Workplace Violence Prevention Planning

Case Example: Two days after being admitted, a patient attempted to light a cigarette in his room. His nurse reminded him that smoking in the hospital is forbidden and that oxygen was nearby making it a dangerous situation. Although he responded in a disrespectful manner, he did not light the cigarette. After the nurse left, however, the patient lit up a cigarette. The nurse smelled the smoke from the hallway and ran into the room, demanding that the patient put the cigarette out immediately. The enraged patient screamed at the nurse and forcibly pushed her away. She was able to grab the cigarette and put it out. The hospital temporarily shut off the oxygen on that floor and provided oxygen tanks to patients in need of them.

Integral to becoming a high-performing highly reliable organization is workforce engagement, the core of which is experiencing joy and meaning in their work. Simultaneously managing safety and healing is complex. A variety of individuals walk through the doors of health facilities: patients, visitors, vendors and others. Unfortunately, some pose challenges that could compromise patient and employee safety. In many cases, these challenges require the attention of health care staff, diverting their focus from delivering care.

Over the past several months, California’s division of Occupational Safety and Health, better known as Cal/OSHA, held five stakeholder meetings with the goal of developing workplace violence prevention regulations. Legislation signed last year, SB 1299, requires Cal/OSHA to develop such regulations covering acute care hospitals. Cal/OSHA, however, has indicated its intent to expand the scope of its regulations to cover all healthcare employers, from clinics and medical offices to home health and school nurses.

While the regulations are still in development, the process thus far reveals that health care employers will be required to implement a workplace violence prevention plan (Plan) in addition to the Injury and Illness Prevention Program (IIPP) required by Section 3203. Items likely to be required as part of the Plan include:

  1. Procedures for the active involvement of employees in the development, implementation and review of the Plan (e.g. identification, evaluation and correction of workplace violence hazards, design and implementation of training).
  2. Methods the employer will use to coordinate the implementation of the Plan, including how employees will be trained, procedures for reporting, investigating and recording of these incidents.
  3. Procedures to ensure that employees comply with the Plan.
  4. Procedures for communicating with employees regarding workplace violence matters.
  5. Assessment procedures for the identification and evaluation of hazards including community-based risk factors for each facility, unit, service or operation.
  6. Procedures for the identification and evaluation of patient-specific workplace violence risk factors.

Cal/OSHA is expected to make revisions on the draft discussion document and begin the formal regulatory process in June with the Office of Administrative Law.

Additionally, the Joint Commission issued a Sentinel Event Alert in 2010 addressing violence in health care settings. The document underscores suggested actions, such as working with the security department to assess the facility’s risk of violence and ensuring procedures for responding to incidents of workplace violence are in place for employees to receive instruction.

One of the key places to start having these discussions is with your facility’s organizational leadership. The third strategy in Through the Eyes of the Workforce is commitment to creating a high-reliability organization. The leadership team needs to engage the workforce in conversations related to connections between respect, workforce safety and patient safety. Successful leaders make a culture of safety a priority; in turn, the health facility staff will feel valued and a part of the organization’s transformation.


California Code of Regulations. Title 8, Section 3203. Injury and Illness Prevention Program 

California Department of Industrial Relations. Workplace Violence in Healthcare.

Preventing violence in the health care setting. Sentinel Event Alert 2010;(45):1-3.

Roundtable on joy and meaning in work and workforce safety. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston, MA; 2013:43.

Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual. Saf. 2015;(June):1-3.