The Federal Health Care Workplace Violence Prevention Act

Submitted by kblatt on March 22, 2018
Federal Workplace Violence Prevention

H.R. 5223 – U.S. Representative Ro Khanna

Violence against nurses and other healthcare workers in hospitals and other healthcare facilities is a problem reaching epidemic proportions across the United States. Nurses report being threatened, punched, kicked, bitten, beaten, choked, and assaulted on the job – and some have faced stabbings and shootings. The Health Care Workplace Violence Prevention Act would mandate that OSHA promulgate a standard requiring all employers to prevent workplace violence in hospitals and other healthcare facilities.

Healthcare workers frequently experience dangerous workplace violence incidents:

  • In 2016, the nonfatal injury rate due to violence for registered nurses (RNs) was over 3 times higher than for all industry.1
  • Healthcare workers in inpatient facilities are 5 to 12 times more likely to experience nonfatal workplace violence than the average for workers overall.2
  • Workplace violence is under reported by hospital employees. In a 2015 study, 88 percent of respondents had not documented in their employer’s electronic system an incident of violence they had experienced in the previous year.3

Workplace violence incidents are bad for patients and hospitals:

  • Workplace violence experienced by nurses has been associated with decreased productivity4 and increased employee turnover.5
  • Workplace violence also reduces the quality of patient care.6

To prevent and reduce the frequency and severity of violent incidents in healthcare settings, a comprehensive federal workplace violence prevention standard must:

  • Broadly define workplace violence to include threats and physical acts of violence, including incidents involving firearms or dangerous weapons.
  • Require employers to develop unit-specific and facility-specific assessment and prevention methods rather than one-size-fits-all plans.7
  • Actively involve employees in developing, implementing and reviewing the plan, and provide detailed and interactive training programs for employees.8
  • Ensures that employers assess hazards and provide correction procedures, including sufficient patient care staffing to prevent workplace violence, trained security personnel who are available to respond immediately to workplace violence incidents, alarm systems, and job and facility design to prevent workplace violence.
  • Require that employers establish policies for reporting of workplace violence incidents and concerns without fear of retaliation; systems for communicating among coworkers, shifts, emergency services, and law enforcement about risks for violence and violent incidents; procedures for incident response and investigation; and methods for correcting hazards.9
  • Requires employers to maintain Violent Incident Logs and must adhere to reporting requirements, both of which are critical to the effectiveness of annual evaluations of workplace violence prevention plans and hazard correction.


  1. Bureau of Labor Statistics. U.S. Department of Labor. “Occupational Injuries and Illnesses and Fatal Injuries Profiles,” available at Non-fatal injury rate for RNs in the private sector due to violence was 12.7 per 10,000 full-time workers. Non-fatal injury rate for all private industry was 3.8 per 10,000 workers.
  2. Ibid
  3. Arnetz, J. et al. Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents. Workplace Health and Safety. Vol. 63, 2015
  4. Gates, D. et al. Violence Against Nurses and its Impact on Stress and Productivity. Nursing Economic$. Vol. 29:2, 2011, pp. 59-67.
  5. Sofield L, Salmond SW. Workplace violence: a focus on verbal abuse and intent to leave the organization. Orthop Nurs. 2003;22:274–283.
  6. Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med. 2001;52:417–427.
  7. A 2017 study found that rates of violent incidents were 60 percent lower in hospital units with unit-specific, comprehensive intervention plans compared to units that did not have such plans. Arnetz, J. et al. Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention. J. of Occup. and Environ. Med. Vol. 59:1, 2017, pp. 18-27.
  8. A 2002 study found that interactive, hands-on workplace violence recognition and intervention training can be effective in reducing violence incident rates and, importantly, that refresher trainings are needed to maintain those effects. Fernandes, C. et al. The Effect of an Education Program on Violence in the Emergency Department. Annals of Emerg. Med. Vol. 39:1, 2002, pp. 47-55
  9. A 2009 study showed that one inpatient psychiatric Veteran’s Affairs Medical Center reduced rates of violence on the day shift — by 89 percent during treatment and 57 percent from pre-treatment to post-treatment — after real-time incident recording tools and regular twice weekly meetings on violence prevention were implemented. In the night shift where continuous involvement of staff in risk assessment and prevention was not implemented, rates of violence did not show significant change.
    Lanza, M. et al. Reducing Violence Against Nurses: The Violence Prevention Community Meeting.
    Issues in Mental Health Nursing. Vol. 30, 2009, pp. 745-50