Healthcare workers face workplace violence at 5x the rate of other industries. Is your team ready?

OSHA's General Duty Clause requires employers to protect workers from recognized hazards, including workplace violence. Healthcare workers face workplace violence at 5 times the rate of other industries. OSHA has cited healthcare employers for inadequate violence prevention under the General Duty Clause. OSHA's healthcare workplace violence guidelines (OSHA 3148) provide a framework employers use to document their prevention efforts. California, New York, Oregon, and Washington have enacted specific state laws with more detailed requirements.

California SB 553 (Labor Code 6401.9, operative July 2024) requires employers to establish, implement, and maintain a written workplace violence prevention plan. The exemptions are narrow, so most practices are covered. A small worksite is exempt only if fewer than 10 people work there at any given time, it is not accessible to the public, and it complies with Cal/OSHA's injury and illness prevention rule (8 CCR 3203). The rest of the list is short: state corrections facilities and law enforcement agencies that meet their own conditions, staff teleworking from a place they choose, and facilities covered by Cal/OSHA's healthcare standard. Those healthcare facilities (8 CCR 3342, operative April 2017, with its plan and training requirements phased in by April 2018) follow that standard instead of SB 553. Both ask for a violent incident log, work-area hazard assessment and annual training. What 3342 adds is reporting workplace violence to Cal/OSHA within 24 or 72 hours depending on severity, refresher training aimed at staff with patient contact and their supervisors, and a one business day limit for answering trainee questions when training is not given in person. Both rules ask for training on your own plan plus an opportunity for interactive questions and answers with someone who knows that plan. This course covers the general material. You supply the plan and the knowledgeable person. Failure to comply exposes employers to Cal/OSHA citations and potential civil liability in the event of an incident.

Inpatient psychiatric units, SUD treatment facilities, and emergency behavioral health settings have the highest rates of workplace violence in healthcare. CARF International and the Joint Commission require workplace violence prevention programs as part of behavioral health accreditation. Staff training in de-escalation and early warning sign recognition is the most effective prevention measure - it prevents most incidents before physical confrontation occurs. Organizations without formal training programs see significantly higher assault rates.

De-escalation techniques use verbal and non-verbal communication to reduce agitation and prevent escalation to violence. Key techniques include maintaining a calm, non-threatening tone and body language, active listening without interrupting, giving the person choices and some control, avoiding commands and power struggles, and validating emotions without endorsing behavior. Research in behavioral health settings consistently shows that trained staff prevent the majority of potentially violent situations from becoming physical. Formal training programs significantly reduce both patient-on-staff assaults and the need for physical restraint.