Violence in the Workplace — How Healthcare Leaders Can Support Staff Through Traumatic Events

We all deserve to feel safe in our workplaces and communities. Unfortunately, violence in healthcare settings is a very real and prevalent issue. It can cause ripples of stress and trauma throughout your entire team.

As a leader, you want to support your staff in the ways they need. But you may feel uncertain about approaching and navigating episodes of violence and trauma with them.

After all, your education and experience never prepared you for dealing with these kinds of issues in your workplace.

But you know the saying—hope for the best, and prepare for the worst.

You can stay hopeful that violence never touches your life—while learning effective ways to respond, in case it’s ever an issue you must face.

Healthcare leaders like you understand the value of support, and reaching out for help. Nobody’s an island, and healthcare organizations depend on everyone working together as a well-oiled machine. One cog out of place, and the whole system feels the strain.

When workplace violence occurs, it impacts everyone—including you.

Because people look to you for guidance and support, you need practical tools in your toolbox to help you help others.

But you’re so busy handling your day-to-day duties—who has time to research and find the information you need?

Thankfully, we’ve got you covered.

This article will explore violence in healthcare settings, and how to prevent its escalation. You’ll also learn strategies to support your team through difficult situations.

Facts about workplace violence in healthcare settings

It’s a sobering statistic that one in four nurses report being assaulted by a patient.

According to the American Hospital Foundation, violence in healthcare has increased since the beginning of the COVID-19 pandemic. They report a notable uptick in reports of physical and verbal assaults toward nursing staff since the pandemic entered our lives.

One comprehensive survey interviewed over 6000 nurses in Minnesota, who reported experiencing acts of physical and non-physical violence at the hands of patients or clients.

This same study noted current statistics of violence in healthcare workplaces are significantly underreported, as many nurses simply accept them as part of the job.

You’ve probably witnessed these effects firsthand, as you and your team struggle to cope with rising care demands, increased acuity and morbidity, staffing issues, and the many other stressors that come with a career in healthcare.

When violence impacts your staff, it can erode morale, create rifts in trust, reduce feelings of safety, and contribute to burnout.

But workplace violence isn’t always cut-and-dried.

In many cases, healthcare workers deal with violence in non-physical forms. This includes verbal assaults, threats, and insults. It can also involve the destruction of property.

Violence in the workplace can also mean physical assaults. 59% of CNAs working with people with dementia reported being physically assaulted on a weekly basis.

No matter the source—healthcare workers experience trauma as a result of witnessing and experiencing violence in the workplace.

Trauma effects can show up in many ways. Some cope by shutting down, others seek to compartmentalize the experience—locking it away in order to continue to perform like always. Others contend with extreme emotions, which can include crying, anxiety, panic, and anger. Some seek to numb themselves to intense feelings and memories. This can sometimes lead to the use of addictive substances.

All of these responses, left unaddressed, can negatively impact work performance and overall quality of life.

Because you’re a strong leader, you're invested in being an effective mentor to your team. That includes working with them to prevent episodes of violence from occurring, and supporting them in overcoming trauma as a result of workplace or community violence and tragedies.

Let’s explore some ways you can help your team recognize the signs of potential violence, as well as strategies to reduce risks.

Recognizing risks and preventing violence in the healthcare workplace

When it comes to violence in healthcare settings, there’s another common saying that rings true—hurt people, hurt people.

While this doesn't excuse perpetrators of violence, it does reframe the issue from a place of awareness—to understand how it occurs and master strategies to stop it from escalating.

When you work in healthcare, you deal with people who are hurting. They may be in physical pain, emotional pain, spiritual pain, or a combination of all three. They may be grappling with depression, anger, fear, confusion, and grief.

These feelings, given the right triggers, can be a catalyst for violent outbursts in some individuals.

The first step in preventing violent episodes involves recognizing triggers and the cycle of anger that leads to violence.

• When a person becomes triggered, something provokes them to feel anger. This may be connected to past trauma they’ve experienced.
• This leads to a strong negative emotional response.
• The feeling of anger produces physical responses in the body, as the sympathetic nervous system gears up for a fight
• The person reacts with a behavior that’s based on the thoughts, feelings, and sensations they’re experiencing

Recognizing this process in action is key to interrupting its progression.

The next step is to use trauma-informed communication strategies to de-escalate the situation and prevent it from turning violent.

Trauma-informed tactics to help recognize and de-escalate issues include—

●      Self awareness — closely monitoring your own physical and emotional responses in the moment, and making adjustments as needed to calm a situation.

●      Rational detachment — practicing controlled awareness of your own behavior during a crisis, with the goal of providing safety for yourself, your staff, and your patients.

●      Verbal loops — validating a person’s statements by listening and repeating what they’ve said to show you’re listening and understand.

●      Interpreting non-verbal cues — recognizing the signs of agitation and calming.

●      Motivational interviewing — a method of communicating with a person that allows them to consider changing their behavior, making it under their control.

Implementing these strategies with real patients and families can look like—

• Standing at an angle to an agitated patient, with hands unclenched and arms uncrossed
• Not arguing with or challenging what a patient says
• Reframing what a patient says, to show you’re actively listening
• Accepting the person as they are, without judgment
• Not taking things personally
• Responding with agreement or validation of a patient’s feelings
• Watching for signs of increasing agitation, such as muscle tension, pacing, heavy breathing, clenched fists, physical posturing, eye rolling, or repetitive movements
• Offering clear choices instead of giving commands
• Showing empathy for feelings expressed
• Avoiding engaging negatively with a patient’s family
• Avoiding escalating a power struggle
• Having clear exit strategy
• Keeping your body language neutral and non-threatening
• Respecting patients’ personal space
• Managing sensory stimuli such as bright lights, strong smells, and loud noises
• Explaining your role and what you plan to do
• Keeping it simple and direct, and allowing them time to process and respond
• Letting them know you want to support them in regaining control

Training your staff in these strategies and modeling them yourself can serve to de-escalate anger before it leads to violence. This will go far in keeping your workplace safe and secure—for you, your staff, and the people you serve.

But what if an episode of violence has already occured? How can you support your team in addressing and overcoming trauma from experiencing violence in the workplace or community?

Coping with the effects of workplace violence and tragedy— Helping your team heal

When violence or tragedy has impacted your team—they look to you for guidance.

Though you may also be coping with the effects of the traumatic event, your leadership role means you’re in a position to offer your staff the tools they need to process and heal.

Martin Luther King Jr. spoke of the measure of great leaders being taken not during times of calm and ease, but “in times of challenge and controversy.”

If violence or tragedy in the workplace or community impacts you and your staff, it’s a chance for you to demonstrate true leadership, by facilitating positive outcomes.

Debriefing your team after a traumatic event is a powerful way to demonstrate your desire to keep open lines of communication, and to offer permission for your team to process what’s occurred.

Acknowledge and normalize what your staff may be feeling. Let them know you’re available to support them, both now and in the future.

Because people process trauma differently, some may benefit from a group setting to share, while others may prefer to seek you out in private to work through their feelings. Some may not wish to discuss their experiences at all, but you should continue to check in to see how you can support them down the road.

And keep an eye out for the signs of burnout—in both yourself and your team.

Common signs of burnout include—

• Emotional exhaustion — the inability to access your emotions and the feeling that your compassion cup has run dry.
• Depersonalization — feelings of disconnection and futility. Can show up as callousness in dealing with patients.
• Decreased sense of accomplishment — feeling like what you do doesn’t matter and isn't vital. Feelings of worthlessness.

Much more than simply a bad day—burnout involves persistent, chronic workplace stress that’s not effectively managed. When episodes of violence or trauma aren’t dealt with, their effects can compound over time and lead to burnout.

According to a study that investigated strategies to cope with violence in healthcare, offers of social and organizational supports were viewed positively by workers who experienced violence.

The study noted social supports “may reduce the stress and other adverse consequences experienced by workers who have been exposed to workplace violence.”

Social support includes talking with coworkers and leadership staff. Encourage your team to share with one another, and provide them with the time, space, and opportunity to do so. Let them know you’re available to listen to their concerns, and practice non-judgment and active listening when they come to you.

Organizational support can come in the form of trainings, company policies and protocols designed to prevent violence, and clearly-defined avenues for incident reporting.

The subjects of this study overwhelmingly reported being open to accepting training as a means of organizational support following a traumatic event.

Cabana has created several live group sessions, focused on workplace violence in healthcare. These sessions are geared toward both healthcare leaders and staff. You can attend one or more of these sessions, and encourage your team to do the same.

Organizations can also support staff by ensuring they’re aware of their rights and responsibilities. Acknowledging and demonstrating that violence will not be tolerated is also vital. Staff can be empowered through involvement in developing safety protocols and security policies to prevent workplace violence.

Practicing self-care is also a key component of trauma recovery. This is crucial for both you and for your team. Here's a helpful guide that details some resiliency strategies to heal from trauma.

Offering access to mental health care is another important way you can support your team throughout their healing process. Many require encouragement to seek out counseling or therapy, so reducing friction by providing access to in-house counseling, or compiling a list of local services and resources can ensure staff pursue additional help.

Healthcare leadership is not for the faint of heart. Your team is lucky to have you, because you’re committed to helping them be their best. If your role ever involves coping with the impact of violence in the workplace, using these tips and strategies will help you successfully navigate the issues you face.

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