Zero tolerance for workplace violence in health care: a call to action

Imagine doing your job in fear. For many healthcare professionals, this is the reality they face every day.

It is no secret; workplace violence is a leading form of occupational injury and results in reduced job satisfaction and fear to perform necessary duties within healthcare. For far too long, violence against healthcare workers has occurred below the radar and has not received the attention it deserves.  Employers, employee representatives and policy makers must tackle this major problem and work together on solutions to make our healthcare workplaces safer.  Our patients depend on it.

A recent member survey conducted by the Ontario Nurses Association (ONA) revealed that 54 per cent of respondents had experienced physical violence or abuse and 85 per cent had experienced verbal abuse in the workplace.  In addition, 2013 Data from the Workers Safety and Insurance Board (WSIB) of Ontario revealed there were 2,087 lost-time injury claims for violence and aggression for all sectors and greater than 30 per cent (or 639 lost time injury claims) of all violence-related lost-time injuries in Ontario occurred in the health-care sector.  The Canadian Nursing Advisory Committee (CNA) in their report says, “Nurses are more likely to be attacked at work than prison guards or police officers.” Beyond the significant human cost to members of the healthcare team, the economic cost of workplace violence should make all employers take notice.

In Ontario, employers are required to implement policies related to workplace violence, develop programs and ensure there are assessments and reviews of those assessments on a regular basis.  Despite these legislated requirements, violence against healthcare workers continues as recently reported in the media.  What must healthcare employers do to make a meaningful improvement in staff safety with respect to violence?

There are concrete steps healthcare employers can take to make their workplaces safer. For example, Code White (hospital code for a violent patient) response time can be dramatically reduced by introducing communication/alarm devices for staff.  After introducing these at our hospital, we saw Code White response time fall by more than 53%, to an average of 57 seconds.  Another concrete step employers can take is to offer de-escalation training for staff.  This training, combined with alarms and patient flagging, has helped reduced use of force incidents at our hospital from 30% in 2007, to 8.9% last year. These practices create a safer environment not just for staff, but also for our patients.

We believe the most important elements of reducing workplace violence are transparency and urgency when workplace violence incidents do occur.  Immediately following an incident at our hospital, a number of key stakeholders, both labour and management, are made aware of the incident and are involved in incident debriefing and action planning processes to understand the incident and identify ways to avoid a similar case in the future. Incidents of violence are treated with the same urgency and escalation within the hospital that major patient care critical incidents receive. By increasing reporting and then transparency of those reports we are able to work together across sectors to address a problem that has long existed, but been avoided or swept under the rug.

We believe a comprehensive violence prevention program includes staff de-escalation training, self-defense training, multi-purpose communication devices/alarms for staff, integrated information system between security and occupational health and flagging of patients with a history of violence.  At the heart of this needs to be a strategic partnership with internal staff and physicians and organized labour. At our hospital, this takes the form of a broadly constituted workplace violence prevention committee comprised of management and front line staff as well as representatives from outside the organization drawn from some of our labour partners, who have all overseen this evolution.  In our experience, this kind of collaboration enables the creation of a culture of zero tolerance for workplace violence.

Ultimately, healthcare workers have the right to work in an environment that is free from all forms of abuse and to not fear coming to work at risk of being injured physically or verbally by patients, visitors or their peers.  As leaders we must have zero tolerance to all forms of violence in our workplaces.  We must take personal responsibility for building the partnerships between staff, labour unions and other stakeholders to make violence reduction interventions a real success. After all, our healthcare professionals and patients are counting on it.

The comments section is closed.

  • Dj says:

    Please contact me as I would like to discuss a plan to prevent the “Code White” and hospital staff injury along with potential fellow patient trauma in witnessing acts of violence in the workplace.

  • Theresa says:

    So I have read the comments. Where are the further comments over the last year? As a nurse that has received abuse from patients, those comments do not mean much to me. Nothing has changed, in fact things have gotten worse.

    I am a healthcare worker exposed to violence everyday. I ask you, do cashiers in your grocery store or your bank teller need d-escalation training or self defense training? I am assuming not. Besides taking employers to task, I would recommend you advertise on a very grand scale, to the public, a zero tolerance to violence. Let the public know that healthcare workers are going to call the authorities for intervention, without judgement or APPROVAL from management. The repercussions need to be delivered to the person(s) doing the assault and not dancing around the periphery by taking on ineffectual management practices. And yes bullying and verbal abuse is assault. Let’s talk about the elephant in the room.
    If the person that delivers the violence is deemed sane (without issues), then charges need to be pressed. Period. If the assailant is not deemed sane (due whatever health affliction), then that also has to follow that person as well. It’s not about stigmatizing but getting that individual help as well as keeping us safe. Families sometimes don’t understand the insidiousness of violence that they tolerate in their lives and that there is help available. Regardless of where the violence comes from, I do not tolerate sugar coating and using politically correct lingo to smooth it over.
    After 30 years I have seen this rampant change to more expected tolerated abuse to healthcare workers. I am done living in fear, time to get out since I can only protect myself. To those supervisors that told me, he’s just delirious, it’s not his fault, you can take my place now.

  • Wendy Nicklin, President and CEO, Accreditation Canada says:

    Toronto East General Hospital provides an excellent example of putting workplace violence prevention into action. Its Board and leadership are to be commended for their ongoing efforts to create a work life and physical environment that supports the safe delivery of care and service.

    Unfortunately, workplace violence is quite common in health care settings, with more than one-quarter of all incidents of workplace violence occurring at health services organizations. While our Qmentum accreditation program had provided for the prevention of workplace violence in the standards, in 2011 we raised the bar and made incorporating workplace violence prevention a required element (ROP) of the program. Participating health care organizations must develop and implement a workplace violence prevention policy in consultation with staff, service providers and volunteers, as well as provide staff with information, training, and a process to report incidents.

    Eliminating workplace violence is a shared responsibility, requiring the ongoing support and commitment of all those working at a health care organization. The Accreditation Canada program enables health care organizations to take the steps necessary to minimize or prevent workplace violence so that they can meet the goal of zero tolerance.

    • Don Taylor says:

      Helpful information, Wendy. Thanks.

      Any particular reasons why your standards don’t require accreditation-seeking organizations to consult with patients/patient caregivers in developing their workplace violence prevention policies? Would have thought that such consultation would be integral to a patient-centred approach to health care.

      • Wendy Nicklin, President and CEO, Accreditation Canada says:

        Thank you for your question, Don.

        Over the past few years, we undertook a revision of all our standards to strengthen the focus on client- and family-centred care. This new focus encourages mutually-beneficial partnerships between patients and health care providers. It also raises the bar on the importance of including patients and families in all aspects of policy and program development, implementation and evaluation, as well as facility design, professional education, and delivery of care. Beginning with surveys in 2016, health care and social services organizations’ efforts at collaboration with clients will be assessed across all organizational activity, including the prevention of workplace violence.

  • Don Taylor says:

    Of course, everyone is entitled to a safe work place and kudos to TEGH for being a staff-centered organization and taking important steps to improve work place safety for hospital staff.

    Hopefully, TEGH is putting as much effort into being a patient-centred organization. By that I mean identifying and modifying the hospital environment (staff behaviour, hospital bureaucracy, communication, etc) that contributes to the patient and family caregiver stress/anxiety Denyse Lynch mentions.

  • Denyse Lynch says:

    Heartily agree “every” workplace needs to offer a violence/abuse-free environment and zero tolerance when it occurs.

    Am wondering if there are more violence related incidents that occur in the health care sector and if there are any stats on this.
    If so, it may be due to patient mental health conditions and/or unacceptable behaviours from patients &/or family caregivers as result of stress and/or pain. If so, the strategies mentioned in this article are sound and should be utilized frequently to keep everyone educated and safe.
    I was a volunteer in a hospital ER department for a few years and was very happy to have learned de-escalation and customer service skills which served me well on more than 1 occasion.

    Also think a notice strategically placed where all can see would educate, reinforce and be beneficial.


Rob Devitt


Rob Devitt is the CEO of Toronto East General Hospital.

Irene Andress


Irene Andress is the Chief Nurse Executive and the Director ofEmergency Department/Medicine Program at TEGH.

Kevin Edmonson


Kevin Edmonson is Manager, Emergency Department, Medical Ambulatory Clinics, Nursing Resource Team & Patient Flow at TEGH.

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