“Do no harm” — healthcare workers and aggressive patient behavior

Once a doctor or nurse is on the clock, patient care comes first. From checking charts and administering medication to managing routines and updating concerned family members, a caregiver always keeps the patient’s well-being top of mind. But there is one facet that healthcare staff have internalized as “just part of the job” — tolerating violent or aggressive patient behavior. In fact, according to the U.S. Bureau of Labor Statistics, healthcare and social services workers in the private sector experience more non-fatal violent incidents than workers in any other industry. While 20% of all workplace injuries happen to healthcare professionals, healthcare workers suffer 50% of assaults. Of assaults on healthcare workers, 80% of violent incidents resulted from interacting with a patient.

Unfortunately, examples of workplace violence can easily be found across all sectors and industries — and the healthcare industry is no exception. Examples of violence against healthcare professionals can vary — from verbal and physical attacks from patients and emotional family members to emergency room incidents involving those with a criminal background to coworker bullying.

Aggressive patient behavior is different from other forms of workplace violence because these behaviors are linked to, or a direct result of, a medical diagnosis. Assertive incidents involving patients are often not malicious or even intentional and could be triggered for a variety of reasons, including:

Understanding and recognizing these potential triggers are just the first steps to reducing the risk of injuries to patients and caregivers.

Aggressive behavior is often unpredictable and can quickly escalate from signs of anxiousness and defensiveness to physical responses. However, there are steps staff can take to help prevent or de-escalate these situations and minimize the risk of injuries.

Build out the toolbox
It’s not enough to know that there is a problem. Organize training and provide resources to staff that demonstrate best practices on how to recognize and help prevent situations from escalating, and if they do escalate, how to respond to assertive patients in a variety of situations.

Check patient schedules
Everyone has a routine — and helping patients stick to theirs, even when in a patient care facility, can help reduce stress. Being flexible with processes, such as early queuing or adjusting shower times to that of home routines, can help comfort patients. Maintaining regular schedules is important, but it’s also important for staff to understand what “regular” is for their patients.

Listen to the patient
Caring for patients goes further than just providing diagnoses. Is the patient giving off verbal or nonverbal cues that something is not right? Are factors such as dehydration, hunger, medications, or even lighting triggering an incident? Paying attention to external factors can help prevent incidents from happening and improve the quality of care.

Institute regular reporting
Employees often see assertive behavior as another facet of the job, so encouraging open communication and prompt reporting is key. Another important step is to set up a protocol so employees can readily identify patients who have exhibited violent or assaultive behavior. (Note: Privacy rights vary by jurisdiction, so consult with your legal counsel to determine what steps you may take.)

Establish the perimeter
Most facilities are equipped with alarm systems and other security measures to help staff in times of an emergency. Review your facility’s layout and confirm that all devices are working properly.

Putting patients first will always be the primary focus of healthcare workers. However, tolerating aggressive patient behavior should not be part of that equation. Staff may hesitate to report aggressive incidents out of embarrassment or fear of reprisal, but any delay could keep staff and patients from getting medical treatment for related injuries — and expose the facility to additional liability. Patient care should come first — but not at the expense of healthcare staff.