1. Pierotti, Danielle PhD, RN, CENP

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Workplace violence, long an unspoken, common component of nursing work, is coming out of the shadows. The Bureau of Labor Statistics reported that in 2016, over 70% of all the workers who suffered trauma and time away from work due to nonfatal workplace violence worked in healthcare and social services.


The National Institute for Occupational Safety and Health (NIOSH, 2019) defines and tracks workplace violence across all private industry. NIOSH classifies workplace violence into four basic types.


* Type I: Involves "criminal intent." In this type of workplace violence, "individuals with criminal intent have no relationship to the business or its employees."


* Type II: Involves a customer, client, or patient. In this type, an "individual has a relationship with the business and becomes violent while receiving services."


* Type III: Violence involves a "worker-on-worker" relationship and includes "employees who attack or threaten another employee."


* Type IV: Violence involves personal relationships. It includes "individuals who have interpersonal relationships with the intended target but no relationship to the business" (American Nurses Association, 2017).



Type II and III are the most common types of workplace violence in healthcare. Anecdotally, many nurses acknowledge significant underreporting of both types. Many organizations lack reporting systems and protocols for responding to these situations. This is at least in part due to the historical culture of nursing. Before reporting a situation, the nurse must recognize it as workplace violence and be willing to self-identify as a victim. Deeply held ideals about putting the patient first, understanding of altered cognitive capacity, the psychology of oppressed groups, and the general culture of a female-dominated profession are powerful cultural themes suppressing reporting. The "MeToo" movement has exposed both the commonality of violence against women and the barriers to reporting. These issues play a role in underreporting of workplace violence in nursing. Additionally, many nurses hesitate to report type II, violence from a patient due to the perceived lack of intent. Cognitive impairment for any reason is perceived as reducing or eliminating culpability. Nurses resist the idea of "blaming" a patient who doesn't understand or lacks the ability to change. All these issues deserve consideration and understanding as components of violence. They are not reasons to withhold a report. Reporting is the only way to learn and take steps to reduce the risk.


The "Workplace Violence Prevention for Health Care and Social Service Workers Act" (H.R. 1309) was introduced by Rep. Joe Courtney (D-CT) in February 2019. The legislation would require employers in the healthcare and social service sectors to develop and implement a comprehensive workplace violence prevention plan.


The legislation specifically requires NIOSH to issue a proposed rule within 1 year and then a final rule within 42 months that will establish workplace violence prevention standards for a variety of care settings, including care provided via home health, home-based hospice, and home-based social work. The legislation, if passed, will require that employers develop a plan to prevent workplace violence in cooperation with direct care employees, include reporting and postincidence investigation protocols and that a summary of illness and injury logs be made available for employees.


As of this writing, 26 other House Members have signed on as supporters and a number of national organizations have endorsed the bill, including the American Federation of Teachers, the AFL-CIO, National Nurses United, and the American Nurses Association. The Visiting Nurses Association of America (VNAA) and its parent association, ElevatingHOME has also signed on as a supporter, identifying workplace violence as a priority topic for 2019. We are working with members to explore and understand workplace violence in home-based care. If you are willing to share your experiences, please contact Danielle Pierotti, PhD, RN, CENP, directly at




American Nurses Association. (2017). Workplace violence. Retrieved from[Context Link]


National Institute for Occupational Safety and Health. (2019). Occupational Violence; Fast Facts. Retrieved from[Context Link]