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

Article Content

Workplace violence (WPV) is a pervasive and serious occupational hazard. In 2016, there were more than 16,000 employees in the private industry exposed to intentional injury from another person resulting in nonfatal WPV, and nearly 70% of those workers were healthcare and social service employees (Bureau of Labor Statistics, 2016). The home care setting has been recognized as an area of high risk for WPV due to the unpredictable and solitary work environment (Occupational Safety and Health Administration, 2015). Given that WPV remains a significant concern among home health clinicians (HHCs), it is important to focus on consequences of WPV, including physical injury, psychological trauma, and poor work performance.


Barling et al. (2001) used structural equation modeling to predict personal and organizational consequences of WPV experienced by HHCs. Results suggest HHCs who have a continued fear of WPV are likely to experience negative mood (i.e., anger and anxiety), and perceptions of injustice from employers. Fear, negative mood, and perceived injustice predict decreased worker commitment and increased withdrawal intentions, poor interpersonal work performance, greater patient neglect, and increased risk of HHCs suffering from cognitive difficulties.


According to Beattie et al. (2018), the threat of WPV results in a fight or flight response leading to a neurobiological response of increased heart and respiratory rate, tightness in the chest and/or stomach, hypervigilance, and an urgent sense of wanting to leave the patients' home. Other responses related to fight include anger, becoming belligerent, and intolerance of one's job/career, while another response related to flight was avoidance. Hanson et al. (2015) found HHCs who experienced WPV had greater stress, depression, sleep problems, and work burnout.


Employee safety, health, and well-being are essential for safe and effective patient care. Not providing HHCs with support and resources to stay safe while on duty, and lack of training regarding worker well-being and WPV prevention are common findings in research. Hanson et al. (2015) used a theoretical model to examine confidence as a moderator in responding to consequences of WPV such as burnout, stress, and depression. Hanson et al. found that a higher level of confidence in responding to WPV weakened the impact of consequences of WPV on burnout and stress. HHCs identified two significant areas that should be included in a WPV prevention program: resilience and de-escalation skills. Resilience allows HHCs to manage and be aware of their own responses to consequences of WPV, and de-escalation skills are needed to mitigate or prevent imminent violence that leads to consequences of WPV.


As a greater number of patients continue to receive care in their private homes, the risk of exposure to WPV will continue to rise, and the number of HHCs experiencing consequences of WPV will increase as well. Further research is needed, specifically prospective studies, in order to better understand consequences of WPV experienced by HHCs.




Barling J., Rogers A. G., Kelloway E. K. (2001). Behind closed doors: In-home workers' experience of sexual harassment and workplace violence. Journal of Occupational Health Psychology, 6(3), 255-269.[Context Link]


Beattie J., Innes K., Griffiths D., Morphet J. (2018). Healthcare providers' neurobiological response to workplace violence perpetrated by consumers: Informing directions for staff well-being. Applied Nursing Research, 43, 42-48.[Context Link]


Bureau of Labor Statistics. (2016). TABLE R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury or illness, private industry, 2016. [Context Link]


Hanson G. C., Perrin N. A., Moss H., Laharnar N., Glass N. (2015). Workplace violence against homecare workers and its relationship with workers health outcomes: A cross-sectional study. Public Health, 15, 11.[Context Link]


Occupational Safety and Health Administration. (2015). Guidelines for preventing workplace violence for healthcare and social service workers. Accessed July 20, 2018.[Context Link]