workplace violence essay

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Workplace Violence

• Workplace Violence Home

Risk Factors

Prevention programs.

• Training & Other Resources

Enforcement

• Workers' Rights
• Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence . OSHA Directive CPL 02-01-058, (January 10, 2017).
• Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers ( EPUB | MOBI ). OSHA Publication 3148, (2016).
• Worker Safety in Hospitals: Caring for our Caregivers, Preventing Workplace Violence in Healthcare . OSHA.
• Taxi Drivers – How to Prevent Robbery and Violence . OSHA Publication 3976 (DHHS/NIOSH Publication No. 2020-100), (November 2019).
• Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments . OSHA Publication 3153, (2009).

This workplace violence website provides information on the extent of violence in the workplace, assessing the hazards in different settings and developing workplace violence prevention plans for individual worksites.

What is workplace violence?

Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. Acts of violence and other injuries is currently the third-leading cause of fatal occupational injuries in the United States. According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI), of the 5,333 fatal workplace injuries that occurred in the United States in 2019, 761 were cases of intentional injury by another person. [ More... ] However it manifests itself, workplace violence is a major concern for employers and employees nationwide.

Who is at risk of workplace violence?

Many American workers report having been victims of workplace violence each year. Unfortunately, many more cases go unreported. Research has identified factors that may increase the risk of violence for some workers at certain worksites. Such factors include exchanging money with the public and working with volatile, unstable people. Working alone or in isolated areas may also contribute to the potential for violence. Providing services and care, and working where alcohol is served may also impact the likelihood of violence. Additionally, time of day and location of work, such as working late at night or in areas with high crime rates, are also risk factors that should be considered when addressing issues of workplace violence. Among those with higher-risk are workers who exchange money with the public, delivery drivers, healthcare professionals, public service workers, customer service agents, law enforcement personnel, and those who work alone or in small groups.

How can workplace violence hazards be reduced?

In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. This policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with company personnel.

By assessing their worksites, employers can identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well-written and implemented workplace violence prevention program, combined with engineering controls, administrative controls and training can reduce the incidence of workplace violence in both the private sector and federal workplaces.

This can be a separate workplace violence prevention program or can be incorporated into a safety and health program, employee handbook, or manual of standard operating procedures. It is critical to ensure that all workers know the policy and understand that all claims of workplace violence will be investigated and remedied promptly. In addition, OSHA encourages employers to develop additional methods as necessary to protect employees in high risk industries.

Provides information on risk factors and scope of violence in the workplace to increase awareness of workplace violence.

Provides guidance for evaluating and controlling violence in the workplace.

Training and Other Resources

Provides online training and other resource information.

There are currently no specific OSHA standards for workplace violence. Also provides links to enforcement letters of interpretation.

Nursing Workplace Violence

• Increase in Nurse Violence
• Influence of COVID
• Long-Term Impacts
• How to Protect Nurses

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While workplace violence in healthcare has been a persistent problem for many years, the rates have spiked during the COVID-19 pandemic. Nurses report escalating rates of COVID-related violence directed at them by frustrated and angry patients and their families.

A 2021 Workplace Health & Safety survey of registered nurses reports that 44% experienced physical violence at least once during the pandemic from patients, family members, or visitors. Over two thirds encountered verbal abuse at least once. RNs who provided direct care for patients with COVID-19 experienced more violence than nurses who did not care for these patients. Nurses also faced difficulty reporting these incidents to management.

The healthcare industry leads all other sectors for non-fatal workplace assaults. Within healthcare settings, violence in emergency departments has reached epidemic proportions during the pandemic. Emergency nurses are particularly vulnerable. Nearly 70 percent of emergency nurses report being hit or kicked at work.

Workplace violence injures healthcare professionals physically and psychologically, resulting in lost workdays, burnout, and turnover. The escalating rates of violence undermine efforts to provide quality patient care and hinder effective responses to combatting the COVID-19 virus.

Fast Facts About Workplace Violence Against Nurses

Sources: Nurses’ Experience With Type II Workplace Violence and Underreporting During the COVID-19 Pandemic | The COVID-19 Effect: World’s nurses facing mass trauma, an immediate danger to the profession and future of our health systems

The State of Workplace Violence Against Nurses

The rates of workplace violence have increased rapidly since the pandemic began. In August 2021 at a hospital in San Antonio , Texas, family members of COVID-19 patients physically and verbally abused healthcare workers for enforcing mask and visiting restrictions. Across the country, healthcare professions who advocate for vaccination and masking mandates have been subjected to online verbal abuse and threats of physical harm toward them or their family members.

Incidents of workplace violence are not restricted to the United States. A patient with COVID symptoms in Naples, Italy grew impatient waiting for treatment and spat at a doctor and nurse. His actions led to a shutdown of the entire ward and quarantine of all staff. In the United Kingdom, patients spat at and verbally abused staff who asked that they wear masks. In Mexico, healthcare workers accused of spreading the virus, have been assaulted and doused with bleach on public streets.

Nurses have become especially vulnerable to these kinds of physical and verbal assaults. Tina M. Baxter, an advanced practice registered nurse who provides consulting services for healthcare organizations, attorneys, and insurance professionals, has personally experienced workplace violence on several occasions.

— “Nurses are the most convenient target as we are with the patients the majority of the time. It is often the nurse who is tasked to enforce the rules about visitation, masking, and other mandates.”

–Tina Baxter, APRN, GNP-BC

She points out that “violence as a whole has increased during the pandemic and the lack of civil discourse in society, too often resorting to violence has become the first instinct instead of the last resort…Nurses are the most convenient target as we are with the patients the majority of the time. It is often the nurse who is tasked to enforce the rules about visitation, masking, and other mandates.”

A recent brief prepared by National Nurses United (NNU) support’s Baxter’s observations. NNU identifies multiple factors fueling COVID-related workplace violence. Nurses constantly face patients and families reacting with anger related to understaffing and increased wait times for care. They frequently deal with aggressive family members who refuse to adhere to visiting and masking requirements. The pandemic fatigue felt by many people and the misinformation spread by untrustworthy media and online outlets have also escalated the violent incidents.

The Influence of COVID on Rising Verbal and Physical Attacks

The recent Workplace Health & Safety survey connects COVID-related violence to the strained relations between nurses and patients. Over 67% of the nurses reported incidents of physical violence or verbal abuse between February and June 2020.

One in ten RNs indicated that reporting the violent incidents to management has become more difficult during the pandemic than before. Underreporting violence during the pandemic may be due to busy workloads, non-standardized reporting procedures, unclear definitions of what constitutes violence, and a perceived lack of management support.

Stressful conditions and more intense patient and family interactions are among the major forces behind the increased risks for aggression and violence toward nurses during the pandemic. Priscilla Grace Barnes, a registered nurse, personal trainer, and nutrition coach, explains that “part of being a nurse isn’t solely caring for the patient, it’s educating and communicating with the family. Many times this communication involves difficult situations around rules and regulations nurses have no control over. We are put in very tough situations.”

The pandemic may have helped spread the mistaken assumption that violence is part of the nursing profession . Many nurses believe that they have a responsibility to provide compassionate care even to those exhibiting violent behavior. As a result, nurses feel they must tolerate unsafe and dangerous conditions, rationalizing that the increase in violence stems directly from the anger and frustration experienced by patients and their families.

The Long-Term Impacts of Nurse Violence

A 2021 research study published in Healthcare reports that nurses who have experienced direct and indirect exposure to workplace violence are two to four times more likely to experience post-traumatic stress disorder, anxiety, depression, and burnout than nurses with no exposure.

According to the International Council of Nurses (ICN), rates of anxiety, trauma, and burnout have spiked dramatically since the onset of the pandemic. ICN data shows that the number of nurses reporting mental health distress has increased from 60% to 80% in many countries. Failure to address these mental health pressures will impact the already existing nursing shortage. ICN estimates a potential shortfall of 14 million nurses by 2030, which amounts to half the current nursing workforce.

— “Working in a hospital I often felt like I was pouring into a cup that had holes in the bottom of it – no matter how much I gave, the cup was never full.”

–Priscilla Barnes

Government, healthcare organizations, and nursing associations must address the pressing need for mental health support and preventive care for nurses. Barnes argues that healthcare facilities must promote psychological wellness to ensure nurse safety: “Nurses are caregivers. We live to serve. But caregivers have to be well. Working in a hospital I often felt like I was pouring into a cup that had holes in the bottom of it – no matter how much I gave, the cup was never full. This only leads to burnout of those who are the lifeline to the hospital – nurses.”

Despite the generally high regard for nurses held by the general public throughout the pandemic, negative public perceptions have also emerged about workplace safety and mental health challenges in the nursing profession. These unfavorable views may deter prospective nurses from entering the field at the time when they are most needed.

Preventing Workplace Violence Against Nurses: What Needs to Happen?

Even before the pandemic, healthcare workers experienced one of the highest rates of workplace violence compared to all other U.S. workers. According to a 2018 report by the Bureau of Labor Statistics , the number of violent injuries has steadily increased since 2011. Because the problem has reached epidemic proportions, nurses, medical facilities, and government agencies must work together to develop concrete measures to prevent the escalation of workplace violence.

— “Workplace violence should not and does not ‘come with the territory’ of being a nurse.”

–Rhonda Collins, DNP, RN, FAAN

One of the first issues to address is the culture of acceptance about violence in nursing. Rhonda Collins, the chief nursing officer at Vocera Communications, a healthcare technology company, cautions that “workplace violence should not and does not ‘come with the territory’ of being a nurse. Healthcare leaders must aggressively act to address this epidemic by validating concerns and ensuring nurses are heard and respected when reporting violent acts.”

What follows are some suggestions for proactive approaches to prevent workplace violence.

Nurses should also be aware of their surroundings, taking into account poorly-lit areas, placement of emergency exits, and crowded public spaces. Nurses can minimize risks by avoiding clothing or jewelry that can be grabbed or pulled. They should exhibit caution when dealing with patients and others who exhibit aggressive verbal cues (e.g., swearing or threatening language), and non-verbal behaviors (e.g., indications of drug or alcohol abuse or throwing objects.)

Nurses should become familiar with their employer’s health and safety policies, report any incidents, and support employees who have experienced violence. Nurses need to become involved in the development of safety policies, procedures, and emergency plans. All personnel should take advantage of available employer-sponsored programs or professional development opportunities on how to respond and prevent violence and how to use de-escalation techniques.

Collins and other nursing leaders argue that healthcare organizations must adopt a “zero-tolerance policy” on workplace violence. In addition to sponsoring educational and support programs, healthcare facilities must develop clear procedures for reporting violent incidents. To combat underreporting, employers must respond to violence seriously. Management has a responsibility to encourage staff to press charges against persons who commit assaults and to support employees when they report these incidents to law enforcement.

Healthcare facilities should upgrade and maintain security procedures and security systems, develop emergency response protocols, and hire sufficient security personnel. Collins suggests that employers provide nurses “with a wearable panic button that calls safety and security personnel so nurses don’t have to reach for a light on the wall when in distress.”

The Occupational Health and Safety Administration does not require employers to implement violence prevention programs, but it provides voluntary guidelines and may cite employers who fail to maintain a safe workplace environment. In early 2021, the House of Representatives passed the Workplace Violence Prevention Act for HealthCare and Social Workers, but it has not yet received Senate approval.

Although no federal laws currently protect healthcare worker safety, several states have passed legislation to protect them from workplace violence. These measures include the establishment of penalties for assaults on nurses, creating a disturbance inside a healthcare facility, or interfering with ambulance service. Only a small number of states require employer workplace prevention programs.

Nurse Resources for Preventing Workplace Violence

In response to the expanding awareness about workplace violence, several government agencies, professional nursing associations, and other special interest groups have developed resources to address safety concerns and violence prevention.

Workplace Violence Prevention Training for Nurses

This interactive course, developed by the National Institute for Occupational Health helps nurses identify risk factors for workplace violence and acquire skills to prevent and manage violent incidents. Nurses can earn continuing education credits by completing this course.

Reducing Workplace Violence with TeamSTEPPS

The Agency for Healthcare Research and Quality provides curriculum materials and webinars designed for clinical teams in a variety of healthcare settings. These TeamSTEPPS resources offer strategies to address difficult situations, reduce the risk of injury, and identify behavioral factors and emotional or psychological issues that lead to violence.

Hospitals Against Violence Workforce and Workplace Violence

Administered by the American Hospital Association, this website provides information on safety resources and practices including preparedness drills and de-escalation training. Featured resources include webinars on creating a culture of safety, mitigating risks, and violence prevention.

Violence, Incivility and Bullying

This website, maintained by the American Nurses Association provides downloadable educational materials, ANA position statements, and issue briefs on reporting incidents of workplace violence and bullying. It also provides links to several violence prevention resources and toolkits.

Workplace Violence Prevention – Interventions and Response Online Course

The Emergency Nurses Association offers several resources to help prevent, mitigate, and report workplace violence. This online course, free to ENA members, helps emergency nurses recognize, prevent, avoid, and respond to violent incidents caused by patients, visitors, intruders, other employees, and management.

Addressing Workplace Violence During COVID and Beyond

The COVID-19 pandemic has exacerbated the problem of escalating workplace violence in nursing. The healthcare industry and the nursing profession must embrace a cultural shift toward accountability and responsibility, providing a safe environment for all healthcare personnel, promoting positive patient care outcomes, and increasing the effectiveness of nursing practice.

Addressing the problem of workplace violence in nursing is in everyone’s interest. Nurses deserve to work in safe settings, performing their duties without fear of injury. Healthcare organizations will face greater nursing shortages due to injury or burnout, impacting the quality and cost of patient care. Effective workplace violence prevention initiatives must include transparent zero-tolerance policies, clear communication and procedures for incident reporting, and educational and support programs.

Meet Our Contributors

Priscilla Barnes

Priscilla Grace Barnes is a registered nurse who graduated with a bachelor of science in nursing and a bachelor of arts in Spanish from the University of Texas at Austin. With over 11 years experience, she has worked from the smallest of patients in the neonatal intensive care unit to the largest of life events with pediatrics and adults in the surgical setting. With a passion for helping others in and out of the hospital, Priscilla also founded Wellness in Bloom(WIB) where she is a personal trainer and nutritional coach. WIB promotes preventative medicine in a friendly environment, by replacing the stress that so often accompanies health and wellness goals with foundational habits that promote sustainability.

Tina Baxter, APRN, GNP-BC

Tina Baxter is an advanced practice registered nurse and a board-certified gerontological nurse practitioner through the American Nurses Credentialing Center. Baxter resides in Indiana and has been a registered nurse for over 20 years and a nurse practitioner for 14 years. She is the owner of Baxter Professional Services, LLC, a consulting firm which provides legal nurse consulting services for attorneys and insurance professionals, among other services. She is also the founder of The Nurse Shark Academy where she coaches nurses to launch their own businesses.

Rhonda Collins, DNP, RN, FAAN

Rhonda Collins, DNP, RN, FAAN has served as chief nursing officer since 2014. As CNO, Dr. Collins is responsible for working with nursing leadership groups globally to increase their understanding of Vocera solutions, share clinical best practices and to bring their specific requirements to Vocera’s product and solutions teams.

Dr. Collins holds a doctor of nursing practice from Texas Tech University Health Sciences Center and a master’s degree in nursing administration from the University of Texas. A registered nurse for 28 years, Dr. Collins is a frequent speaker on the evolving role of nurses, the importance of communication, and how to use technology to improve clinical workflows and care team collaboration.

Reviewed by:

Elizabeth M. Clarke, FNP, MSN, RN, MSSW

Elizabeth Clarke (Poon) is a board-certified family nurse practitioner who provides primary and urgent care to pediatric populations. She earned a BSN and MSN from the University of Miami.

Clarke is a paid member of our Healthcare Review Partner Network. Learn more about our review partners .

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Understanding Workplace Violence Prevention and Response

Introduction.

The  topic of workplace violence tends to dominate the news in the days following a major incident, but not every instance of workplace violence generates national headlines. Each year, an average of nearly 2 million U.S. workers report having been a victim of violence at work, according to the Occupational Safety and Health Administration (OSHA). And the U.S. Bureau of Labor Statistics puts the number of annual workplace homicides at about 400.

A 2022 SHRM survey of U.S. workers found that 28 percent of workers have either witnessed aggressive interactions between coworkers (20 percent) and/or have actually been involved in them personally (8 percent). While no prevention plan is an absolute protection against violence at work, understanding how to prepare for and react to violent conduct is imperative.

Introduction Compliance How to Prepare for Workplace Violence

• Identify the types of violence
• Create a violence prevention plan
• Consider insurance needs
• Know the warning signs
• Recognize risky situations
• Encourage reporting

How to Respond to Workplace Violence

• Active shooters
• Suicidal employees
• Domestic violence
• Bomb or arson threats
• Suspicious mail or packages

HR professionals find themselves in a unique position as both the leaders of workplace violence prevention and sometimes also the targets of employee rage. According to a 2019 SHRM research report, 19 percent of HR professionals are unsure or don't know what to do when they witness or are involved in a workplace violence incident and 55 percent don't know whether their organization has a workplace violence prevention program. See Survey: Half of HR Pros' Workplaces Experienced Violence and SHRM Workplace Violence Research Report .

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as the act or threat of violence, ranging from verbal abuse to physical assaults, directed toward people at work or on duty. Workplace violence also may include acts that result in damage to an organization's resources or capabilities. Many employers consider workplace harassment and bullying to be forms of workplace violence. Also included in this context is domestic violence that spills over into the workplace in the form of assaults, threats or other actions by outside parties with whom employees have relationships and that occur at the workplace.

What can employers do to protect their workers from becoming victims of workplace violence? The ultimate goal is to deter disgruntled insiders or nefarious outsiders from violence by making your company a hard target. A secondary goal is to make sure your company and workforce are prepared for violence so you can minimize casualties and respond quickly in the event of a violent incident. If you can save a life—or many—the return on investment will be well worth it.

See : Census of Fatal Occupational Injuries Summary        Occupational Safety and Health Administration (OSHA) Workplace Violence NIOSH Occupational Violence

The federal Occupational Safety and Health (OSH) Act includes a general duty clause requiring employers to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." According to OHSA's Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence , "employers may be found in violation of the General Duty Clause if they fail to reduce or eliminate serious recognized hazards. Under this Instruction, inspectors should therefore gather evidence to demonstrate whether an employer recognized, either individually or through its industry, the existence of a potential workplace violence hazard affecting his or her employees. Furthermore, investigations should focus on whether feasible means of preventing or minimizing such hazards were available to employers." While there is currently no federal OSHA standard specific to workplace violence, there is potential for such a standard in the future, particularly for the health care industry.

Many states have OSHA-approved plans that must be "at least as effective" as the federal OSH Act and that often have further employee protections. Several states require employers to implement workplace violence prevention programs. For example, in 2017, California health care employers became regulated by the Workplace Violence Prevention in Health Care rule requiring a written workplace violence prevention plan, employee training, state reporting and more.

Common-law principles must also be considered in understanding employer liability for workplace violence, including the following:

• Premises liability is the duty of an employer to keep individuals on the premises safe from injury, including criminal and violent acts of others. Implementing security measures at worksites based on an assessment of potential violence specific to that site is recommended.
• Respondent superior refers to the vicarious liability of an employer for the acts of its employees acting within the course and scope of their employment. This liability is typically very fact-specific and often hinges on whether an employer's actions, or failure to act, contributed to the violent act.
• Negligence in hiring or retention of employees occurs when the employer knew or should have known the potential for violence. Conducting background screens upon hire as well as responding immediately and appropriately to threats of violence in the workplace can reduce this liability.
• Discrimination and harassment claims may arise when workplace violence is motivated by a protected characteristic such as race or religion.

How To Prepare for Workplace Violence

Preparing  for any type of workplace violence is key. Larger companies with robust security departments have the advantages of resources and trained personnel who manage the security effort. But for smaller companies with little or no security measures in place, the responsibility often falls on the general counsel or the head of human resources. See  How to Prepare Your Workforce for Violent Incidents .

As the FBI's Critical Incident Response Group points out in Workplace Violence: Issues in Response , there is no one-size-fits-all plan that employers can download and implement. Every employer will need a plan that is tailored to its particular circumstances and that considers company culture, physical layout, resources, management styles and other factors.

The New York State Department of Labor provides the following examples of employment situations that may pose higher risks of workplace violence:

• Duties that involve the exchange of money.
• Delivery of passengers, goods or services.
• Duties that involve mobile workplace assignments.
• Working with unstable or volatile people in health care, social service or criminal justice settings.
• Working alone or in small numbers.
• Working late at night or during early morning hours.
• Working in high-crime areas.
• Duties that involve guarding valuable property or possessions.
• Working in community-based settings.
• Working in a location with uncontrolled public access to the workplace.

Certain industries are also considered high-risk for workplace violence, including health care , taxi and for-hire drivers , and late-night retail establishments (gas stations, liquor or convenience stores, etc.).

Identify the Different Types of Workplace Violence

The California Division of Occupational Safety and Health, better known as Cal/OSHA, developed a model typology for workplace violence based on the perpetrator's relationship to the victim and/or place of employment that can be used by employers when assessing potential violence in the workplace. When conducting a worksite analysis or threat assessment, each type of perpetrator should be evaluated to determine the likelihood of a violent event and to identify mitigating measures that can be taken to address the particular risk. 

Source: Cal/OSHA.

Create a Workplace Violence Prevention Plan

According to OSHA, the building blocks for developing an effective workplace violence prevention program include:

Management commitment and employee participation. Management commitment, including the endorsement and involvement of top management, will provide the motivation and resources necessary for a successful initiative. Including all levels of employees in the process and soliciting employee feedback allows workers to share their broad range of experience and skills and to provide different perspectives and viewpoints to identify workplace violence hazards and mitigate risks.

• Worksite analysis.  Conducting a needs assessment to evaluate an organization's vulnerability to violence is a vital step in preparing a workplace violence prevention plan. This involves an inspection of the workplace to find existing or potential hazards that may lead to incidents of workplace violence, including an analysis of the physical environment and hazards specific to particular jobs, departments, shifts, etc.  See  Example Evaluation of the Physical Environment  and  Preventing Workplace Violence: 10 Critical Components of a Security lan .
• Substitution of the hazardous practice with a safer work practice such as the use of "buddy systems" when personal safety may be in jeopardy.
• Physical changes that either remove the hazard or create a barrier between the worker and the hazard, such as doors and locks, metal detectors, panic buttons, improved lighting, and accessible exits.
• Changes in work practices and administrative procedures such as a visitor sign-in process or a requirement for home health care workers to contact the office after each in-home visit.
• Safety and health training.  Training should be provided at all levels of the organization upon hire and at least annually thereafter. Suggested topics include an overview of the workplace violence prevention plan, including identified hazards and control measures; risk factors for particular occupations; ways to prevent or diffuse volatile situations; the location and use of safety devices such as alarm systems and panic buttons; and other topics identified by the employer as appropriate to the particular workplace. NIOSH offers a  video  that discusses practical measures for identifying risk factors for violence at work and strategic actions that can be taken to keep employees safe. According to NIOSH, the guidance is based on extensive research, supplemented with information from other authoritative sources.
• Record-keeping and program evaluation.  Maintenance of records is required, including required logs of work-related injuries and illnesses (OSHA Form 300), workers' compensation records, training records, safety committee minutes, and the identification and correction of recognized hazards.

Consider Insurance Needs

Employers should consult with their general liability and workers' compensation insurance providers to ensure adequate coverage. Workplace violence or active shooter insurance policies are available to supplement general liability coverage. According to the International Risk Management Institute, workplace violence insurance provides "coverage for the expenses that a company incurs resulting from workplace violence incidents. The policies cover items such as the cost of hiring independent security consultants, public relations experts, death benefits to survivors, and business interruption (BI) expenses."

Know the Warning Signs

Experts with the Center for Personal Protection & Safety say that when survivors of workplace shootings committed by co-workers remember the incident, they often recall signs that something was wrong—that there were behaviors that should have caused concern. Generally, any behavior that makes employees uncomfortable or leaves them feeling intimidated is cause for alarm.

These behaviors include being disruptive, aggressive and hostile as well as exhibiting prolonged anger, holding grudges, being hypersensitive to criticism, blaming others, being preoccupied with violence and being sad for a long period of time. Experts say what begins as sadness can lead to depression and suicide. Individuals who are contemplating suicide might think about taking their lives and the lives of others as well.

There are other signs. If someone who usually is friendly and outgoing becomes quiet and disengaged, that could be cause for concern. Sometimes people who experience a loss, a death, a reprimand, financial trouble, a layoff or termination can snap. Be mindful, too, of people who are the victims of stalking or domestic violence. Their personal lives might put their colleagues at risk.  See Preventing Workplace Violence Inspired by COVID-19 .

Recognize Risky Situations

There are circumstances in every workplace that increase the risk of a violent incident, including terminating volatile employees and dealing with workers who show signs of potential violence due to a mental illness.

Terminations

According to psychologist Marc McElhaney, CEO of Critical Response Associates, a consulting firm that helps organizations conduct threat assessments, manage crises and separate high-risk workers from the organization safely, there are four general types of problem employees who might cause trouble if they are fired. However, it is important to note that there's no profile of someone most likely to commit violence—anyone is capable of it.

• The Workplace Bully has a history of intimidation. He gets away with bad behavior because no one wants to confront him or make him mad.
• The Disgruntled Employee believes she has been treated unfairly and can't let go of feeling abused by the organization. She is withdrawn, goes to work in a daze, is unhappy and blames the system for her problems. When she is fired, she might take that opportunity to get back at the company.
• The Overly Attached Employee is "the one who won't go away." This person's identity is dependent on his job. He doesn't have many friends or family. Work is his social life, his recreation, his sense of self. If he is fired, he'll feel betrayed, rejected and angry.
• The Nothing-Left-to-Lose Employee is usually in emotional distress because of recent, critical losses in her life. She might be divorced or widowed, have a limited support system, or even seem suicidal. 

Mental Illness

There are times when an employee who is suspected or known by an employer to have a mental illness may seem on the verge of violent conduct. When can, or should, an employer act?

Legally, the federal Americans with Disabilities Act (ADA) and many state laws prohibit discrimination against employees based on an actual or perceived disability, and mental illness is included within the definition of disability. An employer may wish to require a fitness-for-duty exam for a potentially mentally ill employee, but targeting an employee simply due to a real or perceived disability would run afoul of the law, as the ADA generally does not allow medical exams during employment.

However, if such an employee is displaying some of the indicators of potential violence in the checklist above, and the employer has good reason to believe that an employee has a condition that may present a threat of harm to himself or others, requiring an exam would be allowable. The reason must be based on objective facts, not fear or conjecture. The ADA also allows employers to take action if they can show that an employee poses a direct threat to others, defined as "a significant risk to the health or safety of others that cannot be eliminated by a reasonable accommodation." The threat must be based on "an individualized assessment of the [employee's] present ability to safely perform the essential functions of the job" based on a reasonable medical judgment or objective evidence. According to the Equal Employment Opportunity Commission, this assessment must include the following factors:

• The duration of the risk.
• The nature and severity of the potential harm.
• The likelihood the potential harm will occur.
• The imminence of the potential harm.

The availability of any reasonable accommodation that would reduce or eliminate the risk of harm must also be considered.

Employers are encouraged to seek legal counsel prior to taking action or requiring medical exams of employees to avoid violating the ADA.

See  Managing High-Risk Employees  and  Creating a Mental Health-Friendly Workplace .

Encourage Reporting

Employee reports of suspicious or threatening behavior are critical to effective violence prevention programs, and employers should ensure that the internal culture supports such reporting. Workers need to have confidence that their reports will be taken seriously, that their identities won't be divulged unnecessarily and that leaders will take appropriate action. If employees lack confidence in their manager to handle a threatening situation or to report such incidents, employers may want to appoint a more senior person or an HR representative to field concerns.

Furthermore, employers might want to set up a hotline where employees can anonymously report concerns. Whatever method they choose, businesses must make sure employees understand that they must respond immediately and diligently if they perceive a threat. It is a good idea during training to review scenarios that employees might want to report and to explain that they should err on the side of over-reporting.

How to Respond to Workplace Violence

Despite diligent efforts to prevent workplace violence, incidents can and do occur. There is no fail-safe method to eliminate workplace violence entirely, although implementing the prevention strategies recommended by experts and discussed in this toolkit can be very effective. When violence does enter the workplace, employers can be prepared by identifying early the existence of the threat, responding appropriately by involving law enforcement and other professionals, and ensuring that all employees are knowledgeable about effective strategies to reduce the likelihood of injury.

Assess Threats

A threat assessment team is an internal committee of employees from different levels and expertise within an organization whose role is to assess the seriousness and likelihood of a threat once it has been recognized. Training for the threat assessment team should include, at a minimum:

• Behavioral and psychological aspects of workplace violence.
• Identification of concerning behaviors.
• Violence risk screening.
• Investigatory and intervention techniques.
• Incident resolution.
• Multidisciplinary case management strategies.

Most employers will need to engage external specialists with expertise in risk management and workplace violence prevention and intervention to provide the necessary training.

The primary goal of a threat assessment team is to receive and review nonemergency incident reports and recommend appropriate action. In the event of imminent emergency situations, emergency personnel should be contacted immediately.

The threat assessment team can accomplish four goals when it conducts its interview of an employee who has threatened others or acted inappropriately:

• Alert the employee that his behavior has been noticed.
• Give him the opportunity to tell his story.
• Gather information about the person.
• Let him know the behavior is unacceptable.

When internal expertise is not available for certain threats, employers will need to consult with an external professional experienced in threat assessments and crisis management.

Active Shooters

In the event of an active shooter in the workplace, the Department of Homeland Security (DHS) provides guidance employers can use to ensure that their employees know how to respond and understand when to run, hide or fight .

See  Active Shooter – How to Respond .

Suicidal Employees

Suicide threats should always be taken seriously. A human resource professional or the employee's supervisor may be the first person to identify a potentially suicidal employee, so it is critical to recognize the warning signs and encourage at-risk employees to seek help.

If an employee appears to be planning to take action immediately, local emergency authorities should be contacted, since employers usually are not qualified to handle such a situation directly. If there are doubts as to whether the threat is immediate, the HR professional should contact local services, such as an employee assistance program, suicide hotline or hospital. Given the risks of failing to act, it is best to seek professional assistance as soon as possible.

The following are some of the signs you might notice in an employee that may be reason for concern:

• Talking about wanting to die or wanting to kill oneself.
• Making a plan or looking for a way to kill oneself, such as searching online.
• Buying a gun or stockpiling pills.
• Feeling empty, hopeless or like there is no reason to live.
• Feeling trapped or in unbearable pain.
• Talking about being a burden to others.
• Increasing the use of alcohol or drugs.
• Acting anxious or agitated; behaving recklessly.
• Sleeping too little or too much.
• Withdrawing from family or friends or feeling isolated.
• Showing rage or talking about seeking revenge.
• Displaying extreme mood swings.
• Saying goodbye to loved ones; putting affairs in order.

Source: The National Institute of Mental Health.

See NIMH Frequently Asked Questions About Suicide .

Domestic Violence

Domestic violence becomes a workplace issue when the violence follows a victim to work. Employers should avoid dismissing domestic violence as a personal issue as many victims of domestic violence can benefit from the support of their employer. By developing individual and workplace safety plans, employers can prepare for the potential that a domestic situation will escalate in the workplace. According to the Canadian Centre for Occupational and Health Safety, such plans may include the following actions:

• Ask if the victim has already established protection or restraining orders. Help to make sure all the conditions of that order are followed.
• Talk to the employee; work together to identify solutions. Follow up and check on his or her well-being.
• Ask for a recent photo or description of the abuser. Alert others such as security and reception so they are aware of who to look for.
• When necessary, relocate the worker so that he or she cannot be seen through windows or from the outside.
• Do not include the employee's contact information in publicly available company directories or on the company website.
• Change the employee's phone number, have another person screen his or her calls, or block the abuser's calls and e-mails.
• Preprogram 911 on a phone or cellphone. Install a panic button in the employee's work area or provide personal alarms.
• Provide a well-lit parking spot near the building or escort the individual to his or her car or to public transit.
• Offer flexible work scheduling if it can be a solution.
• Call the police if the abuser exhibits criminal activity such as stalking or unauthorized electronic monitoring.
• If the victim and abuser work at the same workplace, do not schedule both employees to work at the same time or location wherever possible.
• If the victim and abuser work at the same workplace, use disciplinary procedures to hold the abuser accountable for unacceptable behavior in the workplace.

[Adapted from: Making It Our Business (2014) from the Centre for Research & Education on Violence against Women & Children]

An Employer's Role in Preventing Partner Abuse

When Domestic Violence Comes to Work

What Employers Can Do When Domestic Violence Enters the Workplace .

Bomb or Arson Threats

Employers should take all bomb or arson threats seriously. The Department of Homeland Security provides a Bomb Threat Checklist employers can use to ensure that all employees know how to handle bomb threats and the procedures to follow.

For threats made via phone, the DHS provides the following guidance:

• Keep the caller on the line as long as possible. Be polite and show interest to keep them talking.
• DO NOT HANG UP, even if the caller does.
• If possible, signal or pass a note to other staff to listen and help notify authorities.
• Write down as much information as possible—caller ID number, exact wording of threat, type of voice or behavior, etc.—that will aid investigators.
• Record the call, if possible.

Suspicious Mail or Packages

All employees with mail-handling responsibilities should be trained in identifying suspicious packages and mail. See  USPS: Handling and Processing Mail Safely .

If a suspicious package or piece of mail is identified, employees should know who to contact internally and when emergency personnel should be contacted. In addition, employees should follow identified procedures, including the following:

• Remain calm.
• Do not open the letter or package.
• Leave the item where it is or place it gently on a flat surface.
• Cover the item using a trash can, article of clothing, etc.
• Shut off fans or equipment in the area that circulate air.
• Alert others to leave the area and keep away from the item.
• Evacuate the area, closing the door and blocking the bottom of the door with a towel, coat, etc.
• Wash hands with soap and water.

Employers may want to post these procedures within the mailroom or provide mail-handling employees with pocket cards or another means to readily access the information.

Related Resources

Preventing Workplace Violence: A Road Map for Healthcare Facilities

Workplace Violence Policy

Workplace Violence Prevention Policy

Weapon-Free Workplace Policy

Available in the SHRM Store:

Give Your Company a Fighting Chance: An HR Guide to Understanding and Preventing Workplace Violence

Workplace Violence: The Early Warning Signs

Example Workplace Violence Prevention Programs and Procedures:

Washington State

State of California

External Resources

There are numerous resources available to employers to assist in preparing a workplace violence prevention program. Federal and state OSHA offices are a good place to start. In addition, NIOSH, the U.S. Department of Labor (DOL) , and other state and federal offices may offer tools and resources to assist employers.

DOL Workplace Violence Program OSHA Workplace Violence Prevention Programs FBI: Workplace Violence: Issues in Response Workplace Violence Prevention Strategies and Research Needs Example Workplace Violence Handbook Online Workplace Violence Prevention Course for Nurses NIOSH Health Hazard Evaluations DHS Interagency Security Committee Violence in the Federal Workplace Guide

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• v.78; 2022 Jun

Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures

Mei ching lim.

a Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, 88400, Sabah, Malaysia

Mohammad Saffree Jeffree

Saihpudin sahipudin saupin, nelbon giloi, khamisah awang lukman.

b Centre for Occupational Safety & Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

Violence at work refers to acts or threats of violence directed against employees, either inside or outside the workplace, from verbal abuse, bullying, harassment, and physical assaults to homicide. Even though workplace violence has become a worrying trend worldwide, the true magnitude of the problem is uncertain, owing to limited surveillance and lack of awareness of the issue. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a global phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. Hence, this review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence.

• • Workplace violence needs to be addressed more comprehensively, involving shared responsibilities from all levels.
• • Emphasis on healthcare management's commitment, assurance, and clearly defined policy, reporting procedures, and training.
• • The healthcare workers' commitment to update their awareness and knowledge regarding workplace violence.
• • The provision of technical support and assistance from professional organizations, NGOs, and the community.

1. Introduction

Violence affects people at all levels of society and can occur anywhere; at home, on the streets, in schools, workplaces, and institutions. Violence had previously been overlooked as a Public Health issue due to the lack of a clear definition, undeniably a complex and diffused matter. It is not as simple as relating violence to scientific facts to define it; instead, it is a matter of judgment of appropriate and acceptable behaviors influenced by culture, values, and social norms. Violence is determined by the World Health Organization (WHO) as the deliberate use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that has consequences or has a high probability of resulting in injury, death, mental distress, mal-development, or deprivation.

Occupational Safety and Health Administration (OSHA) defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at work [ 1 ]. While physical violence (which includes beating, biting, kicking, pushing, slapping, stabbing, and shooting) in the workplace has been acknowledged, little has been done to address the presence of psychological violence until recent years [ 2 ]. Psychological violence is the intended use of power, including the threat of physical force against another person or group with the potential to impair the affected individual's physical, mental, spiritual, moral, or social development [ 2 ]. Besides, harassment which is also categorized as a type of violence, is defined as any behavior that degrades, humiliates, irritates, alarms, or verbally insults another person, including abusive words, bullying, gestures, and intimidations [ 3 ]. This review aims to determine the risk factors and consequences of workplace violence in healthcare settings, as well as emphasizing the joint efforts required to enhance the control and preventative measures of workplace violence.

2. Workplace violence in healthcare settings

Although violence in the workplace affects almost all sectors and groups of workers, it is apparent that violence in healthcare settings provides a significant risk to public health and an occupational health issue of growing concern. The healthcare and social service industries have the greatest rates of workplace violence injuries, with workers in these industries being five times more likely to be injured than other workers [ 4 ]. In addition, workplace violence in the health sector is estimated to account for about a quarter of all workplace violence [ 5 ]. Workplace violence is constantly on the rise in the health industry due to rising workloads, demanding work pressures, excessive work stress, deteriorating interpersonal relationships, social uncertainty, and economic restraints [ 5 ].

Healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018 [ 4 ]. According to World Health Organization (WHO), it is estimated that between 8% and 38% of health workers suffer physical violence at a certain point in their careers. At the same time, many more are exposed or threatened with verbal aggression [ 6 ]. Most violent cases are committed by patients’ family members or friends and followed by patients themselves [ 4 , 7 ]. Violence in healthcare settings worsens when there is a crisis, emergency, or disaster which involves large groups of people who are even more overwhelmed with panic attacks, shock, uncertainties, fears, and worries of the conditions they or their family members are going through [ 6 ]. As a result, healthcare workers become the targets to vent their anger or frustrations. The most vulnerable healthcare workers victimized are staff at emergency departments, especially nurses and paramedics, and staff directly involved with in-patient care [ 5 , 6 ].

Furthermore, the Healthcare Crime Survey conducted by International Association for Healthcare Security and Safety Foundation's (IAHSSF) in 2019 reported the assault rates against healthcare workers increased from 9.3 incidents in 2016 to 11.7 per 100 beds in 2018, which is the highest rate that IAHSSF has ever recorded since 2012 [ 8 ]. 85% of workplace violence occurrences were classified as National Institute for Occupational Safety and Health (NIOSH) Type II Customer/Client Workplace Violence, which involves violence directed at employees by customers, clients, patients, students, inmates, or anybody else for whom an organization provides services [ 9 ]. According to a meta-analysis of 47 observational studies, the overall prevalence of workplace violence against healthcare professionals was 62.4%, with verbal abuse accounting for the highest majority (61.2%), followed by psychological violence (50.8%), threats (39.5%), physical violence (13.7%), and sexual harassment (6.3%) [ 10 ].

Even though some institutions may have a proper formal incident reporting system, there are still many incidents, especially in the forms of bullying, verbal abuse, and harassment, unreported [ 11 ]. Lack of reporting guidelines or policy, lack of trust in the reporting system, and fear of retaliation are among the many reasons for underreporting [ 12 , 13 ]. For example, in Malaysia, with the launching of the guidelines and training modules to address and prevent violence against healthcare workers, more cases were reported with a drastic 159% increase from 167 cases in December 2017 to 432 cases in December 2018 [ 14 ]. The Emergency Department and the Psychiatry and Mental Health Departments were high-risk areas, as they were in other countries, with the most common perpetrators being patients, their relatives, or visitors [ 14 ]. While verbal violence, physical assault, intimidation, and sexual harassment were among the types of workplace violence documented [ 14 ], cyberbullying has been on the rise in recent years, with humiliation, defamation, and unlawful video recording in healthcare settings.

3. Risk factors of workplace violence in healthcare settings

The etiology of workplace violence can be pretty complex, and many risk factors are related to both the perpetrators and the healthcare workers assaulted. The environments under which care and services are provided in healthcare settings contributed to healthcare workers being more prone to occupational violence. Many studies were conducted, and some of the risk or associating factors that contributed to the amplified incidence of violence towards healthcare workers over the recent years are: (i) attitudes and behaviors of patients, family members, friends, or visitors who are often under intense emotional charge and expectations [ [15] , [16] , [17] ]; (ii) healthcare workers and work factors which include shortage of staffs, inexperienced or anxious staffs, poor coping mechanism and lack of training [ [18] , [19] , [20] , [21] , [22] ]; and (iii) system or environmental factors (overcrowded areas, long waiting hours, inflexible visiting hours, lack of information as well as difference of language and culture) [ 15 , 17 , 19 , 20 , 23 , 24 ].

4. Effect of workplace violence in healthcare settings

Violence against healthcare workers in any situation is inexcusable, especially when they are working around the clock to ensure that everyone receives the best treatment possible. The effect of violence harms healthcare employees' physical and psychological well-being of healthcare workers [ 6 ]. Victims of violence are more likely to experience demoralization, depression, loss of self-esteem, ineptitude as well as signs of post-traumatic stress disorders like sleeping disorders, irritability, difficulty concentrating, reliving of trauma, and feeling emotionally upset [ 7 , 17 , 24 , 25 ].

Furthermore, the negative implications of such widespread violence in healthcare sectors have a significant impact on the delivery of health care services, including a decline in the quality of care delivered, increased absenteeism, and health workers' decision to leave the field [ 5 , 15 , 17 , 19 , 25 ]. As a result, the number of health services available to the general public will be limited, resulting in increased healthcare costs due to resource constraints. In addition, if healthcare workers leave their employment due to harassment and threats of violence, equal access to primary health care would be threatened, particularly in developing countries where the number of healthcare workers is insufficient to meet the needs and demands of the population.

Many healthcare employees mistakenly feel that workplace violence is just part and parcel of their jobs [ 26 , 27 ] and that they were unlucky enough to be in the wrong location at the wrong time. Many employees believe no action will be taken against the perpetrators [ 28 ], or they refuse to endure the stigmatization and the inconvenience of filing reports and following through on legal proceedings [ 29 , 30 ]. They are typically concerned that if they speak up about what has occurred to them, they will be shamed or labeled incompetent with a lack of supervisory support [ 12 , 29 ]. Furthermore, the harassed healthcare workers are even more concerned that the offenders may inflict additional harassment, violence, or threats on them and their family members if reports are made [ 31 ].

Hence, it further implies the need for proper awareness and recognition followed by clearly defined control and prevention measures of workplace violence in healthcare settings to prevent the negative impact of workplace violence to both the healthcare staffs and services. These measures are also vital to ensure that all healthcare workers, especially the front liners, are well protected in a safe working environment so that health care services can be continued to run smoothly without any interruptions for the benefit of the community.

5. Collaborative efforts in prevention and management of workplace violence in healthcare settings

The detrimental effects, mainly the psychological impact of workplace violence on affected healthcare employees, are one of the most critical reasons it must be handled before it escalates to higher absenteeism rates or further affects healthcare workers' overall performance. It will have even more negative implications for the healthcare sector when staffing is already scarce, and patient loads continue to rise inexorably.

Nonetheless, there is still much room for improvement in workplace violence awareness and abilities. There is an essential need to have a strong collaborative effort, support, and commitment from top management and the workers to protect themselves. There is no single guideline that is suitable for all settings. Hence, the management of each healthcare setting needs to create or adapt and establish a practical, acceptable and sustainable workplace violence prevention program. It should be according to the needs of their respective environments, using the available guidelines or recommendations by WHO, ILO, DOSH, and evidence-based research.

In non-emergency settings, interventions to prevent violence against healthcare professionals focus on techniques to better manage aggressive patients and high-risk visitors while in emergency circumstances, interventions are more focused on assuring the physical security of healthcare facilities [ 6 ]. Among some of the prevention and control measures in the sequence of effectiveness include; (i) substitution by transferring a client or patient with a history of violent behaviour to a more suitable secure facility or area [ 13 ]; (ii) engineering control measures which include installing barrier protection, metal detectors and security alarm systems, allocating conducive patients or visitors areas and clear exit routes [ 1 , 13 ]; (iii) administrative and work place practise controls which include implementing workplace violence response and zero-tolerance policies [ 1 , 17 , 24 , 32 ], ability to resolve conflict situation [ 33 ], establishing mandatory timely reporting system [ 34 ], ensuring employees are not working alone [ 35 ], flowchart for assessing and response in emergency situations [ 1 , 35 ]; (iv) post-incident procedures and services that include trauma-crisis counselling, critical-incident stress debriefing and employee assistance programs [ 35 ]; (v) safety and health training in order to ensure that all staff members are aware of potential hazards and how to protect themselves and their co-workers through established policies and procedures [ 32 , 35 , 36 ].

Aside from that, international or regional professional organizations, councils, and associations play essential roles in supporting, participating in, as well as contributing to initiatives and mechanisms aimed at minimizing and eliminating the potential risks of workplace violence in healthcare settings [ 5 , [37] , [38] , [39] ]. It includes but is not limited to (i) actively advocating on the awareness and training for workplace violence; (ii) incorporating in their codes of practice, codes of ethics, and clauses concerning the unacceptance of any form of workplace violence; (iii) integrating accreditation procedures in healthcare institutions on the requirement of measures aimed at preventing workplace violence; (iv) establishing workplace violence surveillance by mandatory and guided data collection procedures on the incidents of violence in all healthcare settings; and (v) offering support for victims of workplace violence, specifically in the form of legal aid if necessary.

In addition, participation and contribution from community groups, non-governmental organizations (NGOs), as well as business corporations in terms of technical support and financial assistance, play an essential part in curbing and preventing workplace violence in the healthcare settings [ 5 , 35 , [37] , [38] , [39] ]. Among the initiatives and activities which are highlighted include (i) creating and maintaining a strong network of information and expertise in workplace violence; (ii) assisting in promoting awareness of the risks of workplace violence; (iii) participating in training and educational programs; (iv) assisting in the support structure for the prevention and management of workplace violence; as well as (v) incorporating and emphasizing the importance of good communication skills and coping mechanism among the healthcare workers.

Summary of the risk factors, effects as well as the collaborative efforts which are important in the control and prevention measures for workplace violence in healthcare settings are tabulated in Table 1 .

Summary of risk factors, effects and collaborative management of workplace violence in healthcare settings.

6. Conclusion

It is undeniable that workplace violence needs to be addressed more comprehensively, involving shared responsibilities from all levels. These include (i) government's legislations; (ii) healthcare management's dedication, firm support, assurance, and clearly defined policy, reporting procedures, and training; (iii) the healthcare workers' commitment to update their awareness and knowledge regarding workplace violence; and (iv) the provision of technical support and assistance from professional organizations, NGOs, and the community.

Sources of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

No ethical approval is required for this review.

Not applicable as it is a review and does not involve any new data collection from healthcare workers.

Author contribution

Mei Ching Lim drafted the initial manuscript and was involved in the literature search. Mohammad Saffree Jeffree was responsible for conceptualizing the study, facilitating manuscript writing, and approving the final manuscript. Saihpudin @ Sahipudin Saupin, Nelbon Giloi, and Khamisah Awang Lukman contributed expert input in literature search and facilitated manuscript writing. All authors have seen and approved the final manuscript.

Registration of research studies

Not applicable as it is a review and does not involve any new data collection from healthcare workers .

Dr Mei Ching Lim.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Declaration of competing interest

The authors report no conflict of interest nor proprietary or commercial interest in any product mentioned or concept discussed in this article.

Acknowledgements

Essay about Workplace Violence

What is workplace violence.

Workplace violence is violence or the threat of violence against workers. It can occur at or outside the workplace and can range from threats and verbal abuse to physical assaults and homicide, one of the leading causes of job-related deaths (Osha 2018). Bullying is now considered workplace violence because it has become more common and is also a factor that leads to physical violence. Workplace bullying includes acts of continual hostile conduct that deliberately hurt another person emotionally, verbally, or physically (Mondy 2016).

Bullying can be broken into two parts, the first is physical and the second is psychological. Physical bullying is intimidating or threatening actions like screaming or shoving. Another example would be the invasion of a person’s personal space. Psychological bullying is not as instant, yet a tactic that involves emotions and thinking. Some examples are ridiculing a person in a harmful manner or staring at someone with hostility. Bullying behaviors are now included in most companies’ workplace violence policy. Ultimately, workplace violence is a major issue for employers and employees. This paper will discuss the types of workplace violence, the causes, the impact, statistics, the warning signs and prevention methods for workplace violence.

Types of Workplace Violence

According to the National Institute for Occupational Safety and Health (OSHA), there are five categories of workplace violence. The five types include; criminal intent, customer/client, worker-on-worker, personal relationships, and ideological. Criminal intent is when there is no relationship to the company or an employee. This type of violence occurs while another crime is being committed like shoplifting or robbery. Employees at gas stations and liquor stores, taxi drivers, police officers, and convenience store managers working night shifts face the greatest danger (Mondy 2016). Next is a customer/client affair that transpires while the victim is at their workplace. Social service workers and healthcare workers are the main targets for this mishap.

Following that is worker-on-worker violence. This attack is just what it sounds like, a current or former employee has decided to attack a current employee in the workplace. This could be considered the most common because there are plenty of reasons a person gets irritated or fed up with a coworker. Other reasons are a laid off employee or an employee that was hired without a thorough background check. The next type is personal relationships. This type goes hand in hand with domestic violence.

Typically, the perpetrator has no intentions or bad relationship with the company, they are only focused on the person they know. Women are victims of personal relationships way more than their counterparts. Lastly, ideology is focused on the assassins more than the victims. Ideology is rooted from religious or political views. The type of people associated with this are generally extremists or value driven groups. Examples would be an active shooter or terrorist attacks.

Causes of Workplace Violence

All five types of violence can occur at any time for any given reason. Now we will discuss some of the causes of workplace violence. An employee could be stressed or in denial and those are two causes. Human Resources plays a part in the other two causes which are a lack of pre-employment screening and a lack of an Employee Assistance Program (EAP). Stress is a natural occurrence in any workplace that all employees encounter. Stress could cause an employee to become angry, frustrated or hostile with others. Employers all try to enforce the, “leave your stress at the door” method, but we all know that is not the case. Personal stress could also lead to a workplace incident. Some employers refuse to accept the warnings and behaviors of stressed employees and this covers denial. By ignoring the signs of an employee, the company is putting their employees at risk. Acting as if there is no problem when a potential problem is occurring is equally as dangerous as the workplace violence taking place.

Human resources has two opportunities to lessen the causes by processing a full background check and enforcing the Assistance Programs the company offers. If Human Resources does not run a thorough background check, then there is the possibility that a person with a violent past or a person that is prone to violence might be hired. An EAP is a work-based intervention program designed to assist employees in resolving personal problems that may be adversely affecting the employee’s performance. An EAP could diffuse a situation before the employee has a chance to act.

The Impact of Workplace Violence

Workplace violence undoubtedly affects the person involved, but is also impacts coworkers, executives, clients and the community. Medical bills, workers’ compensation and legal fees are direct losses for a company. While a decrease in productivity, low-morale and negative image are all indirect losses. According to Lower & Associates, as many as half a million employees miss an estimated 1.8 million work days each year resulting in $55 million in lost wages (Ricci 2018). The impact of workplace violence is substantial and can also carry an immense cost to a company.

Every year 2 million American workers report having been victims of workplace violence. Of that 2 million, it is estimated that 25% of workplace violence goes unreported (National Safety Council 2018). According to the U.S. Bureau of Labor Statistics, 409 people were fatally injured in work-related attacks in 2014 (National Safety Council 2018). According to Injury Facts 2016, workplace violence is the third leading cause for deaths overall (National Safety Council 2018). The workers experiencing the most workplace violence are healthcare workers, employees in professional and business services like education, law and media. According to OSHA, taxi drivers are more than 20 times more likely to be murdered on the job than other workers (National Safety Council 2018). According to the Bureau of Labor Statistics, women are overwhelmingly victims when it comes to workplace violence (Ricci 2018).

Warning Signs

Before workplace violence occurs, there are warning signs. Whether the signs are physical or psychological, verbal or non-verbal they still can be strong indicators to a potentially violent situation. An employee that is experiencing a high level of stress may display the following actions; crying, sulking or temper tantrums, excessive absenteeism or lateness, pushing the limit of acceptable conduct or disregarding the health and safety of others, disrespect for authority, swearing or emotional language, an inability to focus, talking about the same problems repeatedly without resolving them, or social isolation. These are some additional warning signs that lead to workplace violence; sweating, trembling or shaking, flushed or pale face, clenched jaws or fists, a change in voice, glaring or avoiding eye contact, or violating your personal space. These are all examples of signs that could be clues to a person’s future behavior, but they are also signs that could be prevented.

Now that we have covered what workplace violence is, the types, causes and warning signs, we will discuss some prevention methods. A company that can recognize the potential of a workplace incident are in the best position to prevent it. Establishing a zero-tolerance policy for workplace violence is the best prevention method an employer can offer. With that being said, there is no way an employer can avoid the risk completely. Incidences of some unbalanced person coming in and shooting people happen randomly, and organizations can do little to anticipate or prevent them (Mondy 2016). Companies can do three things to prevent workplace violence. First, there needs to be a plan of action for detecting angry workers. Second, there needs to be training on handling employment issues. Third, the company should form a workplace prevention program or add to the current program and policy. It is critical to ensure that all employees know the policy and understand that all claims of workplace violence will be investigated and remedied promptly (OSHA 2018).

Before we conclude, we must incorporate Saint Leo’s Core Value: Respect. Respect is a vital role in our everyday actions. Respect should be given to all people, especially in the workplace no matter if the person is the manager or subordinate. Giving a coworker/employee respect could make all the difference in the result of workplace violence. In conclusion, nothing can guarantee that an employee will not become a victim of workplace violence. Workplace violence is a serious act and can cause major damage to all that are involved. 

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Experiences of Violence and Harassment at Work: A first global survey

Violence and harassment at work has affected more than one in five people

The first global survey on experiences of violence and harassment at work aims to bring a better understanding and awareness of an issue rooted in complex economic, social and cultural factors.

• Open access
• Published: 13 July 2023

Influence of psychosocial safety climate on occupational health and safety: a scoping review

• Mustapha Amoadu 1 ,
• Edward Wilson Ansah 1 &
• Jacob Owusu Sarfo 1  

BMC Public Health volume  23 , Article number:  1344 ( 2023 ) Cite this article

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Creating a healthy, decent and safe workplace and designing quality jobs are ways to eliminate precarious work in organisations and industries. This review aimed at mapping evidence on how psychosocial safety climate (PSC) influence health, safety and performance of workers.

A literature search was conducted in four main databases (PubMed, Scopus, Central and Web of Science) and other online sources like Google Scholar. A reference list of eligible studies was also checked for additional papers. Only full-text peer-reviewed papers published in English were eligible for this review.

A search in the databases produced 13,711 records, and through a rigorous screening process, 93 papers were included in this review. PSC is found to directly affect job demands, job insecurity, effort-reward imbalance, work-family conflict, job resources, job control and quality leadership. Moreover, PSC directly affects social relations at work, including workplace abuse, violence, discrimination and harassment. Again, PSC has a direct effect on health, safety and performance outcomes because it moderates the impact of excessive job demands on workers’ health and safety. Finally, PSC boosts job resources’ effect on improving workers’ well-being, safety and performance.

Managers’ efforts directed towards designing quality jobs, prioritising the well-being of workers, and fostering a bottom-up communication through robust organisational policies, practices, and procedures may help create a high organisational PSC that, in turn, promotes a healthy and decent work environment.

Peer Review reports

Introduction

Every job has tremendous inherent health, safety and well-being challenges, thus, creating a safe and decent work for improved health and safety outcomes becomes eminent [ 1 , 2 ]. For instance, pprecarious jobs and work environment are detrimental to the health and safety of workers and place huge financial burden on workers and their organisations [ 2 ]. Occupational incidents do not affect only workers and their families, but have a huge burden on society through impaired productivity and increased use of healthcare and cost [ 3 , 4 ]. According to the International Labour Organisation (ILO) working conditions are worsening globally, and majority of workers are found in precarious employment [ 1 ], which is responsible for about 7,600 deaths daily [ 1 ]. Therefore, occupational health and safety (OHS) remains the key factor to restoring dignity at work and improving worker health outcomes, to meet the Sustainable Development Goal (SDG) target 8, which seeks to eliminate all forms of precarious work and ensure a decent and safe workplace for all [ 1 ]. However, robust research designs and reviews are needed to map quality evidence to inform interventions and policies aimed at creating such a safe and decent work for all workers.

Evidence from the World Health Organisation (WHO) and ILO shows that in 2016, about 1.9 million deaths occurred globally due to occupational accidents and injuries [ 5 ]. Again in 2017, about 2.78 million workers died from occupational-related accidents and injuries [ 6 , 7 ]. Thus, globally, about 7,600 workers died daily in 2017 due to precarious and unhealthy working conditions, but this affects poor developing nations disproportionately. For instance, the African region recorded the highest global occupational communicable diseases among over one-third of its working population and 20% of its workforce has experienced serious work-related accidents [ 1 ]. These unfortunate trends of statistics are frightening and might be as a result of insufficient safety regulations and enforcement as well as emerging industries and technological advancements which may require updated safety protocols and training [ 1 ]. Also, these figures give the indication that most workers, especially those in developing countries do not have access to a decent, safe and healthy workplace [ 5 , 8 ]. Perhaps, global economic pressures are forcing some industries and organisations to focus on cost-cutting and increase productivity instead of protecting the well-being and safety of their workers [ 1 ]. There is the need for adequate measures and pragmatic steps taken by national regional and global bodies to guarantee decent, safe, and healthy workplace for all workers [ 5 , 8 ]

Evidence shows that global occupational morbidity and mortality from psychosocial hazards keep increasing, something that need urgent attention [ 5 , 8 ]. Psychosocial working conditions or exposure to psychosocial hazards by workers, to a greater extent, is dependent on the interplay between job demands and job resources (job design) [ 9 , 10 ]. Most work stress models such as the job demand-resource, job demand-control and effort-reward imbalance argue that work environments with high job demands and fewer job resources expose workers to impaired health outcomes that lead to impaired performance and less productivity [ 11 ]. Psychosocial safety climate (PSC) has been the basis for job designs and improving social relations at work, perhaps it is capable of prioritising the well-being and safety of workers [ 12 ]. Besides, PSC is capable of buffering the effect of high job demands on workers’ health and safety [ 11 ].

In organisations with high PSC, the well-being and safety of workers are prioritised [ 11 , 12 ], commitments and efforts are made by senior management to involve and leverage workers’ participation in designing jobs and programmes that help create a safe and healthy work environment for improved well-being, safety and productivity [ 12 ]. Empirical evidence from work stress, organisational psychology and safety science showed PSC as a unifying framework for dealing with work stress [ 11 ]. While there is a growing body of research work exploring PSC, not enough is understood about its importance and application to psychosocial working conditions, health and safety, and performance of workers. Hence, this review maps evidence on the influence of PSC on psychosocial working conditions, health and safety, and performance, thus, to inform workplace policies and actions that create a safe, decent and healthy workplace for all workers to achieve SDG 8 and improve organisational performance.

The authors carried out this scoping review using the guidelines by Arksey and O’Malley [ 13 ], by identifying and stating the research questions, identifying relevant studies, study selection, data collection, data summary and synthesis of results, and consultation. Two research questions guided this review. (1) What is the influence of PSC on (a) psychosocial work factors, (b) health and safety outcomes of workers, and (c) performance and productivity outcomes? (2) what is the moderating role of PSC in the health erosion and motivation pathways?

Authors created a search technique that employed a combination of controlled vocabularies like Medical Subject Headings (MeSH) and keywords for each of the four major electronic databases (PubMed, Scopus, Central and Web of Science) to address the research questions and map relevant literature. Table 1 illustrates the search strategy conducted in PubMed. The search strategy used in PubMed was then modified for search in other databases. The authors used four key words in their search strategy (1) psychosocial safety climate, (2) psychosocial work factors, (3) Health and safety and (4) performance.

Additional searches were conducted in Google, Google Scholar, JSTOR, Emerald, and Taylor and Francis to gather adequate and relevant peer-reviewed papers for this review. Reference lists of eligible full-text articles were also searched for additional papers. A chartered librarian was consulted during the search for literature and data screening process. The authors started the search for papers on December 5, 2022, and ended on March 29, 2023. The authors developed eligibility criteria for data screening. Studies published in the year 2010 and later were included because we were interested in studies that explored PSC using PSC-12 and that PSC-12 was published in 2010 [ 12 ] (See Table 2 for details on eligibility criteria).

The Mendeley software was used to remove duplicates. Abstracts and full-text records were screened and papers selected based on eligibility criteria. Data from eligible papers were extracted independently by MA and reviewed by EWA and JOS. Disagreements among authors during the data screening and extraction phases were resolved during weekly meetings to ensure accuracy in extracted data. Data extracted included authors, purpose of the study, design, population, sample size, measure for PSC, and study outcomes. These data were relevant to help map evidence to answer the research questions and make relevant recommendations for future studies. Extracted data is presented in Table S 1 . The authors read through the final extracted data, organised data into themes and results presented and discussed.

Search results

The results from the four main databases yielded 13,669 records and additional search produced 42 records. After removing duplicates (2,490 records) using the Mendeley software, 11,221 records were available for screening. After removing non-full text and records irrelevant to the review, 156 full-text records were available for further screening. Checking of reference lists of full-text records produced additional 24 records. Thus, 180 records were finally screened. Finally, 87 full-text records were excluded, the remaining 93 were included in the thematic synthesis (See Fig.  1 for search results and screening process).

PRISMA flow diagram of search results and screening process

Study characteristics

Most reviewed studies used a cross-sectional survey design (See details in Fig.  2 ), and were conducted among workers in Australia (30) and Malaysia (24) [See details in Fig.  3 ]. The general working population, healthcare workers and workers in academia remained the most explored groups using PSC (See Fig.  4 for more details). Most of the reviewed studies were published in the year 2022 (See Fig.  5 for more details).

Study designs of reviewed studies

Map showing countries and continents where reviewed studies were conducted

Occupational groups explored by reviewed studies

Number of studies based on the year of publication

Findings from this review were reported based on the two research questions, and into four sections; (1) influence PSC on psychosocial work factors, (2) influence of PSC on health and safety, (3) influence of PSC on performance outcomes and (4) the moderating effect of PSC.

Influence of PSC on psychosocial work factors

Three sub-themes were developed from the findings of the reviewed studies. The themes are job demands, job resources, and hostile work factors.

Job demands

Evidence is strongly established in the literature that PSC is negatively and significantly associated with job demands [ 12 , 14 , 15 , 16 , 17 , 18 , 19 ]. PSC has a significant and negative association with cognitive demands [ 20 ], psychological demands [ 15 , 21 , 22 , 23 ], emotional demands [ 22 , 24 , 25 , 26 ], quantitative demands [ 27 ], work intensification [ 28 ], work pressure [ 25 , 29 ], conflicting pressure [ 30 ], workload [ 25 ], long-working hours [ 31 ], hindrance demands [ 32 , 33 , 34 , 35 , 36 ], challenge demands [ 32 ] and compulsive working [ 37 ]. However, a reviewed study found no significant association between PSC and challenge hindrance [ 36 ]. Job insecurity [ 38 ], work-family conflict [ 14 , 38 , 39 , 40 ], effort-reward imbalance [ 41 ] and family-work conflict [ 39 ] are reduced in high PSC context.

• Job resources

Job resources are high in a positive PSC context at various occupational settings [ 17 , 18 , 19 , 21 , 42 , 43 , 44 , 45 ]. Key job resources such as job control [ 26 , 46 , 47 ], decision authority [ 21 ], decision influence [ 48 ], skill discretion [ 21 , 25 ], co-worker support [ 38 ], supervisor support [ 22 , 46 ], managerial support [ 49 ], organisational support [ 50 ] and organisational rewards [ 22 , 51 ] were found to have a positive and significant association with PSC. Furthermore, workers in a high PSC work environment were more likely to perceive a high possibility for development [ 20 ], organisational justice [ 22 , 52 ], health-centric [ 53 ], quality leadership [ 27 , 54 ], psychological capital [ 55 ] and emotional resources [ 45 ] at work.

Workplace abuse

PSC had a negative and significant association with workplace bullying [ 29 , 51 , 56 , 57 , 58 , 59 , 60 , 61 ], and that, workplace violence [ 29 , 62 ], physical or verbal abuse [ 63 ], and harassment [ 29 , 51 ] were reduced or eliminated in the presence of a high-level PSC.

Influence of PSC on worker health and safety

Findings indicated that burnout [ 19 , 27 , 33 , 34 , 35 , 59 , 64 ], job strain [ 65 , 66 ] and emotional exhaustion [ 21 , 22 , 24 , 25 , 48 , 61 , 67 ] might be a result of low organisational PSC. Also, fatigue [ 68 , 69 ], injuries [ 67 ], accidents [ 70 ] and circulatory diseases [ 71 ] had a significant and negative association with PSC. Moreover, mental health issues such as psychological distress [ 23 , 26 , 42 , 49 , 54 , 64 , 67 ], stress [ 27 , 72 ], depression [ 31 , 41 , 65 , 73 ] and PTSD [ 56 ] might be a result of low workplace PSC. Meanwhile, reviewed studies found that workers that perceived high levels of PSC at work were more likely to experience improved general health, safety and well-being [ 12 , 16 , 17 , 55 , 57 , 62 , 74 ], psychological well-being [ 15 , 58 ], personal resilience [ 75 ], psychological safety [ 54 , 76 ], and self-worth [ 77 ].

Influence of PSC on job performance outcomes

Improved job performance was linked to higher perceived organisational PSC [ 32 ]. Similarly, job satisfaction [ 17 , 27 , 77 , 78 ], work engagement [ 17 , 21 , 22 , 25 , 27 , 37 , 42 , 57 , 69 , 79 , 80 ] and job commitment [ 27 , 44 , 52 ] are three key performance outcomes (psychosocial outcomes) that were consistently reported to be associated with high level of PSC. However, two studies reported no significant association between PSC and job engagement [ 44 , 81 ], but improved productivity was expected in a highly perceived PSC work environment [ 20 , 75 ]. As a result, issues that affected productivity, such as turnover intentions [ 41 , 61 , 78 ], absenteeism [ 71 , 82 , 83 ], presenteeism [ 23 , 28 , 82 , 84 ], and need thwarting [ 40 ] were reduced or eliminated in highly perceived PSC work environment. These might lead to more funding opportunities [ 47 ], sustained profits [ 83 ] and reduced compensation claims [ 83 ].

Elimination of unsafe working behaviours [ 85 ] and improvement in workplace safety behaviours [ 38 , 86 ], safety participation [ 87 ] and compliance [ 87 ] were also common in workplaces where management prioritises the well-being of workers. Workers were more likely to be workaholics [ 44 ], have high morale [ 83 ], and develop organisational citizenship behaviours [ 50 ] in a high PSC context. Moreover, adaptive and proactive work behaviours [ 88 ], creative problem solving [ 55 , 89 ], taking of personal initiatives [ 80 ], personal development [ 80 ], positive service behaviour [ 88 ], workaround [ 68 ], and service recovery performance [ 90 ] were more likely to be observed in high PSC work environment. Perhaps, managerial quality is one of the key benefits in a high organisational PSC context [ 64 , 91 ]. For instance, the quality of patient care and patient safety was protected when healthcare professionals perceived high PSC in their facilities [ 30 , 70 ].

The moderating role of PSC

One key strength of PSC was its buffering effect on precarious work conditions on health, safety and performance outcomes [ 11 ].

The effect of workplace abuse on workers’ health and safety

The effect of workplace abuse and violence on workers’ health and safety is controlled by the presence of PSC. For instance, reviewed studies reported that PSC moderated the effect of workplace bullying on psychological contract violation [ 92 ], work engagement [ 57 , 79 ], PTSD [ 56 ]and psychological distress [ 52 ]. Also, PSC played a moderating role in the effect of workplace harassment on psychological distress [ 52 ], and the impact of workplace stigma on bullying and burnout [ 59 ]. Contrary to the argument of Dollard et al. [ 11 ], the moderating role of PSC on the association between workplace bullying and psychological contract violation had an inverse result [ 92 ].

The effect of job demands on workers’ health and safety

Evidence also indicated that PSC could buffer the effect of job demands on workers’ health and safety. For example, the effect of job demands on burnout [ 81 ], fatigue [ 69 ], work engagement [ 69 ] and depression [ 93 ] were found to be moderated by PSC. Also, the association between emotional demands and emotional exhaustion [ 12 ] and psychological distress [ 94 ] were reduced in the presence of high-level organisational PSC. Furthermore, the relationship between work-family conflict and insecurity, as well as the association between job insecurity and safety behaviours are buffered by the presence of workplace PSC [ 38 ]. The high level of workplace PSC among nurses reduced the effect of work intensity on presenteeism [ 29 ].

The effect of job resources on workers’ health and safety

It was expected that in a high PSC work environment, job resources’ effect on workers’ health and safety would be enhanced [ 11 ]. For instance, the effect of job resources on safety behaviours [ 38 ], and workaholism [ 43 ] were boosted in the presence of high PSC. Evidence also showed that the effect of social support (support from co-workers and supervisors) on work engagement [ 81 ]and the effect of job control on mindfulness among workers improved in the presence of high PSC [ 95 ]. Moreover, a reviewed study found that a supportive work environment’s effects on personal hope were lowered in low PSC [ 76 ]. Besides, health-centred leadership had the greatest impact on psychological health when oil and gas workers perceived high PSC [ 53 ]. Finally, the interaction between job demands and job resources in predicting distress among police workers was moderated by PSC [ 26 ].

The effect of mental health on workers’ behaviours

In an unsafe work environment, workers’ mental health is severely impaired [ 88 ]. In such a situation, the high presence of PSC is expected to control the effect of mentally distressed on workers’ performance [ 12 ]. A reviewed study confirmed this hypothesis and reported that the effect of depression on workers’ positive organisational behaviour was attenuated by the presence of PSC [ 17 ].

A thorough literature search conducted in PubMed, Scopus, Central and Web of Science and other databases such as Google and Google scholar produced 13,669 records. Through a robust screening process, 91 studies that explored psychosocial safety climate using PSC-12, PSC-8 and PSC-4 as a measure were included in this review. Reviewed studies showed that PSC, as an upstream job resource construct, was essential in designing jobs by matching job demands and resources. Thus, PSC has consistently been found in the literature to be negatively associated with job demand variables such as psychological demands, emotional demands, quantitative demands, work intensification, work pressure, conflicting pressures, job insecurity, work-family conflict, family-work conflict, and effort-reward imbalance. Moreover, PSC is positively associated with job resources (job control, social support, quality leadership, organisational rewards, decision authority and influence, emotional resources, organisational justice, and personal development). Hence, PSC has great influence on psychosocial work factors (job demands and job resources). Also, it was established that PSC was negatively associated with workplace abuse, such as stigma, discrimination, bullying, and harassment. Furthermore, PSC directly improves workers’ health, safety, and performance, proving a strong buffering effect for health and safety of workers. This shows that PSC has influence of health and safety and performance outcome of workers and reduce the effect of precarious work on the health and safety of workers. Discussion of findings have been done according to the research questions.

PSC as a precursor to psychosocial work factors (job demands and resources)

Managers need to be guided by ethics and value for workers when making decisions regarding job design and nature to foster healthy and decent workplaces [ 96 ]. However, job design and the promotion of a healthy and decent workplace might depend on the priority managers give to productivity or profits as against the well-being and safety of the workers [ 11 ]. In many cases where the manager’s priority was overly focused on productivity and profits, job demands were high, affecting workers’ health and safety, especially in a resource-limited work environment [ 12 ]. However, when managers shift attention from productivity to well-being and safety of their workers, excessive job demands are likely to be reduced, to protect the health of the workers. Perhaps, the negative association between job demands and PSC is explained by the shift of managers’ attention from productivity to valuing the psychological well-being and safety of the workers and vice versa.

The review further found that in a low PSC context, excessive job demands are expected, due to the lack of feedback from workers or the lack of opportunity for workers to voice their frustrations concerning high level of job demands [ 59 ]. In such organisations, job demands were likely to be high because of the likelihood that managers prioritised an up-to-bottom communication rather than a bottom-up approach, to ensure that workers’ voices are heard and factored into the job designs [ 43 , 95 ]. There is high likelihood of reduced job demands when organisational PSC is high, because workers will be involved, consulted, participated in designing their jobs, workplace health and safety policies and any intervention that creates a healthy and decent workplace for such workforce. Finally, PSC was observed as an upstream job resource and its presence at the workplace is a signal for reduction in excessive job demands and helping workers to fulfil their requirements, that achieve organisational goals and a sense of belongingness [ 11 ].

The quality of a worker’s productivity or performance is influenced by the design of their job, which also establishes how workers would carry out their responsibilities and meet organisational and personal goals. It is worth appreciating that quality work involved resourcing workers adequately to cope with excessive job demands [ 12 , 44 ]. The positive association between job resources and PSC indicates that in a high PSC work environment, workers have the confidence to access the needed resources to accomplish their job demands and responsibilities [ 43 ]. Thus, in such a context, workers are encouraged, trained and offered the opportunities not only to access job resources but to utilise these resources for organisational and personal growth [ 11 ]. Besides, in a high PSC context, adequate job resources are made available to workers to ensure that the psychological well-being of workers are prioritised over productivity. On the other hand, in a low PSC context, job resources were limited and, to a larger extent, non-existing, which exposes workers to job strain and poor health outcomes [ 12 ], that will further compromise productivity.

Workplace abuse and violence are unhealthy factors that exposed workers to precarious situations. We found that workplace abuse, bullying, harassment, stigma and discrimination were social-relational factors that created an unhealthy, corrupt and indecent workplace, violated human rights, and compromised the dignity of workers [ 56 , 61 ]. Various mechanisms might explain the negative association between PSC and workplace abuse. First, in a high PSC context, workplace social relations are supposed to improve and give workers the signal that there are available resources for dealing with any form of abuse [ 12 ]. Also, workers who are abused victims were given opportunities to find solutions in such positive worksites [ 12 , 71 ]. This way of solving workplace conflicts or abuse might not be present in a low PSC work context which may fuel turnover intentions and turnovers of affected workers [ 41 , 78 ]. Finally, it would be difficult for many workers to report abuse in organisations where PSC is low, and that majority of these workers may not have the opportunity to seek redress since such institutions practice the top–bottom approach communication that usually limits open communication and trust in management [ 41 ]. But, in a high PSC context, managers give cues to workers about social-relational aspects of work, such as how workers should interact with one another and the behaviours that would be rewarded or punished [ 12 ].

PSC as a precursor to workers’ health and safety

Evidence suggests that PSC positively correlated with improved worker health, safety and performance outcomes [ 13 , 97 ]. High-quality work with manageable job demands, and adequate job resources were more likely in a high PSC work environment, where managers value and safeguard workers’ psychological health for improved well-being, safety and performance outcomes [ 18 , 59 , 66 ]. Thus, a high PSC context foster satisfaction of psychological needs, job satisfaction, job commitment, and mental health maintenance, which translate into improved productivity [ 58 , 88 , 89 ]. Basically, in such a PSC context, workers perceive that their well-being is a priority to managers, hence, become intrinsically motivated, which may lead to improved mental health and well-being [ 98 , 99 ], and positive performance outcomes. Unfortunately, low PSC environments are more likely to produce low-quality work that threatens and obstructs worker job satisfaction, resulting in psychological distress, exhaustion, fatigue, impaired well-being and organisational performance [ 62 , 68 ].

The evidence is that PSC moderates the effect of psychosocial work factors on health, safety, and performance outcomes [ 26 ]. One explanation is that PSC acts as a safety signal [ 52 ], when danger cues such as work pressure, excessive job demands, and workplace abuse are present. This safety signal works by indicating options such as access to and safe use of available resources to counteract the psychosocial hazards to prevent the onset of impaired health, safety and performance outcomes [ 26 , 54 ]. Aside from being a safety signal, PSC could initiate resource caravans or gain spirals, promoting workers’ well-being and productivity [ 96 ]. A study found that PSC moderated the association between workplace bullying and psychological contract violation [ 93 ]. It is worth noting that receiving support at the workplace was not always be connected with favourable health and performance outcomes, primarily when the support is obtained in an unsafe or negative work environment [ 93 ], making the organisational climate increasingly important.

Implications for practice

Creating and promoting a healthy, safe and decent workplace might start with integrating PSC as an essential upstream psychosocial resource at every workplace. Moreover, efforts directed towards prioritising and valuing the well-being and safety of workers by managers may be the beginning of eliminating precarious working condition. Thus, the experience of workers at the workplace, to a greater extent, influence workers perception of PSC. Still, this premise does not change the fact that managers possess the power and resources to design quality jobs through pro-worker and robust organisational policies and practices [ 12 ]. Dollard et al. [ 12 ] argued that PSC was a modifiable variable; hence, managers should know that change could be implemented by improving involvement and communication mechanisms around psychosocial hazards and mental health issues. This could also be achieved by management demonstrating commitment and support for stress prevention and psychological treatment. Furthermore, managers commitment becomes paramount to any workplace policies targeting workers’ well-being [ 24 , 92 ].

Workers who experienced bullying were more prone to rage and irritation, which have undesired consequences to the worker and the organisation. Thus, managers need to pay attention to these signals and act quickly to relieve workers of distressing feelings. Managers need to give workers channels to vent their rage since doing so would make them feel better [ 100 ]. Organisations could, for instance, offer victims psychological counselling services and listen to their complaints. Understanding the implicit expectations from fair treatment of workers may also help managers to manage and deliver on the expectations of employees, which in turn, helps prevent violations and other adverse outcomes. Perhaps, fostering a bottom-up approach to communication allows workers to report excessive job demands and low job resources and enables workers to talk about workplace abuse and hostility [ 35 , 100 , 101 , 102 , 103 , 104 , 105 ]. Also, managers need to create a safe and decent psychosocial work environment that may lower the risk of workplace bullying and can successfully prevent the events leading to an escalation of vices and eventually increase productivity and organisational image [ 106 , 107 , 108 , 109 , 110 ].

Recommendations for future research

Reviewed studies exploring PSC were mainly conducted in Australia, Malaysia and Canada, and not much research attention was given in Africa and South America. Also, existing PSC literature concentrates on occupational groups such healthcare workers, education workers, police and workers in the banking sector. Hence, studies from developing nations and other worker groups such as agricultural workers, road transport workers, rescue workers and military officers are needed. Moreover, the direct effect of PSC on some psychosocial work factors such as lone working, shift workers and those working extended hours may need more exploration. Furthermore, more studies are required to tease out the conditions under which the strength of PSC matters in the work context [ 12 ]. In addition, qualitative designs are needed to understand PSC through shared and individual experiences, working conditions and the psychological health of workers. More quality studies that adjust for confounding variables may be essential in understanding the independent effect of PSC on psychosocial work factors and stress symptoms. Finally, understanding PSC through the experiences of minority workers such as refugees, child workers, pregnant workers, and workers in the informal sectors might help improve the working conditions of vulnerable workers.

Limitations in this review

About 63% of the included studies are cross-sectional surveys whose findings might be affected by response bias since they mostly rely on self-report measures. This situation may affect the generalisation of findings in this review. Also, the literature search was restricted to only peer-reviewed articles and papers published in English. This situation may affect the number of included studies and the depth of information presented in this review. Including only papers that explored PSC using PSC-12, PSC-8 and PSC-4 as measures may reduce the number of included studies which also affect the depth of information provided in this review. However, the authors pulled 93 studies from 45 countries globally, which may help understand PSC’s importance in creating a safe and healthy work environment for workers.

Organisational PSC is an essential upstream job resource that directly affects psychosocial work factors, including job demands, job insecurity, effort-reward imbalance, work-family conflict, job resources, job control and quality leadership. In addition, PSC directly affects social relations at work, including workplace abuse, violence, discrimination and harassment. Moreover, PSC directly affects health, safety, and performance outcomes. Besides, PSC moderates the effect of working conditions on workers’ health, safety and performance across different occupational groups and settings. Therefore, designing quality jobs, prioritising the well-being of workers and fostering bottom-up communication through robust organisation policies, practices, and procedures may help create a high workplce PSC for healthy and decent work for all workers, for productivity and organisational integrity.

Availability of data and materials

All data generated or analysed during this study are included in this article and its supplementary information files (Table S 1 ).

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We are grateful to Dr. Kwame Kodua-Ntim of Sam Jonah Library, University of Cape Coast, Ghana, for his enormous support during data search and screening process.

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Amoadu, M., Ansah, E.W. & Sarfo, J.O. Influence of psychosocial safety climate on occupational health and safety: a scoping review. BMC Public Health 23 , 1344 (2023). https://doi.org/10.1186/s12889-023-16246-x

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#MeToo Stalled in France. This Actress Might Be Changing Things.

Judith Godrèche says the abuse of children and women is stitched into the fabric of the French movie industry. This time, the country seems to be listening more closely.

“I don’t see myself as the messiah. I didn’t invent #MeToo. There were women who talked here before me,” Judith Godrèche said. Credit... Andrea Mantovani for The New York Times

Supported by

By Catherine Porter and Aurelien Breeden

Reporting from Paris

• April 3, 2024

Judith Godrèche did not set out to relaunch the #MeToo movement in France’s movie industry.

She came back to Paris from Los Angeles in 2022 to work on “ Icon of French Cinema, ” a TV series she wrote, directed and starred in — a satirical poke at her acting career that also recounts how, at the age of 14, she entered into an abusive relationship with a film director 25 years older.

Then, a week after the show aired, in late December, a viewer’s message alerted her to a 2011 documentary that she says made her throw up and start shaking as if she were “naked in the snow.”

There was the same film director, admitting that their relationship had been a “transgression” but arguing that “making films is a kind of cover” for forms of “illicit traffic.”

She went to the police unit specialized in crimes against children — its waiting room was filled with toys and a giant teddy bear, she recalls — to file a report for rape of a minor.

“There I was,” said Ms. Godrèche, now 52, “at the right place, where I’ve been waiting to be since I was 14.”

Since then, Ms. Godrèche has been on a campaign to expose the abuse of children and women that she believes is stitched into the fabric of French cinema. Barely a week has gone by without her appearance on television and radio, in magazines and newspapers, and even before the French Parliament, where she demanded an inquiry into sexual violence in the industry and protective measures for children.

In response, many other women and men have publicly spoken to say that they, too, were victimized in the country’s revered movie industry, where some directors have long been celebrated for transgressing social and moral norms in the name of their art.

While #MeToo quickly toppled several powerful men in Hollywood after the movement started in 2017, its impact in France has been slower. It has caused some small changes in the industry but has also confronted strong resistance.

This time, many actresses and experts say they sense a shift in perception.

“Something very profound and very luminous is in the midst of happening,” said the actress Anouk Grinberg. “People who defend victims are no longer considered enemies and hyenas that hunt after men.”

An association of actresses, A.D.A., was formed in 2021 to lobby for change in the industry, including for having intimacy coordinators — professionals who help actors and film crews navigate sex scenes — on set as standard practice. Members say that they have been overwhelmed by applicants to join the association, as well as by victims offering testimonies.

“The difference now,” said Clémentine Poidatz, an A.D.A member, “is people are listening.”

Signs of shifting attitudes are hard to measure. But Ms. Godrèche, who was a film star in France before moving to the United States a decade ago, has received an emotional reception from powerful audiences, including committee members in both the French Senate and National Assembly.

In one public hearing, Erwan Balanant, a centrist lawmaker, said he was embarrassed that he had loved the films she starred in when they were both teenagers. He no longer saw them the same way, he added.

Ms. Godrèche was also invited to give a speech at the Césars, France’s equivalent of the Oscars, four years after it awarded the best director prize to Roman Polanski, who fled from the United States in 1978 after pleading guilty to unlawful sex with a 13-year-old .

At the ceremony, Ms. Godrèche, addressing France’s cinema stars and power brokers, asked how they could collectively accept “that this art that we love so much, this art that binds us” is used as a cover to abuse girls.

She received a standing ovation.

In an interview, Ms. Godrèche, who was among those in the United States to speak out about the movie producer Harvey Weinstein , said: “I don’t see myself as the messiah. I didn’t invent #MeToo. There were women who talked here before me.” She understood how difficult it is to drive fundamental cultural shifts, she added.

“You need to hit the door, and hit the door, and hit the door,” she said. “You don’t need one piano. You don’t need one guitar. You need a whole fanfare — a brass band.”

That banging had already bought some bouts of reckoning and some structural changes. The French government now offers financial incentives for films to recruit more female talent and requires producers to be trained in preventing sexual violence before receiving certain subsidies.

But there has been fierce resistance, too. The #MeToo movement has often been dismissed as an encroachment of puritanical American mores on an essential part of France’s intellectual and cultural identity.

The particularities of French cinema also make it averse to change. Moviemaking in France is often seen as an art form first and foremost, not a business, and sets are rarely treated like any other workplace.

While most applaud a redistributive funding system that shields independent films from box office pressure, critics say that it also makes some directors immune to introspection and hoists their artistic vision above all else — including, occasionally, the law.

Added to that is the distinctly French admiration of the artist’s role as a rule breaker in a world where “there is no war of the sexes, there are only relations of seduction,” said Geneviève Sellier, an emeritus professor of cinema studies at Bordeaux Montaigne University who runs a feminist criticism website called Gender and the Screen .

That situation “is obviously an extremely convenient mask for male domination,” she added.

Some male actors have also raised their voices. One of them, Aurélien Wiik, started the #MeTooGarçons hashtag , or #MeTooBoys, which has been used by people in other walks of French society to recount their experiences of abuse.

One of the most prominent men to face accusations in France is the movie star Gérard Depardieu . Over a dozen women have said that he sexually harassed or abused them. In 2021, he was charged with raping and sexual assaulting a young aspiring actress, Charlotte Arnould. Mr. Depardieu has categorically denied any wrongdoing, and he has not been convicted. The investigation is continuing.

In December, just before Ms. Godrèche began to speak out, a television investigation showed footage of Mr. Depardieu making crude and sexist comments during a 2018 trip to North Korea.

The videos elicited outrage, but President Emmanuel Macron pushed back, condemning what he called a “manhunt” against the actor.

Ms. Arnould said she believed a change was afoot because more women were speaking out. But, she added, she was not optimistic about the results.

“Men are still not afraid enough. For that to happen, it would require a total reversal of the system and a collective awakening,” she said in an email.

Much of the outrage about the television documentary focused on Mr. Depardieu’s vulgar comments about a prepubescent girl riding a horse. But less fury was kindled by the interviews with four adult women who say they were directly victimized by him.

“For the general public, there’s more empathy for children than when it’s adult women talking about assault,” said Ariane Labed, an A.D.A. founder. For the women, she said, there is still a lingering blame — as in “she should have known better.”

In 2020, France’s literary establishment was shaken by the publication of “Consent,” a book by Vanessa Springora that detailed the torturous relationship she had at age 14 with the celebrated writer Gabriel Matzneff, then 49, under the complacent gaze of the country’s cultural elite . Many of his published works detailed his sexual pursuits with girls and boys in their early teens or younger.

Confronted with that historically lax attitude, France strengthened its prohibition of sexual contact with minors under 15 , reclassifying it as rape when the adult is more than five years older.

Ms. Godrèche said she saw her story as cinema’s version of “Consent.”

She started in films as a child, and landed a role at 14 in a film by the director Benoît Jacquot. Their relationship played out in plain view. They bought an apartment together when she was 15 and he 40.

She has also accused Jacques Doillon, another director, of sexually assaulting her twice — once when she was starring in his film “The 15-Year-Old Girl” about a father who falls in love with his son’s girlfriend. Mr. Doillon also played the father, and demanded 45 takes for a sex scene with her, she told French radio .

Through their lawyers, both men denied the allegations and declined to comment further.

Mr. Doillon is suing Ms. Godrèche for defamation over comments she made on Instagram accusing him of having sexual relations with children.

In an interview with the newspaper Le Monde , Mr. Jacquot acknowledged his relationship with Ms. Godrèche — and many other young women whom he considered his muses — but denied having any sexual relations with her before she was 15. He also disputed having been violent or coercive with her.

It was Mr. Jacquot, speaking in that 2011 documentary, that set off Ms. Godrèche’s campaign. Among the specific demands Ms. Godrèche has made is a parliamentary investigation into sexual violence and risks to children in the film industry. She has echoed A.D.A.’s call for intimacy coordinators, particularly when children are involved.

But she considers the current reckoning in France to be much larger.

“French cinema represents French society,” she said. “The directors are fathers and uncles and best friends of the family and grandfathers. And it is within these families that we tell children and women and young men and men to not speak.”

A month after she began to speak out, Ms. Godrèche asked her followers on social media to send her their own stories of abuse. Since then, she said, some 5,000 messages have poured in.

Many, she said, had never disclosed the abuse before. Others raised abuse in their family that was never acknowledged.

She is currently making a short film inspired by their stories, she added. “This is just the beginning.”

Ségolène Le Stradic contributed reporting.

Catherine Porter is an international reporter for The Times, covering France. She is based in Paris. More about Catherine Porter

Aurelien Breeden is a reporter for The Times in Paris, covering news from France. More about Aurelien Breeden

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Preventing Workplace Violence Essay

Conflicts are part of every management. According to ALICE Training Institute (2015), close to 700 people are murdered in the various places of work, and between 1992 and 2012, approximately 15,000 cases of violence at the workplace that were recorded were all homicide victims. Several cases of violence at workplaces have led to serious fatalities. Nonfatal cases remain common with the CNN reporting 572,000 cases of nonfatal crimes in 2009 at various workplaces (ALICE Training Institute, 2015).

Largely, the Occupational Health and Safety Administration (OHSA) put the estimated value to be approximately 2 million cases of workplace violence per annum – ranging from physical and verbal abuses to homicides. Organizations, therefore, have to put in place necessary conflict handling mechanisms to help in averting conflicts from degenerating into violence. Cross-cultural misunderstanding is one key factor that if not well handled can result in workplace violence (Perkins & Arvinen-Muondo, 2013). Various organizations have to make unrelenting efforts to resolve differences considerately while factoring in the cultural considerations.

The cultural difference comes up with communication challenges. Communication is in two distinct forms: verbal and non-verbal communication. Tones of voice, gestures, facial expressions, body language, and posture have an immense impact on communication ( Resolve cross-cultural misunderstandings , 2008). The difference in rules across varied cultures affects the ways of communication whether verbal or nonverbal. Notably, the rules are particular to every culture and must not be underestimated. For instance, in some cultures, when a person maintains continuous eye contact in a conversation, he/she is interpreted as being disrespectful. The scenario is the true position for the aboriginal cultures.

In the current global world, organizations first have to appreciate the rules of communication in different cultures before learning how to communicate with employees from other cultures. In addition, the different managements at the workplaces have to be aware of the most common obstacles to effective communication across the different cultures within the workplaces (Canadian Centre for Occupational Health & Safety, 2016). This initiative will eliminate instances where one will be highly likely to judge an individual from another culture based on the cultural values, which do not tally with those of the former.

In this manner, cases of workplace violence will be reduced or eliminated. Appreciating the concept of individual differences is another way of preventing violence at the workplaces. By the management explaining to members the strength of having people with varied cultures as well as differences, employees will be in a position to learn to accommodate each other in order to build a strong team (Doherty & Guyler, 2008). In this aspect, the unity and understanding at the workplace will help curb the cases of workplace violence.

Unresolved conflicts or negative conflict resolution at the workplace can have detrimental effects to the emotional and physical health of people given their strong relationship to stress. Stress at work emanates from different avenues: concerns about employee layoffs, overwork, and conflicts. Stress and conflicts if not well managed affect the body, mind, and causes injury rates.

Employees with these challenges, as Lorainne (2004) observes, pay less focus on the requirements of the jobs, and easily make errors that cause injuries. If left unresolved, conflicts intensify and eventually affect a larger group or even the whole workforce. Cultural difference, on its part, can lead to dysfunctional communications, backstabbing, and disrespect among employees as well as with the management. Unresolved conflicts lead to stress that later causes ailments such as ulcers, hypertension, and cardiovascular diseases.

Effective conflict resolution mechanisms are important for the sustainable growth of organizations. Organizations should implement policies and procedures that manage conflicting situations. Unresolved conflicts results in long-term stress in workers, which eventually affect the output and productivity of an organization.

ALICE Training Institute. (2015, November 15). 10 ways to prevent workplace violence .

Canadian Centre for Occupational Health & Safety. (2016). Violence in the workplace .

Doherty, N., & Guyler, M. (2008). The essential guide to workplace mediation & conflict resolution: Rebuilding working relationships . London, UK: Kogan Page.

Lorainne, G. (2004, July 29). The mind-body connection: Workplace conflict, stress & the risk of injury .

Perkins, S., & Arvinen-Muondo, R. (2013). Organizational behaviour: People, process, work, and human resource management . London, UK: Kogan Page.

Resolve cross-cultural misunderstandings . (2008).

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2020, August 26). Preventing Workplace Violence. https://ivypanda.com/essays/preventing-workplace-violence/

"Preventing Workplace Violence." IvyPanda , 26 Aug. 2020, ivypanda.com/essays/preventing-workplace-violence/.

IvyPanda . (2020) 'Preventing Workplace Violence'. 26 August.

IvyPanda . 2020. "Preventing Workplace Violence." August 26, 2020. https://ivypanda.com/essays/preventing-workplace-violence/.

1. IvyPanda . "Preventing Workplace Violence." August 26, 2020. https://ivypanda.com/essays/preventing-workplace-violence/.

Bibliography

IvyPanda . "Preventing Workplace Violence." August 26, 2020. https://ivypanda.com/essays/preventing-workplace-violence/.

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