Workplace violence is a growing concern, especially in the healthcare industry. In 2018, healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence.
The violence issue has become nearly unavoidable, with the World Health Organization (WHO), estimating that between 8 to 38% of all health workers will suffer physical violence at some point during their career, with many more experiencing verbal aggression or threats.
In 2020, the CDC reported health care and social assistance workers had an incidence rate of 10.3 (out of 10,000 full-time workers) for injuries resulting from assault or violent acts by other persons.
It’s scary how common violent behavior from patients is becoming in healthcare. Suppose you’re working in the industry, or studying towards a degree like online FNP programs. In that case, learning how to spot potentially violent patients and respond is important.
Our guide covers different early warning signs to look out for, including verbal and non-verbal cues. We also discuss various strategies for identifying, assessing, and defusing any potentially violent situations to protect yourself and others.
Early warning signs
When it comes to working in healthcare, most violent behavior from patients is usually preceded by warning signs. This can come in the form of either verbal or non-verbal cues, like swearing, speaking loudly, heavy breathing, clenched fists, and a sudden behavior change.
It’s not always possible to predict a potentially violent patient, but learning the different signs can help. Spotting a warning sign can end up being the difference between diffusing a situation and a dangerous event occurring.
Getting impatient
Although it isn’t always the case, getting impatient can be a precursor for someone getting angry. If you notice a patient who is looking at their phone or watch repeatedly, bouncing their leg, or pacing—it’s a sign they could be getting impatient.
There are also a few other verbal and non-verbal cues to look out for. A few other key signs a patient could be getting impatient are big sighs, coughing to get attention, and crossing their arms.
Glare and stare
Keep an eye out for the infamous ‘glare and stare’. It’s when a patient consistently stares at the reception desk or medical staff. It typically indicates they’re thinking or planning to approach.
While the ‘glare and stare’ doesn’t necessarily mean the patient is angry, it could be a precursor, especially if they approach staff. The last thing you want is the glare and stare to escalate to anger or invading personal space.
Tone or volume changes
An easy-to-tell early warning sign, if a patient is getting potentially angry, is if their voice changes. It’s important to remember though, that anger doesn’t always present itself as yelling and shouting.
Many people express anger in different ways, and if they’re getting angry—their volume could get quieter, or their tone is getting more abrupt. When you’re working in healthcare, it’s essential to take note of all the tone and volume shifts to get a firm understanding of someone’s feelings.
Invading personal space
If a patient begins to get too close and breaks into your personal space, it could be a sign the situation is escalating. Typically, entering someone else’s personal space is used as an intimidation technique and can signify aggression.
It’s critical to draw clear boundaries when working, and if someone is breaking those—give them a warning. If someone keeps moving into your personal space, despite the reminders, talk to a superior and get assistance to handle them. It’s always better to be safe than sorry.
Examples of patient aggression/violence
The terms aggressive or violent patients cover a wide variety of behaviors and situations. The following are just a few examples of patient aggression and violence.
- Verbal aggression, including threats, swearing, and yelling
- Abusive letters, messages (emails), and calls
- Threatening or inappropriate body language
- Assault of any kind
- Acts of indecency
- Destruction of property or possessions
- Stalking or loitering
What causes violent behavior?
There are countless reasons to explain why someone might resort to violent or aggressive behavior in the workplace. For the healthcare industry, the following are the most common reasons for patients.
- If they have to wait a long time to be seen/attended to
- They have just received bad news
- An error has been made by staff
- There has been a delay in treatment or diagnosis
- Medication or a condition can also be the cause of aggressive or violent behavior.
These may also be exacerbated by drug or alcohol use, underlying mental health conditions, and any extenuating circumstances.
Handling a violent patient
Understanding how to handle and respond to a violent patient is just as crucial as spotting the warning signs. We recommend the identification, assessing the risk, and defusing strategy.
Along with the listed tactics, always report all aggressive patient incidents to a manager/supervisor and follow company protocol. Following company policy is critical for your safety, maintaining professionalism, and a paper trail if documents are required.
Identifying the problem
When handling a violent patient, understanding their feelings and the cause is important. That’s why it’s critical to identify the problem if possible. This can be done by asking the patient themselves.
If you can understand and address the issue, you can follow up by assessing the risk and defusing the situation. It’s essential to remember, however, sometimes—patients aren’t always able to identify the root cause for what’s making them angry or upset.
Assessing the risk
Before taking any action, it’s important for your safety and anyone else’s (including the patient) to assess the situation. It’s essential to treat the risk of violence and aggression like any other risk and hazard in the workplace.
Defusing the situation
While there is no guidance for what constitutes a gold standard in defusing practices, the following tips have shown efficacy in de-escalation-related studies. If a patient shows any potentially violent warning signs, implement them when possible.
- Avoid the use of restraints if possible, they can cause a patient to get more irritated or aggressive.
- Adopt a non-confrontational attitude in communication, and utilize verbal techniques that are clear and easy to understand.
- Avoid using any abbreviations or healthcare terms when a patient is angry. Data has shown this can lead to more aggression—stick to terms and language they can understand.
- If possible—implement environmental controls. Make the patient’s surrounding environment as comfortable as possible, for example, minimizing loud noises and warm lighting.
- Respond to the patient’s concerns or condition—this can also help foster a sense of trust.
What to avoid
There is no right way to respond to a violent or aggressive patient, but in most cases avoiding the following can be beneficial.
- Responding defensively: It’s a natural response, particularly if you feel like someone is getting angry at you for no reason, but try to avoid responding defensively as it may just escalate the other person’s anger.
- Getting angry: When interacting with a potentially violent or agitated patient, it’s important to be mindful and avoid getting angry along with them. Try to keep in control of your emotions and remain professional.
