Workplace Violence in Nursing

This post was inspired by the recent news story of the Dignity Health nurses picketing for a safer work environment, as well as other stories related to workplace violence against nurses.  You can read more about the Dignity Health workplace safety complain here.  The article itself has also been cross-posted via Pulse on Linkedin.

Workplace Violence In Nursing

A Real Solution to a Very Real Problem

by Jeffrey M. Miller SPS, DTI


There is no doubt in anyone’s mind that workplace violence continues to be on the rise, as-well-as a clear and present danger for every business. The Department of Justice and O.S.H.A. report that no business is immune to it. Surprising to many though, is the fact that one of the industries affected most by workplace violence attacks is that of healthcare – specifically nursing.

And, while there continue to be incidents where nurses picket and protest against their organization to get better safety measures, as-well-as those who fight for new legislation that will put laws in place to either impose greater punishment on those who act out, or mandates on healthcare organizations to provide safer working conditions; the reality is that neither of these things will stop the damage from occurring when an actually assailant attacks. One of the reasons for this is that people are trying to apply logic and reasoning to deter an otherwise irrational individual, or one who is acting with criminal intent… neither of which care about your logic and reasoning!

Unlike a typical workplace violence “Zero Tolerance” policy in, say, a manufacturing business where things can be made more secure and hiring practices can be used to weed out potentially aggressive employees, a healthcare facility is a “soft target” that is open to the public and therefore less easy to control with conventional prevention tactics. This, coupled with the fact that the typical assailant attacking a nurse is doing so out of a sense of fear, grief, pain, medications, or an un-diagnosed psychosis, makes healthcare not only different from the majority of industries, but also the reason the FBI created a sub-category for them.

Statistics presented at events like the annual “International Conference on Violence in the Health Sector” and “Congress on Violence in Clinical Psychiatry” clearly show that, regardless of the evidence highlighting the need for greater training and safety protocols, and the effectiveness of such things, nurses are not being given what they need to actually BE safer on the job. Organizations are still leaning toward one-off training programs that are not easily remembered, and security-based initiatives that ignore the problems with lags in response time, and others issues that just cannot make-up for the need for nurses receiving the training that will make them an active, integral part of their own safe working environment.

Security and workplace violence training for nurses and other medical staff should be seen as an investment with a positive ROI, rather than as another non-profit-centered expense. Because, when the right systems, protocols, procedures, and training are in place, patients and staff alike feel safer and less stressed. This equates to not only better job performance on the part of staff, with less lost-time incidents and reduced employee turn-over, but also a better reputation for the facility and organization and a greater willingness on the part of potential patients WILLINGLY choosing that hospital over another option,

Looking at the problem through the lens of strategic perspective, and not merely the limited viewpoint of ‘throwing more guards’ at a problem as a simple, gut-level response, it’s easy to see how the requisite training that allows nurses to effectively respond to acts of violence is, and has long been, sorely missing. And, if healthcare organizations want to stop the bleeding from their bottom lines from such real, debilitating expenses as: lost-time cost, employee turnover and the related recruitment, training, overtime, etc. that results; lower productivity and job satisfaction; higher stress and stress-related illnesses; and potential O.S.H.A. complaints or law suits for injuries sustained; they are going to have to address the reality that, unfortunately, sometimes violence IS a part of the job and, just as is done in law enforcement, get the right kind of long-term, liability-conscious training in place – training that is customized to nursing, and proven to work against a variety of attacker types and their methodologies.

With nurses being 25 times more likely to be attacked on the job than a police officer, and accounting for upwards of 75% of the daily assaults that occur in the workplace – assaults which can happen faster than any guard can respond to, even one in the same room – it’s unconscionable how this type of oversight continues. We must remember that security guards are, first and foremost, a deterrence… not an end-all to beat-all answer, especially in those situations where the assailant knows that security is present but chooses to act anyway.

Designing effective safety protocols, as-well-as customized response training and not merely relying on “zero-tolerance” statements or non-aggression agreements, are both THE most overlooked factors, AND two of the most significant things an organization can do to protect it’s people, it’s assets, it’s reputation in the face of negative PR, and it’s bottom line from the effects of workplace violence.

Are you concerned that your staff is safe enough? Want to take the next step to protecting them from the next attack?  If so…

Download the Workplace Violence Program Assessment Self-Audit Tool now.  This short, easy-to-complete management tool is is an abridged version of the one we use and designed to give you a clearer picture of where you are and where to begin with making your staff more safe and secure.  Click here to get your complimentary Workplace Violence Program Assessment Tool now.


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Jeffrey M. Miller is the Founder and Principle Consultant of the Jeffrey M. Miller Consultancy, an independent consulting firm created to help CEOs and senior HR, Operations, Nursing & Security leaders identify potential threats and design customized policies, procedures and related training that gives them the peace-of-mind from knowing that their people are as safe as possible from the horrors, fear, damage and loss of workplace violence.

He is the author / co-author of several books, videos, and training programs, including: “Workplace Violence in Mental and General Healthcare Settings” (2011, Michael Privitera, ed.), “GIS in Hospital and Healthcare Emergency Management” (2010, Ric Skinner, ed), “Danger Prevention Tactics: Protecting Yourself Like a Pro!,” and the “Rapid Reset & Recharge” 3-Minute Stress Reduction Meditation System for Busy Professionals. Among others, Jeff has helped such organizations as Geisinger Health System, AAIM, Nissan North America, and the Stephen F. Austin University School of Nursing.

He can be reached via his office at: (570) 884-1119 or


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This could have ended very differently, with a much greater loss to UPS than some lost time during a work day.  Of course they will deal with worker-related lost time, productivity, and possibly more as the trauma and other parts of the post-incident recovery phase progresses.  Their ability to handle these with pre-planned processes designed to get things back on track (other than “whip-cracking” and avoidance psychology) will determine just how much will be lost.

The hope is that not only this business, but every other with leaders and owners concerned about protecting themselves and their people against the loss, damage and trauma from workplace violence will use this incident as a reminder that, very often, the attacker will not be one of your own who has gone “postal,” as they say.

As I outline in my report, “Backwards Thinking in Workplace Violence Planning & Staff Training” (available free here:, this is one of the reasons concerned leaders and business owners cannot fall into the trap of limiting their focus on passive prevention and deterrence like “Zero Tolerance” statements, banned weapons lists, or punitive action warnings.  The reality is that…

Most attackers don’t care about these things… and some situations are just not preventable.

But, they are actionable!

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As covered in “Backwards Thinking…”, there are actually 5 different attacker types, each of which require attention in your processes and response protocols.  This case is one of those other four types – one of domestic violence bleeding over into the workplace and affecting not just the partner/victim of the perpetrator, but also anyone else in the vicinity of the violence.

Again, this is something, along with several other attacker types and situations (including hostage-taking and police stand-offs and shoot-outs), that must be addressed and made a part of the customized, company-centric processes and tailored and tailored training in place to truly provide the safe workplace you want for your people.

We know the horrors of violence and how much easier it is to avoid having to think about it and hope that it never happens.  Unfortunately, this only leaves you less prepared and an easier target should the face of violence appear.  That’s why we channel our decades of experience at preventing, defending against, and mitigating the damages from different types of attackers and their methods, and help our clients not only develop the kind of customized processes and tailored training that saves lives, property, money, and reputations… but also allows concerned leaders to be confident and sleep soundly at night, knowing that their company and workplaces are as safe and as prepared as possible.

To discuss your concerns and project needs, take advantage of a 20 minute complimentary consulting call.  Call today at +1-570-884-1119.  Because you never know what tomorrow will bring!


workplace violence risk assessment vulnerability

By Jeffrey M. Miller SPS, DTI


When you think about workplace violence, what comes to mind? Because, the way you define anything – including workplace violence – limits how you will deal with that thing!

In fact, when most managers, administrators, or business owners think about workplace violence and the types of people who commit these acts, they limit their definition to the aggressive employee who lashes out at others on the job. And, while the aggressive employee is one type of assailant, there are many industries, including healthcare, where this type is least likely to ever emerge as a problem.

In the realm of workplace violence, there are actually 5 attacker types! By type, I don’t mean what he or she does to commit an act of violence – nor do I mean the weapons they use, or anything of the like.

What I mean by type is…

“The relationship that the attacker has to the company and it’s employees as targets!”

As I teach my clients, here are the five workplace violence attacker-types:

1) Current Company Employee. This is the attacker that everyone tends to focus on. However, as in the case of schools and universities, organizations can forget “non-traditional” workers or members of the company community such as students, independent contractors, and the like. This belief that it is only employees who attack creates the most risk in companies where there is a great working environment and everyone is getting along. In fact, the medical and healthcare industries have one of the lowest incidents of employee-initiated violence. And yet they rank near the top for total number of incidents of workplace violence!

2) Former Employees. It’s easy to forget those who were fired or quit under less-than-happy conditions. Once gone should not be “easily forgotten.” Usually, workers who are “let-go” for poor conduct or performance have a long string of employment problems elsewhere. And, many of these people hit bottom and develop levels of stress, anxiety, and depression that cause them to turn their blame outwards. A high percentage of workplace violence attacks come from employees who have been fired weeks, months, and even years before the attack!

3) Outsiders – Customers or “Strangers.” These are the attackers who choose a target for whatever reason, but have no direct ties to the company itself. The terrorist attacks on the twin towers of the World Trade Center is a perfect example of this. Another example is the robber who holds up a convenience store, or the customer who doesn’t like the bill he just got from the mechanic who repaired his car.

4) Domestic Violence. This is the spouse or significant other who enters the company to commit an act of violence on a specific person. However, there is often considerable collateral damage due to other employees “getting in the way” or getting caught in the cross-fire!

5) Off-site Client Attackers. This attacker is a virtual unknown to many. But, every year, thousands of employees – in-home visiting nurses, salespeople, utility workers, and others – are assaulted, beaten, robbed, and killed by clients, customers, and others while working outside of the company’s walls!

As you can see, if you expand your perspective and definition of who perpetrates acts of workplace violence, then what you need to do to protect yourself and your people from it, must expand as well.

Fortunately though, training your people to be able to avoid, evade, escape from, or defend against attacks does not require different strategies and tactics for each attacker type. What “is” required though, is an understanding of how to respond in each scenario so as to be the most effective with the least amount of work.

If you’re serious about getting this type of training, you can start by reading this new workplace violence report titled, “Backwards Thinking” In Workplace Violence Planning & Staff Training. It will give you the information you need to get others on board and make this topic a priority project in your company.


Jeffrey M. Miller,SPS, DTI is an internationally-recognized risk assessment and emergency management expert. He is an Amazon best-selling and award-winning author, and co-author of the books: “Workplace Violence in the Mental and General Healthcare Setting,” and “Using GIS in Hospital and Healthcare Emergency Management.” For more information and to download your complimentary report, go to:

For a free initial consult and to discuss your company’s needs, Jeff can be reach at: +1-570-884-1119.

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