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Workplace Violence in Healthcare

What is workplace violence in healthcare?

The World Health Organization (WHO) defines workplace violence as “incidents where

staff are abused, threatened or assaulted in circumstances related to their work, including

commuting to and from work, involving an explicit or implicit challenge to their safety, well-being

or health”. 1 According to the US Centers for Disease Control and Prevention (CDC), workplace

violence can further be broken down into different types: criminal intent, customer/client, worker-

on worker, and personal relationship.

The most common type of workplace violence seen in the healthcare setting is

customer/client, also known as client-on-worker-violence. This type of violence occurs when a

patient, patient family member, friend of the patient, or other visitor is violent towards the

healthcare worker(s) treating them, or present in the area of their treatment. Healthcare settings

which are at highest risk and expectation of experiencing workplace violence include

emergency, psychiatric, and geriatric settings. 2 In a survey of emergency physicians, the most

commonly reported forms of violence were verbal threats, with 74.9% of polled physicians

reporting having experienced it in the last 12 months. Of these same physicians, 11.7%

indicated they were victims of physical assault as well. 3

According to the CDC, another commonly reported form of workplace violence in

healthcare settings is the worker-on-worker, also known as lateral (or horizontal), violence which

may include bullying, verbal abuse, and emotional abuse (most typically “unfair, offensive,

vindictive, and/or humiliating” words). 4 Resident physicians are particularly vulnerable to this

type of violence due to their position “on the food chain” in clinical settings. A study which

assessed workplace violence and harassment against emergency medicine residents found that

97% of the residents in the study experienced some form of threats, with 78% experiencing

verbal threats, and 52% experiencing sexual harassment. 5

How workplace violence impacts physicians:

Workplace violence can have a negative impact on the mental and physical health of

health care professionals, including physicians. Beyond the obvious physical and mental

implications which workplace violence may have, it is equally important to discuss its role in

physician burnout.

Burnout Syndrome is emotional exhaustion, depersonalization, and reduced personal

accomplishment in the setting of the work-place. 6 Burnout within the medical community has

been a particularly pernicious phenomenon, and one which has only been exacerbated by the

COVID-19 pandemic. Studies show physicians who experienced workplace violence were more

likely to be at a higher risk of burnout. 7 8 Consequences of physician burnout are increased

medical errors, poor patient care, decreased physician productivity and job satisfaction,

increased odds of physician alcohol abuse, and increased risk of suicidal ideation. 9 Considering

this, it seems clear that highlighting and addressing the issue of workplace violence with

practical and culture changing solutions is one of the most important challenges the medical

community must grapple with.

Workplace violence, physician burnout, and the role of gender

Female physicians experience burnout more frequently than male physicians, and

although many factors may contribute to this imbalance, workplace violence may play a

significant role. Female physicians are often the victims of workplace violence, including

physical and sexual abuse 10 11 As Asha George and colleagues’ paper states, this “violence

against female healthcare workers is the tip of the iceberg of gender power imbalances”. 12 By

addressing gender differences in workplace violence and burnout, the medical community can

work to fight gender inequities in healthcare.

What can we do about it?

One of the most important next steps we as a community can all take is to educate

healthcare professionals regarding the problem of work-place violence, particularly as it is a

topic of discussion that seems so seldomly scrutinized. It is especially important to have

education regarding workplace violence education early in medical training as students, in order

to ensure the principles are ingrained early in future generations of physicians. Medical schools

can include workplace violence education within their curriculum to educate students on how

they may protect themselves during medical school, as well as during their careers. Equally vital

is to convey and train physicians on the importance of creating an environment free of any and

all forms of violence.

Moreover, stressing the importance to all healthcare professionals the need to report

workplace violence and the negative consequences which can occur if it is not reported should

be incorporated into any healthcare (hospital or clinic) training. Together, we can work to

decrease the prevalence of workplace violence and create a safer working environment for all.


  1. International Labour Organization, International Council of Nurses, World Health Organizations, and Public Services International. (2002) Framework Guidelines for Addressing Workplace Violence in the Health Sector. Retrieved from:

  2. Occupational Safety and Health Act. (2016) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (OSHA 3148-06R 2016)

  3. Kowalenko T, Walters BL, Khare RK, Compton S; Michigan College of Emergency Physicians Workplace Violence Task Force. Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005 Aug;46(2):142-7. doi: 10.1016/j.annemergmed.2004.10.010. PMID: 16046943.

  4. Department of Health and Human Services, Centers for Disease Control, National Institute for Occupational Safety and Health. Violence—occupational hazards in hospitals. April 2002

  5. Schnapp, B. H., Slovis, B. H., Shah, A. D., Fant, A. L., Gisondi, M. A., Shah, K. H., & Lech, C. A. (2016). Workplace Violence and Harassment Against Emergency Medicine Residents. The western journal of emergency medicine, 17(5), 567–573.

  6. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press, 1996.

  7. Gan, Y., Jiang, H., Li, L., Yang, Y., Wang, C., Liu, J., Yang, T., Opoku, S., Hu, S., Xu, H., Herath, C., Chang, Y., Fang, P., & Lu, Z. (2019). Prevalence of burnout and associated factors among general practitioners in Hubei, China: a cross-sectional study. BMC Public Health, 19(1), N.PAG.

  8. Hacer TY, Ali A. Burnout in physicians who are exposed to workplace violence. J Forensic Leg Med. 2020 Jan;69:101874. doi: 10.1016/j.jflm.2019.101874. Epub 2019 Oct 14. PMID: 31669822.

  9. West, CP, Dyrbye, LN, Shanafelt, TD. (Mayo Clinic, Rochester, MN; and Stanford University Medical Center, Stanford, CA, USA). Physician burnout: contributors, consequences and solutions (Review). J Intern Med 2018; 283: 516– 529.

  10. Komaromy, M., et al. (1993). "Sexual Harassment in Medical Training." New England Journal of Medicine 328(5): 322-326.

  11. Phillips, S. P. and M. S. Schneider (1993). "Sexual Harassment of Female Doctors by Patients." New England Journal of Medicine 329(26): 1936-1939.

  12. George A S, McConville F E, de Vries S, Nigenda G, Sarfraz S, McIsaac M et al. Violence against female health workers is tip of iceberg of gender power imbalances BMJ 2020; 371 :m3546 doi:10.1136/bmj.m3546

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