After you take this class, you will be able to:

  1. Detail ways to prevent violence in the workplace.

  2. Act correctly if violence or the threat of violence occurs in the workplace.


There is always a chance that violent acts can come into our life. It can happen at any time. It can happen in any place. Violence can happen:

  • in our home,
  • in our schools,
  • on our streets,
  • in any store,
  • in our own hospital or nursing home,
  • in the parking lot where we work,
  • in any building,
  • on a plane,
  • in any airport and
  • at every place of work.

Each day we hear sad and terrible stories about violence in the home, child abuse, road rage, gun shots in schools, bombs and germs in the mail, terrorism and other acts of violence.

Nursing assistants and all other people must learn about the warning signs of violence. They must also know how to act if it occurs. This will help us to stay safe and without any injuries or death while we are doing our job. It also saves the lives of our patients, visitors and the other people that we work with.

This class will teach you how to:

  • prevent violence,
  • stay safe,
  • keep your visitors safe,
  • keep your patients safe and
  • keep those that you work with safe.


Healthcare is at MORE risk than most other work places for a couple of reasons. Violence happens more often if a person:

  • has a mental problem,
  • is taking a medicines or has
  • a disease that can lead to it.

We take care of these kinds of patients. Many of our patients have mental problems. Some may be taking a medicine with side effects that can lead a person to commit violent acts. Still others may have a physical problem, or disease, that makes them more violent than they would be without this disease or disorder. For example, a patient with a mental problem may try to kill themselves or the members of their family. Before they had this mental problem, they never even would have thought about such a terrible act.

The danger is also greater than other places of work because we let patients, visitors, husbands, wives and total strangers pass through our doors when we know little or nothing about the person and their past. It is very possible that one of our visitors has shot people where they worked just days before they came to our hospital or nursing home.

People in these groups are known to sometimes be violent:

  • employees who are not happy,
  • staff who have been fired,
  • angry husbands, wives or friends of your co-workers and
  • patients or family members who are angry with the hospital, nursing home, the doctor or other people that work there.

OSHA: Workplace Violence

The United States and OSHA say that violence, “in its most extreme form, homicide, is the second leading cause of fatal occupational injury in the United States. Nearly 1,000 workers are murdered, and 1.5 million are assaulted in the workplace each year. … there were 709 workplace homicides in 1998, accounting for 12% of the total 6,026 fatal work injuries in the United States” (OSHA, 2002, pg 1)

OSHA says that all hospitals and nursing homes must:

  • have security and safety plans,
  • find and correct things that can lead to violence,
  • do things to prevent violence and
  • give training to employees on safety, security, and ways that we can keep ourself and our patients safe.


People with these things may be violent:

  • a mental disorder
  • substance abuse of alcohol and/or drugs
  • a past history of violence
  • a lot of stress
  • a head injury
  • a thinking problem or confusion
  • feelings of being trapped with no way out
  • money problems
  • family problems
  • infection
  • a lot of pain
  • a change in the body’s fluid balance (dehydration, for example)
  • high blood sugar
  • low blood sugar
  • a thyroid problem
  • a major change in one’s life (moving, losing a job, getting fired, etc.)


Hospitals and nursing homes can prevent violence and injuries at work by providing these things:

  • security staff,
  • emergency procedures,
  • crisis teams,
  • enough staff,
  • alarms and/or panic buttons,
  • video cameras,
  • bright lighting in indoor and outdoor areas,
  • procedures for working in groups and walking in groups, especially during night time hours and
  • education.


Learning about the warning signs of violence helps us to be able to act correctly when one of these signs is seen.

Here are some of the warning signs that people may show:

  • Angry body posture. For example, a person may come up very close to your face and just stare into your eyes with an angry look on their face. They may also wave their arms in anger or make a fist with their hand.
  • A red face
  • Neck veins that look like they are popping out of the neck
  • Pacing, or walking around in an angry way
  • Squeezing of the hands
  • Shouting
  • Heavy breathing
  • Huffing and puffing
  • Threats. For example, a person may say, “I am going to shoot Dr. Smith”, or “There is a bomb on the first floor”.


You must act right away if violence may happen. You must also act right away if it has already started. You must act in the right way; and you must act quickly. You can prevent injury when you act in the right way and you act quickly.

The first thing that you must do is call for help. Call for help if you can not control the situation alone and in a very fast way.

If it gets out of your control, call for help immediately and:

  • Move near an exit, such as a door or the stairs. Do not allow the person to block the exit if this is possible without injury.

  • Speak calmly and in a soft way. Speak in a low voice. Do NOT yell. Use only one calm, soothing tone.

  • Stay calm.

  • Hold your body in a calm and non-threatening way. Keep your arms loose and at your side. Do NOT cross your arms. If you cross your arms, the person will think that you are angry and a danger to them.

  • Stay at eye level with the person but do NOT look at them directly in their eyes.

  • Stay a couple of feet away from the person. This will keep you safe if they try to hit you.

  • Stand with your feet spread apart and with your front foot pointing toward the potentially violent person and your rear foot at a right angle to your front foot. This will help you keep your balance if you are hit or pushed.

  • Show respect and caring for the person.

  • Leave if your life and safety is in danger.


In addition to very direct physical attacks with no weapon, there can also be other violent acts that can happen in the places we work. Some of these acts can include:

  • A person with a gun or a knife who is trying to or threatening to kill someone, or even themselves,
  • The taking of a hostage or a group of hostages,
  • Bomb explosions and bomb threats,
  • Acts of terror and bioterrrorism,


People With Knives and Guns

  • Stay calm
  • Get help

Hostage Taking

  • If you are taken hostage, stay calm. Call or signal for help if you can.
  • If you see that other people are being taken hostage, report it immediately.

Bomb Threats

  • Evacuate the area according to your hospital or nursing home procedure. Follow the instructions of the supervisor or another person that is in charge.

  • If you get a telephone bomb threat, keep the person on the phone as long as you can at the same time that you are calling or signaling for help. Write down everything that the person says. Make a note of how they are acting (nervous, intoxicated, angry, calm, etc.). Try to find out their name and where they live, if possible. Also, try to find out why they want to bomb the hospital or nursing home.

  • Stay calm.

Acts of Bioterrorism

  • If you or your patients are contaminated with a bioterrorism germ, report it immediately. Follow the instructions of your supervisor.

  • Inspect all mail and packages before you open them. If you notice a lot of extra stamps and/or you do not know who the mail came from, notify your supervisor before it is opened.


In our daily lives, especially after the tragic events of 9-11, you should:

Be aware of your surroundings.

We must look and listen at all times. We must look and listen wherever we are and wherever we go. If anything, anything at all, looks unusual or suspicious, report it immediately to the correct person.

For example, if you get on an elevator in your hospital or nursing home and see a lunch bag on the floor of the elevator, do NOT touch it. IMMEDIATELY notify your supervisor or the safety office. This lunch bag is unusual. You do not normally expect to see a lunch bag on the floor of an elevator.

Another example involves hearing something unusual. If you hear two people, who are not employees, whispering in your hospital lobby, report it. If you hear an unusual noise in the basement during the night time hours, report it. The whispering people and the noises are both unusual. It is possible that nothing at all is wrong, but the safest thing to do is to get an expert to make that decision, not you. If you are not sure that things are safe, report your suspicions.

Follow Your Policies and Procedures

Your hospital or nursing home has policies and procedures for fires, bomb threats, violent acts and all other emergencies. These policies and procedures must be followed ALL the time WITHOUT any changes.

One of the best ways to insure your safety and the safety of your patients and visitors is to follow these procedures when an emergency occurs.

In your community, it is necessary to follow these procedures as well. For example, if you see an actual or possible act of violence or terrorism you must call 911 for the police.

If you see a fire, you call the fire department or 911, as established in your living area. If you see something suspicious or unusual in the airport, or anywhere in your community, you should also report it to the police or the law enforcement body in charge of the area.


Violence can happen anywhere and at anytime. These dangers are present in all places of work, including in hospitals and nursing homes.

Nursing assistants and all other people who work in healthcare must know about workplace violence, its signs and the proper way to act if violence occurs. All of this knowledge makes our place of work a much safer place.


Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

National Institute for Occupational Safety and Health. (2010). “Violence in the Workplace”. [online]

Occupational Safety and Health Administration of the US Department of Labor. (2002). “Workplace Violence”. [online]

United States Office of Personnel Management. (2010). “Workplace Violence- A Guide for Agency Planners”. [online]
Copyright © 2010 Alene Burke