Workplace Violence and Abuse Prevention

Prepared by members of the MNA Workplace Violence and Abuse Prevention Task Force

Statement of the Problem

Violence pervades many aspects of American society as well as the international community. Healthcare facilities known as "caring places", and once considered immune, are now frequently the site of violence.

The National Institute of Occupational Safety and Health (NIOSH) at the
U. S. Department of Health and Human Services, Centers for Disease Control, defines workplace violence as violent acts, including physical assaults and threats of assaults, directed toward persons at work or on duty. (1) The U. S. Department of Justice defines a threat as a statement or expression of intention to hurt, destroy, punish, etc. as in retaliation or intimidation. (2) It is widely recognized that following these violent events, many nurses and other healthcare workers often leave their jobs in healthcare and never return.

The healthcare setting was once perceived as a refuge from the elements outside, as a place to treat the sick and injured. Now it has joined the many workplaces that experience more than 1,000,000 assaults annually. In fact, healthcare and social service workers have the highest incidence of injuries from workplace assaults. Emergency departments and psychiatric units have always witnessed violence. Current trends in patterns indicate that violence now pervades throughout the hospital.

Prevalence of Violenc in Healthcare Settings

The U.S. Department of Labor, Bureau of Labor Statistics (BLS) data reveal that healthcare and social service workers are at high risk of violent assault at work. In 2000, heathcare and social service workers overall had an incidence rate of 9.3 per 10,000 for injuries resulting from assaults and violent acts. This compares to an overall private sector injury rate from assaults and violent acts of 2 per 10, 000 full time workers.(3)

Between 1993 and 1999, violent victimization, in the workplace and against nurses reached 429,100 reported events. Workplace violence and victimization rates for nurses were 72% higher than for medical technicians and more than twice the rate of other medical field workers.(4)

According to the U.S. Department of Justice, Federal Bureau of Investigation, "of greater concern is the likely under-reporting of violence and a persistent perception within the healthcare industry that assaults are part of the job. Under-reporting may reflect a lack of institutional reporting policies, employee beliefs that reporting will not benefit them, or employee fears that employers may deem assaults the result of employee negligence or poor job performance."(2)

Traumatic Effects of Violence on Patients

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, post traumatic stress disorder (309.81) is identified as a disorder that affects a person who has: "1. experienced, witnessed, or were confronted with an event or events that involve actual or threatened death or serious injury or a threat to the physical integrity of self or others and 2. the person's response involved intense fear, helplessness, or horror".(5)

These events are known to precipitate a multitude of persistent and debilitating responses. "The traumatic event is re-experienced in one or more of the following ways, recurring and intrusive distressing recollections (and dreams) of the event, intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event or physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event". (5)

MNA Task Force members believe that patients suffer secondary traumatization in the same manner and from the same causes as nurses and other healthcare workers who experience or witness workplace violence or abuse.

Association Position on Prevention

The MNA believes that employers have a responsibility to provide safe and healthful working conditions in accordance with the Occupational Safety and Health Act of 1970. This includes preventing and addressing conditions that lead to violence and abuse and by implementing effective security and administrative work practices to protect the safety and health of workers.

THE MNA recommends that all healthcare employers implement a Workplace Violence Prevention Program that is consistent with OSHA Guidelines for Preventing Workplace Violence to Health Care and Social Service Workers.(4)

OSHA identifies the following key components of a Workplace Violence Prevention Program:

  1. Management commitment and employee involvement
  2. Worksite hazard analysis
  3. Hazard prevention and control
  4. Safety and health training for workers, managers and supervisors including where and how to report injuries
  5. Post incident debriefing activities including appropriate evaluation and treatment of all workers affected by an incident of violence
  6. Accurate recordkeeping and frequent evaluation of the program by employees and management

    Additionally, MNA believes the Workplace Violence Prevention Program should include:
  7. Policies that address harassment and bullying
  8. Methods for detection, confiscation and control of firearms and weapons from anyone (other than law enforcement officers) who enter the facility.
  9. Security guards trained according to national standards

Once workplace hazard analysis has identified incidents of violence and risks for violence, engineering, administrative and work practice controls must be developed to protect workers (and patients). Because incidents and hazards associated with actual or potential violence and abuse differ from one facility to another, each employer must develop an individualized plan.

Each facility should develop a defined plan for the agency's response to any incident of violence, including the right and protection to call the police and file criminal charges against assailants.

Nurses and others should become familiar with their employers' guidelines including policy recommendations, reporting procedures and suggested methods to help prevent and/or reduce workplace violence and abuse.

What the Union Can Do to Help Victims of Workplace Violence and Abuse

MNA bargaining units are encouraged to address workplace violence and abuse prevention in contract language with their employers. Sample contract language is available by contacting the MNA health and safety program.

Plan a system for addressing Workplace Violence and Abuse and helping those who have become the victims.

Encourage the victim to:

Report the incident
Talk about the incident
Follow the steps outlined below in Ten Actions a Nurse Should Take if Assaulted at Work
Contact the MNA Health and Safety Program for support

Show that you care by:

Providing non-judgmental listening
Deflecting self blame
Helping with police reports
Keep in contact by phone or visiting

Massachusetts General Law (M. G. L. c. 258 B) contains the Massachusetts Victim Bill of Rights, to assure that rights of individuals who are victims of assaults and aggression at work are protected. A copy can be obtained from the Massachusetts Office of Victim Assistance. The Massachusetts Office of Victim (and witness) assistance is available to all who file police or court reports of violence.

Ten Actions a Nurse Should Take if Assaulted at Work
Update 04/04

  1. Get help. Get to a safe area.
  2. Call 911 for police assistance, (it is your civil right to call police).
  3. Get relieved of your assignment.
  4. Get medical attention.
  5. Report the assault to your supervisor and union representative.
  6. Get counseling or assistance for Critical Incident Stress Debriefing (CISD) to address concerns related to Post Traumatic Stress Disorder (PTSD).
  7. Exercise your civil rights, file charges with the police.
  8. Get copies of all reports and keep a diary of events.
  9. Take photographs of your injuries.
  10. Return to work only when you feel safe and supported.


It is the firm belief of the MNA Workplace Violence and Abuse Prevention Task Force members that a Workplace Violence Prevention Program is one step in the process of protecting nurses and other healthcare workers from violence and abuse. Violence and Abuse Prevention Programs must be supportive to workers and avoid blame and retaliation. MNA further recommends that violence aftercare plans identify a debriefing process that includes all workers impacted by a violent incident whether or not they were personally involved in the incident.

Resources for Assistance and Information

Massachusetts Office of Victim Assistance
One Ashburton Place, Suite 1101
Boston MA 02108
email at

U.S. Department of Labor OSHA
Region I
639 Granite Street
Braintree, MA 02184

Massachusetts Victim
Compensation and Assistance Division
Office of the Attorney General


U. S. Attorney's Office
Victim/Witness program


Massachusetts Department
of Industrial Accidents

600 Washington Street
Boston, MA 02111

Members of the MNA Workplace Violence and Abuse Prevention Task Force have prepared informational materials for nurses and others to assist with issues of workplace violence and abuse. These materials can be obtained by contacting:

Massachusetts Nurses Association
Health and Safety Program

340 Turnpike Street
Canton, MA 02021
or 800.882.2056 or


(1) U.S. Dept. of Health and Human Services, Centers for Disease Control, National Institute of Occupational Safety and Health, (NIOSH) Violence, Occupational Hazards in Hospitals, April 2002
(2) U. S. Department of Justice, Federal Bureau of Investigation, Workplace Violence, Issues in Response, 2004 p 24, p 54
(3) U. S. Department of Labor, Occupational Safety and Health Administration, Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers, (OSHA 3148), 2003
(4) U. S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Special Report, National Crime Victimizations Survey, Violence in the Workplace, 1993-99, December 2001 190076
(5) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000