1. Small, Tamara F. PhD, APRN, FNP-C

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Workplace violence (WPV) is a major concern of home healthcare clinicians (HHCs). Contrary to popular belief, WPV is not limited to homicides and incidents that make nightly news, but can manifest in more subtle ways, such as with verbal abuse. The Joint Commission (2018) recognized that verbal abuse has been tolerated far too long, is often overlooked, and exceeds all other categories of violence. In 2019, Karlsson et al. found HHCs experienced more verbal abuse than physical abuse when the source was patients and/or family members (22% vs. 7.4%). Although, verbal abuse is nonphysical violence, it can escalate to physical assault (Lanza et al., 2006). A meta-analysis by Byon et al. (2020) found the rate of verbal abuse by patients was higher than physical abuse for home healthcare physicians, nurses, therapists, and social workers compared with home health aides, nursing assistants, and personal care workers. Karlsson et al. (2019) found small workspaces, unclear plan for care delivery, and caring for patients with limited mobility are risk factors for verbal abuse.


Consequences of verbal abuse are usually insidious and may go unrecognized for an extended time. Therefore, clinicians may be reluctant to report WPV incidents that are perceived as less severe or when consequences are not immediately recognized. Clinicians exposed to verbal abuse may suffer from psychological trauma, fear, stress, depression, sleep disorders, anxiety, posttraumatic stress disorders, decreased job satisfaction, and burnout. Another consequence is that clinicians might reduce time spent with verbally abusive patient or may even refuse to provide care altogether.


It's important to recognize verbal abuse and be proactive in addressing problems early. When verbal abuse takes place, workers should be vigilant for the following signs of imminent physical assault: angry facial expressions, pacing, restlessness, mumbling, and persistent staring. HHCs should become aware of their own behavioral responses when confronted with verbal abuse. This is especially important because patients may perceive HHCs as "guests" in their home versus healthcare professionals; thus, a certain level of respect or politeness may be expected from the HHC regardless of what the patient may say. Practicing self-awareness allows the worker to become sensitive to their feelings and behavioral responses to negative behaviors, which in turn may de-escalate WPV.


Unfortunately, verbal abuse in home care has been the mainstay and accepted all too often, leading to a false belief that it is a workplace norm. HHCs have a right to be safe on the job. In the absence of effective interventions and resources, organizational support, and federal law, the safety of HHCs will continue to be jeopardized. WPV can no longer be tolerated or accepted as a workplace norm. Instead, workplace norms should include a supportive work environment, respectful communication, and empowerment through education and training.




Byon H. D., Lee M., Choi M., Sagherian K., Crandall M., Lipscomb J. (2020). Prevalence of type II workplace violence among home healthcare workers: A meta-analysis. American Journal of Industrial Medicine, 63(5), 442-455.[Context Link]


Karlsson N. D., Markkanen P. K., Kriebel D., Gore R. J., Galligan C. J., Sama S. R., Quinn M. M. (2019). Home care aides' experiences of verbal abuse: A survey of characteristics and risk factors. Occupational and Environmental Medicine, 76(7), 448-454.[Context Link]


Lanza M. L., Zeiss R. A., Rierdan J. (2006). Non-physical violence: A risk factor for physical violence in health care settings. American Association of Occupational Health Nurses, 54(9), 397-402.[Context Link]


The Joint Commission. (2018). Physical and verbal violence against healthcare workers. Sentinel Event Alert, Issue 59.[Context Link]