Whether or not anger results in violence depends, in part, on the potential perpetrator's focus, and associated risk factors (see below). Eight different types of focus that can result in workplace violence have been identified. (Table 1) [13]

Table 1. Anger-Focus Model of Non-Object-Focused Workplace Violence
MOTIVATIONFOCUSGOALASSOC. CHARACTERISTICS
AngerHealthyNon-violent anger

resolution

Conference; Legal redress; Work harder;

Job change; etc.

AngerWork-related issuesRetributionWorkplace targeted
AngerNon-work related

issues

Retribution; Inflict

pain/suffering on others

Workplace convenient; Opportunistic;

Injury &/or Signif. damage

AngerDepressive issues;

Self-aggrandizement;

Excitement/attention

Reduce emotional

pain/suffering in self

Signif. damage; Unknown victims;

Random violence

AngerAnxiety issues;

Perceived threat

ControlTerrorism; Domination
AngerPersonality issues:

Inadequacy

Self-enhancementBias crimes; Humiliation;

Domination; Sex crimes

AngerPersonality issues:

Dependency

AcceptanceAttachment; Stalking; Following; Random violence;

Violence-by-proxy

Psychosis/

Drug states

IrrationalIrrationalIrrational
AccidentUnintentionalUnintentionalCarelessness; Uninformed; Neuropsych. status
OtherNot otherwise

specified (NOS)

The anger-focus model: 1) characterizes workplace violence according to the focus of the perpetrator; 2) allows for the gathering of separate statistics for object-focused crime and non-object-focused crime; and 3) shows that domestic violence, school shootings, terrorist activities, and non-object violence that occurs in the workplace are similarly motivated. [13] Consequently, understanding the factors driving one type of non-object-focused violence should help us to develop strategies for mitigating the other types of non-object-focused violence. Thus, we can see that these crimes can be mitigated by reducing the frustration level of the potential perpetrator, reducing the level of the potential perpetrator's perceived injustice, or changing the focus the potential perpetrator to a more healthy focus. [13]

A very large percentage of non-object-focused perpetrators are either arrested, killed by police, or killed themselves after committing their violent act. If we consider suicide-by-cop, it has been suggested that somewhere between 25-50 percent of non-object-focused workplace homicides result in suicide. [14] [15] Suicide is virtually unheard of following an object-focused crime, it just doesn't make sense. Non-object-focused workplace violence is purposeful, occurs in stages, and is seldom if ever a spontaneous event. [13]

The five stages of non-object-focused violence that have been identified are:

Thirty risk factors have been identified. Fourteen of these risk factors are social & situational; twelve are psychological, and four are behavioral. [13]

Signs of potential threats

There is little information on what certainly causes workplace violence, however it is agreed that a combination of personal factors, workplace factors, and individual interactions contribute to violence in the workplace. The Federal Bureau of Investigation (FBI) recognizes the following behaviors as warning signs for potential perpetrators of workplace violence: [16]

The National Safety Council also recognizes excessive use of drugs or alcohol as well as absenteeism, or change in job performance that is unexplained. Paying attention to these warning signs and reporting them may help prevent events of workplace violence. [17]

Prevention

The United States Department of Labor's purpose is to " promote a safe environment for our employees and the visiting public, and to work with our employees to maintain a work environment that is free from violence, harassment, intimidation, and other disruptive behavior". Hemati-Esmaeili (2018) supports,“As worksites for healthcare providers and related occupations vary in purpose, size, and complexity, WVPP should be designed to specifically target the unique nature and varied needs of each organization” (par. 5) [18] Therefore, the DOL has provided information in order to work towards their purpose of keeping the workplace safe for individuals. The information is provided in order to help the people of the workplace to be able to identify potentially harmful behaviors as well as recognize their responsibilities to prevent violent behavior. The DOL administered the Workplace violence program in order to help employees respond to and prevent workplace violence through better understanding. They have also identified seven key factors to help prevent workplace violence: [4]

  1. Work Environment- As the work environment directly and heavily influences the employees and clients, it is crucial that the environment remains positive and open. This encourages better communication and positive attitudes in the workplace.
  2. Security- Additional safety measures such as security may help deter possible violent events from occurring. This could include security guards, cameras, or other technological machines such as metal detectors.
  3. Education- educating employees on current policies and procures as well as on possible warning signs of workplace violence.
  4. Performance / conduct indicators- ways to be aware of changes in employee behavior, such as absenteeism or change in performance.
  5. Employee support services- services available for employees to express concerns
  6. Early intervention- not letting symptoms go unnoticed or unresolved
  7. Take appropriate actions- notify authorities when needed

It is also recommended that employers treat terminated employees with respect in order to avoid the feeling that they are being victimized. Additional precautions may be alerting security that there will be job termination that day. [5]

Responses

According to the Department of Homeland Security in the situation of workplace violence, while staying calm, one should run, hide, or fight. It is suggested to only fight if there are no other safe options. [19] In the event of having to handle a violent or potentially violent person, there are five steps to follow. First demonstrate concern for the employee and show that you care. Second, do not judge the person, but observe their behaviors. Third is to demonstrate empathy. Fourth is to engage in conversation with them, let them express what will help them. Finally, work with them to create a solution that will not put anyone at risk. [17]

Deadly examples

Aggression

Dr. Arnold H. Buss, of the University of Texas at Austin (1961), [33] identified eight types of workplace aggression:

In a study performed by Baron and Neuman, [34] researchers found pay cuts and pay freezes, use of part-time employees, change in management, increased diversity, computer monitoring of employee performance, reengineering, and budget cuts were all significantly linked to increased workplace aggression. The study also showed a substantial amount of evidence linking unpleasant physical conditions (high temperature, poor lighting) and high negative affect, which facilitates workplace aggression. [35] Individuals who resort to mass shootings at work often threaten to kill before any actual violence takes place. [36]

Risk assessments

In the United Kingdom there is a legal obligation to complete risk assessments for both physical and psychosocial workplace hazards. Other countries have similar occupational health and safety legislation in place relating to identifying and either eliminating or controlling for hazards in the workplace. Workplace violence is considered to be a significant hazard in its own right. Regulation 3 of the Management of Health and Safety at Work Regulations 1999 states that, "every employer shall make a suitable and sufficient assessment of:

Occupational groups at higher risk

The Canadian Centre for Occupational Health and Safety lists the following higher risk occupations. [37]

Health care workers are at high risk for experiencing violence in the workplace. Examples of violence include threats, physical assaults, and muggings. According to estimates of the Bureau of Labor Statistics (BLS), the rate of nonfatal occupational injuries and illnesses involving days away from work was 15.1 per 10,000 full-time workers in 2012. [38] This rate is much higher than the rate for total private industries, which is 4.0 per 10,000 full-time workers.

There are many contributing factors that can lead to health-care workers, specifically nurses, experiencing workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. A few environmental factors may include the specific setting, long waiting times, frequent interruptions, uncertainty regarding the patients' treatment, and heavy workloads. [39] Organizational factors may include inefficient teamwork, organizational injustice, lack of aggression management programs, and distrust between colleagues. [39] This may also include inadequate security procedures. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills and/or awareness of how to interpret aggressive situations. [39]  Misunderstandings may also occur due to the communication barrier between nurses and patients. [40]  A few examples of this are a lack of privacy for the patient, background noise, and the patient's condition being affected by medication, pain, and/or anxiety.

See also

Related Research Articles

Industrial and organizational psychology "focuses the lens of psychological science on a key aspect of human life, namely, their work lives. In general, the goals of I-O psychology are to better understand and optimize the effectiveness, health, and well-being of both individuals and organizations." It is an applied discipline within psychology and is an international profession. I-O psychology is also known as occupational psychology in the United Kingdom, organisational psychology in Australia and New Zealand, and work and organizational (WO) psychology throughout Europe and Brazil. Industrial, work, and organizational (IWO) psychology is the broader, more global term for the science and profession.

Violence is the use of physical force to cause harm to people, animals, or property, such as pain, injury, death, damage, or destruction. Some definitions are somewhat broader, such as the World Health Organization's definition of violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."

<span class="mw-page-title-main">Work accident</span> Occurrence during work that leads to physical or mental harm

A work accident, workplace accident, occupational accident, or accident at work is a "discrete occurrence in the course of work" leading to physical or mental occupational injury. According to the International Labour Organization (ILO), more than 337 million accidents happen on the job each year, resulting, together with occupational diseases, in more than 2.3 million deaths annually.

Psychological abuse, often called emotional abuse, is a form of abuse characterized by a person subjecting or exposing another person to a behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder.

Sex differences in crime are differences between men and women as the perpetrators or victims of crime. Such studies may belong to fields such as criminology, sociobiology, or feminist studies. Despite the difficulty of interpreting them, crime statistics may provide a way to investigate such a relationship from a gender differences perspective. An observable difference in crime rates between men and women might be due to social and cultural factors, crimes going unreported, or to biological factors for example, testosterone or sociobiological theories). The nature or motive of the crime itself may also require consideration as a factor.

Workplace bullying is a persistent pattern of mistreatment from others in the workplace that causes either physical or emotional harm. It can include such tactics as verbal, nonverbal, psychological, and physical abuse, as well as humiliation. This type of workplace aggression is particularly difficult because, unlike the typical school bully, workplace bullies often operate within the established rules and policies of their organization and their society. In the majority of cases, bullying in the workplace is reported as having been done by someone who has authority over the victim. However, bullies can also be peers, and subordinates. When subordinates participate in bullying this phenomenon is known as upwards bullying .The least visible segment of workplace bullying involves upwards bullying where bully- ing tactics are manipulated and applied against “the boss,” usually for strategically designed outcomes.

A workplace is a location where someone works, for their employer or themselves, a place of employment. Such a place can range from a home office to a large office building or factory. For industrialized societies, the workplace is one of the most important social spaces other than the home, constituting "a central concept for several entities: the worker and [their] family, the employing organization, the customers of the organization, and the society as a whole". The development of new communication technologies has led to the development of the virtual workplace and remote work.

Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, psychosocial workplace factors that affect accident risk and safety, and interventions designed to improve and/or protect worker health. Although OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, for a long time the psychology establishment, including leaders of industrial/organizational psychology, rarely dealt with occupational stress and employee health, creating a need for the emergence of OHP. OHP has also been informed by other disciplines, including occupational medicine, sociology, industrial engineering, and economics, as well as preventive medicine and public health. OHP is thus concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. The World Health Organization and the International Labour Organization estimate that exposure to long working hours causes an estimated 745,000 workers to die from ischemic heart disease and stroke in 2016, mediated by occupational stress.

Workplace aggression is a specific type of aggression which occurs in the workplace. Workplace aggression is any type of hostile behavior that occurs in the workplace. It can range from verbal insults and threats to physical violence, and it can occur between coworkers, supervisors, and subordinates. Common examples of workplace aggression include gossiping, bullying, intimidation, sabotage, sexual harassment, and physical violence. These behaviors can have serious consequences, including reduced productivity, increased stress, and decreased morale.

Workplace safety in healthcare settings is similar to the workplace safety concerns in most occupations, but there are some unique risk factors, such as chemical exposures, and the distribution of injuries is somewhat different from the average of all occupations. Injuries to workers in healthcare settings usually involve overexertion or falling, such as strained muscles from lifting a patient or slipping on a wet floor. There is a higher than average risk of violence from other people, and a lower than average risk of transportation-related injuries.

An occupational fatality is a death that occurs while a person is at work or performing work related tasks. Occupational fatalities are also commonly called "occupational deaths" or "work-related deaths/fatalities" and can occur in any industry or occupation.

<span class="mw-page-title-main">Occupational stress</span> Tensions related to work

Occupational stress is psychological stress related to one's job. Occupational stress refers to a chronic condition. Occupational stress can be managed by understanding what the stressful conditions at work are and taking steps to remediate those conditions. Occupational stress can occur when workers do not feel supported by supervisors or coworkers, feel as if they have little control over the work they perform, or find that their efforts on the job are incommensurate with the job's rewards. Occupational stress is a concern for both employees and employers because stressful job conditions are related to employees' emotional well-being, physical health, and job performance. The World Health Organization and the International Labour Organization conducted a study. The results showed that exposure to long working hours, operates through increased psycho-social occupational stress. It is the occupational risk factor with the largest attributable burden of disease, according to these official estimates causing an estimated 745,000 workers to die from ischemic heart disease and stroke events in 2016.

<span class="mw-page-title-main">Physical hazard</span> Hazard due to a physical agent

A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.

Counterproductive work behavior (CWB) is employee's behavior that goes against the legitimate interests of an organization. This behavior can harm the organization, other people within it, and other people and organizations outside it, including employers, other employees, suppliers, clients, patients and citizens. It has been proposed that a person-by-environment interaction (the relationship between a person's psychological and physical capacities and the demands placed on those capacities by the person's social and physical environment.) can be utilized to explain a variety of counterproductive behaviors. For instance, an employee who is high on trait anger is more likely to respond to a stressful incident at work with CWB.

Workplace harassment is the belittling or threatening behavior directed at an individual worker or a group of workers.

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work. The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise. The World Health Organization has prioritized the workplace as a setting for health promotion because of the large potential audience and influence on all spheres of a person's life. The Luxembourg Declaration provides that health and well-being of employees at work can be achieved through a combination of:

<span class="mw-page-title-main">Occupational safety and health</span> Field concerned with the safety, health and welfare of people at work

Occupational safety and health (OSH) or occupational health and safety (OHS), also known simply as occupational health or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at work. These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of occupational safety and health program/department etc. OSH is related to the fields of occupational medicine and occupational hygiene.

A psychosocial hazard or work stressor is any occupational hazard related to the way work is designed, organized and managed, as well as the economic and social contexts of work. Unlike the other three categories of occupational hazard, they do not arise from a physical substance, object, or hazardous energy.

<span class="mw-page-title-main">Patient-initiated violence</span> Occupational hazard

Patient-initiated violence is a specific form of workplace violence that affects healthcare workers that is the result of verbal, physical, or emotional abuse from a patient or family members of whom they have assumed care. Nurses represent the highest percentage of affected workers; however, other roles include physicians, therapists, technicians, home care workers, and social workers. Non clinical workers are also assaulted, for example, security guards, cleaners, clerks, technicians. The Occupational Safety and Health Administration used 2013 Bureau of Labor Statistics and reported that healthcare workplace violence requiring days absent from work from patients represented 80% of cases. In 2014, a survey by the American Nurses Association of 3,765 nurses and nursing students found that 21% reported physical abuse, and over 50% reported verbal abuse within a 12-month period. Causes for patient outbursts vary, including psychiatric diagnosis, under the influence of drugs or alcohol, or subject to a long wait time. Certain areas are more at risk for this kind of violence including healthcare workers in psychiatric settings, emergency or critical care, or long-term care and dementia units.

<span class="mw-page-title-main">Workplace hazard controls for COVID-19</span> Prevention measures for COVID-19

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of COVID-19. Vaccination is the most effective way to protect against severe illness or death from COVID-19. Multiple layers of controls are recommended, including measures such as remote work and flextime, increased ventilation, personal protective equipment (PPE) and face coverings, social distancing, and enhanced cleaning programs.

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