Workplace Violence in Health Care Settings

Workplace Violence in Health Care Settings

Greenville Community Hospital (GCH) was located in an affluent suburb of a metropolitan area. A large psychiatric hospital was geographically adjacent. In fact, the two hospitals shared facilities, such as a conference center and some office buildings. Thanks to good teamwork between the two, a consistent pattern of admitting patients via the Emergency Department (ED), then to the psychiatric hospital had emerged.

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Lately, however, an uptick of substance abuse-related ED admissions had created a large backlog in GCH. The patients could not be admitted to the psychiatric hospital because they were short on beds for long-term rehab. Drug rehabilitation facilities in the area were either too expensive ($24,000–$40,000 for 28 days), if private pay, or overbooked, if Medicaid supported. In the meantime, the patients had multiple health issues secondary to drug use. The patients were now being placed on a non-secure unit, along with routine medical–surgical patients.

On a night lit by a full moon, Rosemary, a floor nurse, went in to take the vital signs of a young female patient who had been admitted for a heroin overdose. She found the girl awake, hostile, aggressive, mumbling incoherently with bloodshot eyes and dilated pupils. When she approached the patient, the patient grabbed her; screamed obscenities; attempted to choke her; then chased her out of the room. Rosemary ran towards the nursing station to ask for help. Fortunately for her, the patient was ataxic and uncoordinated and collapsed on the floor. The security guard was not in sight and Rosemary waited a few minutes before he showed up. She also called for a rapid response team to revive the patient.

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She wondered how much longer she could do this job. There was no way to call for help, no safe place or room for staff to hide from aggressive patients. It was only a matter of time before she was injured—or killed.
1. What are the major issues in this case?

2. Research on workplace violence in health care settings and present current statistics. Who are the victims and perpetrators? Why are health care professionals reluctant to report workplace violence directed towards them?

3. What are the management implications of this case? What impact does workplace violence have on health care professionals and to the organization? What should management be doing to protect their employees?

4. If Rosemary had been injured, who would have been responsible? What if the patient attacked another patient or hospital visitor? What are the legal and ethical obligations of Greenville Community Hospital to its employees and to its patients and how do they apply to this case?

5. What strategies can be taken to prevent workplace violence? Create an emergency plan for the staff in this unit while they await administration’s decision on renovations.

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Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). (2001). Women’s safety and health issues at work. Retrieved from

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). (2002). Violence: Occupational hazards in hospitals. Retrieved from

Duhart, D. T. (2001). Violence in the workplace, 1993–1999. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Special Report. Retrieved from

Emergency Nurses Association. (2015). ENA workplace violence toolkit. Retrieved from

Gillespie, G. L. (2008). Consequences of violence exposures by emergency nurses. Journal of Aggression, Maltreatment & Trauma, 16 (4), 409–418.

Janocha, J. A., & Smith, R. T. (2010). Workplace safety and health in the health care and social assistance industry, 2003–2007. Retrieved from

Kowalenko, T., Walters, B. L., Khare, R. K., & Compton, S. (2005). Workplace violence: A survey of emergency physicians in the state of Michigan. Annals of Emergency Medicine, 46, 142–147.

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New York State Department of Labor. (2009). Workplace violence prevention program guidelines. Retrieved from

Occupational Safety and Health Administration (OSHA). (2015). Guidelines for preventing workplace violence for health care & social service workers. Retrieved from

The Joint Commission (TJC). (2010, June 3). Preventing violence in the health care setting. Sentinel event alert. Issue 45. Retrieved from

The Joint Commission (TJC). (2014, August). Preventing violence and criminal events. QuickSafety: An advisory on safety & quality issues, Issue Five. Retrieved from

Tjaden P., & Thoennes, N. (1998). Prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey Washington, DC: Department of Justice (US). Publication No.: NCJ 172837. Retrieved from

Tjaden, P., & Thoennes, N. (2000). Extent, nature, and consequences of intimate partner violence: findings from the National Violence against Women Survey. Washington, DC: Department of Justice (US). Publication No.: NCJ 181867. Retrieved from For more information Workplace Violence in Health Care Settings check out:


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