Violence against health care staff in hospitals: an underestimated problem?

Violence against health care staff in hospitals: an underestimated problem?

  • issue 77

Sabine Hahn

Internationally the prevalence of violence against heath care staff is on the rise and more widespread than is commonly believed.1 Health professionals are the second most exposed professional group to violence at their workplace after police and security personnel.2 Depending on the different healthcare sectors, health care staff are exposed to various physically and mentally injurious and stressful interactions with patients and their visitors. Negative outcomes of these aggressive interactions are reduced patient and staff safety and quality of care, psychological distress, physical injuries, and reduced satisfaction. These consequences are generally underestimated, and supervisors and managers have too little knowledge of the subject. Therefore, they often neglect the importance of violence at the workplace, and take inadequate measures or prevention strategies to effectively support staff in dealing with patient and visitor aggression.

Known in all areas of health care

When health professionals are asked how often they were insulted, threatened, or even physically attacked in their daily work and felt hurt by patients or visitors, over 50% respond to having experienced this stressful situation in the last 12 months. Almost all health professionals experience patient and visitor violence during their professional life.3-5 Nurses are involved most often, but also physicians, physiotherapists, midwives, etc. are affected to varying degrees. The frequency of health care staff being involved in violent incidences seems to depend on the health care setting and/or workplace.6

More strategic interventions are needed

Many general hospitals seem to pay less attention than psychiatric care or long-term care7to international recommendations for protecting health professionals from aggression and violence at the workplace. Is patient and visitor violence in acute care taken less seriously or even accepted as part of the job in this health care sector? It seems that this attitude is widespread in acute care, not only among the professionals themselves, but also among managers. How else is it possible that the wide-spread verbal violence, bruises, scratches, bites, and other injuries as well as their consequences are noticed less frequently in this area of health care? The costs caused by the experience of aggression and violence in the workplace and the premature retirement of professionals are also negated. This is surprising, as the International Labour Office, the International Council of Nurses, and national laws emphasize that safety at work must be guaranteed for all staff. Managers do not yet seem to be sufficiently aware of the issue and their responsibility for the physical and psychological integrity of their employees in the workplace. In addition, they still seem to have too little knowledge about the frequency, causes, and consequences of this danger at the workplace and too little expertise in dealing with these demanding situations.8-10Managers play a key role in combating workplace aggression. They have a significant influence on the working atmosphere and environment. Without their support, no adequate reduction of patient and visitor violence seems possible.

Systematic strategic approach to reduction of patient and visitor violence

The effective implementation of knowledge and guidelines to reduce workplace violence is often difficult.3 This has to do with the complex interplay between the factors important in the development of patient and visitor violence in hospitals. For example, the complex organizational structures, an unfriendly and uncomfortable environment, close physical and psychological contact, as well as the professional role in the interaction between health professionals and patients or relatives, and the personal characteristics of the persons involved in the violent interaction.

Therefore, a systematic and strategic approach needs to be implemented in the whole organization on macro-, meso-, and micro-levels.6 The macro-level means, e.g., the professional bodies, research, and health care organizations bringing the topic of workplace violence and patient and visitor violence to the public and into the political discussion. The meso-level means implementing a clear organizational attitude about violence and aggression at the workplace and supporting a corporate culture of safety and a staff and user friendly (work) atmosphere.8Here the important role of the management in health care in reducing patient and visitor violence becomes apparent. The focus is on leadership and a clear strategy for the organization – including structural framework conditions – as well as comprehensive security management. These measures need to be embedded in a clear political orientation against aggression and violence. In addition, more attention must be paid to the patient’s need for information and orientation as well as to the need for safety-enhancing interaction between patients, relatives, visitors, and health care staff. At the micro-level, employees need sound knowledge and strategies on how to respond to the needs of patients and which interventions are successful in preventing aggression and violence. In addition, employees who have experienced aggression and violence in the workplace must be supported by their superiors with professional competence so that the negative consequences of such challenging events can be identified and addressed at an early stage. Models like the Model of Strategies Addressing Violence in Health Care will support health care organizations and their management in increasing their knowledge and effective strategies against violence at work.3



  1. Hahn S, Zeller A, Needham I, et al. Aggress Violent Behav2008;13(6):431-41.
  2. ILO ICN WHO PSI, Workplace Violence in the Health Sector: Country Case Studies Research Instruments Survey Questionnaire (English). Joint Programme on Workplace Violence in the Health Sector. 2003, ILO/ICN/WHO/PSI: Geneva, 1-14.
  3. Hahn S, Hantikainen V, Needham I, et al. J Adv Nurs
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  6. Hahn S. Patient and Visitor Violence in General Hospitals. Maastricht: Universitaire Pers Maastriecht, 2012.
  7. Heckemann B, Zeller A, Hahn S, et al. Nurse Educ Today 2015;35(1):212-9.
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