Type 1 Perpetrator

No legitimate business relationship to workplace I.E- Robber/ criminal act

Type 2 Perpetrator

Current or former Customer, visitor, or vender

Type 3 Perpetrator

Current or former employee, supervisor, or manager

Type 4 Perpetrator

Employee's current/former spouse, significant other, relative or acquaintance

Types of threats

Direct- "I'm going to shoot you"
Conditional- if i get fired, i'll be back here with my gun"
Veiled- "you'll be sorry"

3 categories of cultural influences that impact violence

1. societal culture
2. family culture
3. corporate culture

Societal culture

Media- glorifies violence and desensitizes people, unrealistic héros in movies/TV
Video games- realistic images, easy access to weapons
Economy- as econ. declines and unemployment rates increase workers become insecure, apprehensive, and disgruntled.

Family Culture

2 income families & nuclear family disintegration, increased emotional abuse, alcoholism, drugs, DV= workers acting out at work.
Patterns of emotional abuse and violence passed down to generation. Family roles are reenacted at work ("rule breakers"/"rule enforcers")

Corporate Culture

when employees are happy and feel valued the likelihood of violence decreases.
Toxic factors: irritating physical environment, cramped/sterile or unclean work environ, poor implementation of security, "blame organization", inconsistent adherence to policies, autocratic management style, poor communication and conflict resolution, unfair discipline

Types of Employer Negligence

1. negligent hiring
2. negligent supervision
3. Negligent retention
4. negligent training

Negligent hiring (employer neg.)

hiring someone they know, or should have known, would pose a risk of harm to others.
Need to:
-contact previous employers/ references
-background check

Negligent supervision (employer neg)

employer failed to adequately supervise an employee who threatened/injured a co-worker. Employer did not respond effectively to the conduct of the potentially violent employee
Mitigated by:
-prompt intervention
-mediation/disciplinary action

Negligent Retention (employer neg)

employer was aware of an employee's potential for violence but did not take sufficient action to prevent the employee from harming co-workers
Reduced by:
-prompt, comprehensive investigation
-development of appropriate response plan

Negligent training (employer neg)

failed to implement a program or the one they have was insufficient or inadequate.
Need:
-program that is comprehensive but not overbearing

Essentials in development of a program

Prepare- development of a program before something happens is better than having to react to it after it happens
Learn- reading books, manuals, videos, guidelines from Fed-OSHA or Cal-OSHA
Assess- examine options and select which is most appropriate
Network- ask for help from others in the field.

Success of workplace violence prevention program

1. easy to understand and implement- logical flow of steps
2. comprehensive- role of every employee level to preventing and responding to
3. defensible- address issues (employer negligence)

7 Step system

1.Establish a workplace violence prevention team
2. Assess vulnerability and security procedures
3. Establish and communicate policies and procedures
4. conduct training
5. respond to incidents
6. Develop prevention strategies
7. Evaluate program effectiveness

Essential components of programs

1. System
-Clear defined components
-partnership (all stakeholders involved)

2. Intervention
-timely reporting
-prompt investigation
-estab. process & procedures
-periodic follow up

3.Prevention
-comprehensive pre-employment process
-periodic training

Necessary Team Members

Legal
Human Resources
Mental Health Professional
-Can be the same as the mental threat assessment specialist if psychologist etc.
Security
Threat Assessment Specialist
** The Team leader can be anyone and is in charge of coordinating activities of the team and as a liaison to other team members and consultants

Team Responsibilities

ProgramDevelopment/Implementation/Management
Violence Vulnerability/Security Assessment
Policies and Procedures
Communication Plan
Training Plan
Incident Response/Investigation
Threat Assessment
Incident Management
Trauma Response
Resource Specialists

Violence Vulnerability Assessment

1. can inform and alert management to possible dangers that may be present within the organization
2. process provides a clear and undisputed educational message to all employees

Goal- ID areas of low compliance with established standards and to produce specific action-item recommendations to improve compliance

2 Steps:
1.evaluate the organization's systems, policies, and procedures
2. assess both employees behavior and the perceptions of customers, vendors, and contractors with regard to workplace violence.

Prevention Policy

formal written statement that defines workplace violence, states commitment to maintaining a safe work environ., and provides examples:
-of threats and acts of violence.
-positions on weapons and "zero tolerance" statement
-disciplinary response (counseling, suspension, termination, prosecution)

Program Manual

Included:
Policy
Violence Vulnerability Assessment procedures
communication plan
training programs
procedures for reporting
method of investigations
steps for managing difficult employees
procedures for terminating employees
trauma response plan
plan for evaluating effectiveness of program

Also list:
internal and external resources (police, security, DV organization, team members

Trainings for managers

comprehensive
study actual cases and potential scenarios
role playing warning signs
anger and stress management
effective pre-employment screening process
problem solving and conflict resolution techniques
managing and terminating employees
threat recognition
assessment
response and when to help and when to go get help

Trainings for all employees

warning signs
what to do when they recognize signs
what they can do to avoid behaviors

Level 1 violence

verbal abuse
excessive profanity
Lack of cooperation with supervisor(s)
Spreads rumors/gossip
Intense arguments with others
Adopts belligerent attitude to others
sexual comments
Expresses suicidal thoughts
Displays overt signs of anger (red face, clenched fists, angry facial expression, etc.)
Exhibits impaired judgment, defective reasoning, poor reality testing

*Have time to intervene

Level 2 violence

Makes threatening statements/gestures
- verbal
- written
- email
- text
Disobeys policies/procedures
Vandalizes/steals property
Claims to be persecuted
Portrays self as victim of unjust management
Argues in an increasing belligerent manner
Sends sexual notes/email
Makes suicidal threats/gestures
Interrupts computer network functioning
Defaces organization's web site
Acts out anger (throws things, hits objects. etc.)

*Still have time to intervene cause no physical violence has occurred. But harder

Level 3 Violence

Engages in physical confrontations (fist fights, throwing objects at others, brandishing a weapon, etc.)
Utilizes weapons to harm others
Commits armed robbery
Attempts/commits murder, other violent physical acts
Engages in major property destruction through arson, use of explosives, etc.
Attempts/commits suicide

Responding to an incident

concerning behavior is observed
reported
Prevention team is notified
Team conducts investigation and threat assessment
Team manages incident to a safe conclusion

Investigation process

1. Conduct Interviews
- Reporting party
-victim
-witness
-manager/supervisor
-alleged perpetrator
-others
2. Assemble Information
-HR
-Security file
-mental health records
-internet search (FB, google, etc)
3. Conduct Threat Assessment
-level of violence
-behavior patterns (blamer, hostile, impulsive, psychosis, depression, sub. abuse, romantic triangle/obsession, DV, stalking)
-risk factors (general, workplace, personal, DV, Imminent)
-violence inhibitors
-threat level
4. Establish Threat Level
5. Determine Response Options
6. Develop Response Plan
7. Follow-Up

Work related risk factors

attendance problems
concentration problems
avoids difficult tasks
poor work efficiency
low frustration tolerance
tendency to hold grudge
testing rules
mood swings

Personal risk factors

relationship problems
family problems
financial difficulties
physical illness
marked changes in appearance
stress
no support system

Imminent Risk factors

extreme behavior
unusual interest in violence
interest in publicized violence
obsession with weapons
display of weapons
comments about revenge
threats
mood swings
irritability
withdrawal
decreased communication
low frustration tolerance
detachment

violence inhibitors

fear of consequences
intact family structure
organizational relationships
transferable job skills
religious beliefs

Response Options

Warning
counseling
evaluation
treatment referral
suspension
agreement
termination
prosecution

Responding to level 1 & 2 behaviors

1. document details (who, what, where, when)
2. notify victim of investigation
3. visit incident site (if needed)
4. interview witnesses
5. interview perpetrator
6. escort perpetrator off site (if appropriate)
7. Notify authorities (weapon or treated life)
8. determine team members who will investigate
9. referral options
10. response options

Prior to termination meeting

-investigation completed
-review all documentation
-develop written termination meeting plan
participants selected
-set date, time, location
-written document detailing behavioral reasons for termination
-review documentation with legal team
-steps outlined
-"what if" scenarios

Site factors for termination meeting

location- exists/away from mainstream
physical layout & furniture- no objects on table
-"sanitizing"- removal of anything that could
be used as a weapon.
attire- no loose clothing, hair, shoes, etc.
panic button
escape route
security

During the meeting

2 neutral participants
maintain self control
treat employee with dignity and respect
exhibit empathy and understanding
no breaks
do not allow to return to work area

Responding to level 3 behavior

1. alert others to leave danger area/take cover
2. evacuate site/take cover
3. notify security/ police
4. seek medical care
5. secure site
6. account for all employees

After the incident

-trauma response specialist- stress debriefing
-assemble prevention team
-senior management should be present and visible
-HR help victims get help/services
-communication specialist- deals with media
-security secures area
-clean up

Prevention strategies

1. application/interview process
2.drug testing
3.pre-employment screening

Drug testing

Drugs affect: ability to preform job, attendance, judgment, financial difficulties, accidents

helps decrease potentially problem employees

pre-employment screening

background check
- criminal
- civil
- credit records
- driving record
- weapon registration

checking references, work history, drug tests

Methods for assessing the effectiveness of the program

1. monitor the # and types of incidents occurring within the organization
2. conducting a periodic violence vulnerability assessment
3. comparing the organization's incidents to established norms
4. conducting an effectiveness survey within organization

5 step strategic plan for downsizing

1. planning the announcement- clear and precise plan offering support services and other "severance" components. Thank employees for contributions thus far. Should be delivered by senior executive.
2. determine the survivors and victims- method of downsizing (voluntary retirements/resignations, across the board cuts, specific reductions), consider protected employees, job analysis
3. understanding and anticipating the reactions- shock, denial, anger, acceptance.
4. monitoring and managing the victims- managers make list of people they think could become violent if terminated.
5. managing and motivating the survivors- assurance and support. fewer employees means more work for the ones staying and illicit violence or resentment.

Domestic violence

pattern of abusive behaviors used to obtain power and control over a person in an intimate relationship

Warning signs of DV

excessive calls/visits from current/former partner
reluctance to respond to contacts
irrational/unfounded fear of losing job
inability to travel for work
seasonally inappropriate clothing
wearing sunglasses indoors
overachiever

DV risk factors

recent break up
previous physical violence
threats
sub. abuse
personality disorder
unemployed perpetrator

Employer's role in managing DV

recognize as a workplace issue
respond with understanding
refer to professionals

Prevention Team and DV

address issues:
-temporarily removing employee from worksite
-notifying police
-placing armed security on site
-having assessment specialist evaluate level of risk
-steps to eliminate threat

Obstacles to successful resolution

1. advice could backfire
2. don't follow professional advice
3. information withheld
4. incomplete/distorted information
5. reckless behavior

Restraining orders

PROS
-keeps at safe distance
-increases sense of safety
-provides deterrent
-serve as leverage
-enables law enforcement arrest if violated
-repeat violations could lead to jail

CONS
-paper
-requires court appearance
-violations occur
-law enforcement response varies
-released on bail
-not all lead to prosecution
-failure to arrest can empower perpetrator

3 most serious types of warfare

1. conventional warfare
2. guerrilla warfare
3. international terrorism

international terrorism

acts that violate the criminal laws of the US. intended to intimidate or coerce a civilian population, influence policy of a country by intimidation or coercion or affect the conduct of a government by assassination or kidnapping

counterterrorist strategies to protect American workplace

-look for people who show an interest in security systems and personnel
-look for people who show interest in lay outs of buildings and outside
-ID vehicles that frequently circle or appear to be surveying the grounds
-be aware of panhandlers, street vendors, frequent passers by that are interested in the facility
-watch for cameras, note taking, or questions to security or staff
-watch for groups involved in any of these activities.

prevention of chemical and biological attacks

-close unnecessary openings to business
-control mail/deliveries (look for no return address, heavy parcels, wires, odors, items marked "personal")
-control vulnerable points (air intakes, pipes, AC)
-monitor emails/phone calls
-security cameras at entrance points
-vehicle inspections

School violence definition

complete range of antisocial and aggressive acts of physical, verbal, or visual violence intended to harm, demean, intimidate or infringe upon any member of the school community or are intended to destroy the physical assets of a school.

School violence behaviors

physical assaults, uncontrollable bouts of anger directs towards others, bullying, fighting, sexual assaults, hostile verbal expressions, stealing, vandalizing, dealing drugs, carrying/threatening/using guns/knives/weapons

Types of threats- School violence

1. direct- "I'm going to blow up the school"
2. indirect- "this school is going to get it"
3. veiled- "there could be fewer students in class next week"
4. conditional- "the teacher will pay if they fail me"

3 Levels of School violence threats

1. high level- specific, direct, implies serious and impending danger. perpetrator has taken steps to implement the threat (obtaining weapon)
2. medium level- perpetrator has carried out some planning and thoughts. veiled threats. threat could be carried out but may appear implausible.
3. low level- indirect, vague, minimal risk to victims. details are unrealistic.

School Perpetrator personality profiles

loner
oppositional
sub. abuser
gang member
racist
bully
bully victim
depressed
suicidal
pervious offender
bizarre/psychotic
love relationship breakup

Warning signs of school violence

daily loss of temper, difficulty controlling anger, making threats, fighting, engaging in risky behavior, sub. abuse, fascination in weapons, access to firearms, disciplinary problems, social withdrawal, isolation and loneliness, victim of violence, writing/drawing violent images, chronic hitting/bullying

preventing violence in workplace and school is based...

knowledge, trust, communication, prompt action

What is workplace violence?

Any physical assault or threatening behavior or verbal abuse occurring in the workplace

What does WPV stand for?

Workplace violence

What can you do regarding dress and grooming to protect yourself from WPV?

Having long hair pulled back so no one grabs it, clothing that does not restrict your movement, not wearing jewelry or long earrings, and using breakaway safety cords or lanyards for items like badges, keys, or glasses

What is it recommended to look for in patient background checks?

History of violence, crime, drugs, alcohol abuse, family history of violence or arrest, and mental health diagnosis

Why should you have a mobile phone with you in case of workplace violence?

To call using a code word if something goes badly and ensure someone knows where you are

What are some verbal tactics?

Allow person to express concern, used a shared problem solving approach, be empathic, avoid being defensive or contradictory, apologize if appropriate, follow through with their problem, and avoid blaming others

What are some non verbal tactics?

Be calm, maintain eye contact, listen, nod head, respect personal space, approach from an angle or the side, covert that you are in control, demonstrate supportive body language, avoiding threatening gestures, and avoid laughing or smiling inappropriately

What are some types of violence?

Criminal intent, client on worker, worker on worker, and personal relationship

What are some events/people who are more likely to start violence in the workplace?

People with a history of violence, are delirious, under the influence of drugs or alcohol, transporting patients, working alone, poor environmental design, poor lighting, lack of emergency communication, presence of fire arms, working in neighborhoods with high crime rates, lack of training and policies, under staffing, high worker turn over, inadequate security staff, long wait times and overcrowded rooms, unrestricted public access, and perception that violence is tolerated

What percentage of nurses have experienced violence in the workplace?

80%

What are the consequences on workplace violence?

Heavy physical and emotional toll, physical injuries, permanent or temporary disabilities, psychological trauma, job stress, financial toll, legal expenses, staying in the profession, absent in nurses, increased use of sick leave, lower productivity, low morale, increased request in transfer, and fatigue

What are the reporting requirements for instances of WPV?

To record and report all work related fatalities to osha within 8 hours and all work related inpatient hospitalizations that require care or treatment, amputations, or a loss of an eye within 24 hours

Employers covered by the 1904 must record work related injuries and illnesses that result in what?

Death, days away from work, restricted work, transfer job, medical treatment beyond first aid, loss of consciousness, and significant injury or illness,

What is workplace violence?

Any physical assault or threatening behavior or verbal abuse occurring in the workplace

What does WPV stand for?

Workplace violence

What can you do regarding dress and grooming to protect yourself from WPV?

Having long hair pulled back so no one grabs it, clothing that does not restrict your movement, not wearing jewelry or long earrings, and using breakaway safety cords or lanyards for items like badges, keys, or glasses

What is it recommended to look for in patient background checks?

History of violence, crime, drugs, alcohol abuse, family history of violence or arrest, and mental health diagnosis

Why should you have a mobile phone with you in case of workplace violence?

To call using a code word if something goes badly and ensure someone knows where you are

What are some verbal tactics?

Allow person to express concern, used a shared problem solving approach, be empathic, avoid being defensive or contradictory, apologize if appropriate, follow through with their problem, and avoid blaming others

What are some non verbal tactics?

Be calm, maintain eye contact, listen, nod head, respect personal space, approach from an angle or the side, covert that you are in control, demonstrate supportive body language, avoiding threatening gestures, and avoid laughing or smiling inappropriately

What are some types of violence?

Criminal intent, client on worker, worker on worker, and personal relationship

What are some events/people who are more likely to start violence in the workplace?

People with a history of violence, are delirious, under the influence of drugs or alcohol, transporting patients, working alone, poor environmental design, poor lighting, lack of emergency communication, presence of fire arms, working in neighborhoods with high crime rates, lack of training and policies, under staffing, high worker turn over, inadequate security staff, long wait times and overcrowded rooms, unrestricted public access, and perception that violence is tolerated

What percentage of nurses have experienced violence in the workplace?

80%

What are the consequences on workplace violence?

Heavy physical and emotional toll, physical injuries, permanent or temporary disabilities, psychological trauma, job stress, financial toll, legal expenses, staying in the profession, absent in nurses, increased use of sick leave, lower productivity, low morale, increased request in transfer, and fatigue

What are the reporting requirements for instances of WPV?

To record and report all work related fatalities to osha within 8 hours and all work related inpatient hospitalizations that require care or treatment, amputations, or a loss of an eye within 24 hours

Employers covered by the 1904 must record work related injuries and illnesses that result in what?

Death, days away from work, restricted work, transfer job, medical treatment beyond first aid, loss of consciousness, and significant injury or illness,

Workplace Violence

Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.
Threats, verbal and physical abuse, physical assaults, homicide

National Institute for Occupational Safety and Health Categories of Violence

Criminal Intent
Customer/Client
Worker-on-worker
Personal Relationship

Criminal Intent

Soley based on the nature of the crime
No association with victims
Less common

Customer/client

Committed by someone who has a client working for them or vice-versa
Most common

Worker-on-worker

Occurs between coworkers/peers

Personal Relationship

Manifests in the workplace when someone has a personal relationship with a worker and attempts to bring them harm in their work environment
Puts everyone in the work environment in danger

Indicators of Work Place Violence

Attendance Problems
Adverse Impact on Supervisor's Time (supervisor has to fix issues)
Decreased productivity
Inconsistent work patterns
Safety Issues (accident prone)
Poor health and hygiene
Unusual Behavior
Evidence of possible drug/alcohol use
Continual excuses/blame
Unshakable depression

Warning Signs

3 levels

Level 1

Initimadating/bullying
Disrespectful
Verbally abusive
Uncooperative
Employer should document behavior and meet with employee privately

Level 2

Escalation of the situation
Argues with customer
Refuses to obey
Verbalizes to hurt coworkers
Sends threats
Document behavior, meet with employee, and if necessary call 911

Level 3

Usually results in an emergency response
Display of intense anger
Suicidal threats
physical altercations
Utilization of weapon
Call 911, remain calm, leave area, cooperate with law enforcement, Document incident

What is the best protection employers can offer?

Zero-tolerance policy toward violence

workplace violence

any act or threat of physical violence harassment intimidation or other threatening disruptive behavior that occurs at the worksite

Workplace violence occurs

in or outside the workplace and can range from threats and verbal abuse to outright physical assault

Best protection

establish a zero tolerance policy toward workplace violence

Business owners are being held liable

for not creating and maintaining a safe work environment

Employers who are at increased risk for workplace violence include

exchange money with the public
transport passengers, goods, services
work alone or in small group
work late at night or early in the morning
work in high crime areas

Workplace violence falls int four categories

criminal intent
customer/client
worker on worker
personal relationship

Some warning signs that might signal future violence in the workplace include

excessive drug or alcohol use
change in behavior or decline in job performance
depression withdrawal or suicidal comments
emotional responses to criticism mood swings

Prevention

show that the quality of the relationships between each member of a team is important to you and everyone else on that team

Terminations

have security officers present avoid embarrassing the employee and take an threats made during the termination seriously

Employers should

ensure that the internal culture is comfortable in reporting threatening or suspicious behavior

Workplace violence (WPV) refers only to incidents that involve physical violence. Is this statement true or false?

False

Consequences can be both acute (short-term) and chronic (long-term). Is this true or false?

True

Workplace violence in the healthcare setting may lead not only to nurses leaving the profession, but to negative side effects on recruitment into the nursing profession. Is this true or false?

True

Workplace violence is a recognized hazard within the healthcare industry. Is this true or false?

True

Studies have found higher patient satisfaction levels in hospitals where more nurses are dissatisfied or burned out. Is this true or false?

False; opposite of this

Type 1: Criminal Intent

the perpetrator has no legitimate relationship to the business or its employees, and is usually committing a crime in conjunction with the violence (robbery, shoplifting, trespassing).

For example:
- A hospital administrator assaulted in the hospital parking garage
- A home healthcare nurse is mugged while conducting a home visit

occurs less frequently

Type 2: Client-on-Worker

most common in healthcare settings accounting for almost 80% of incidents, according to the Bureau of Labor Statistics. This course considers the customer/client relationship to include patients, their family members, and visitors, and will be referred to as client-on-worker violence

Research shows that this type of violence occurs most frequently in emergency and psychiatric treatment settings, waiting rooms, and geriatric settings, but is by no means limited to these.

Type 3: Worker-on-Worker

between coworkers is commonly referred to as lateral or horizontal violence. It includes bullying, and frequently manifests as verbal and emotional abuse that is unfair, offensive, vindictive, and/or humiliating though it can range all the way to homicide

often directed at persons viewed as being "lower on the food chain" such as in a supervisor to employee or doctor to nurse though incidence of peer to peer violence is also common.

Type 4: Personal Relationship

the perpetrator has a relationship to the healthcare workers outside of work that spills over to the work environment

For example, the husband of a nurse follows her to work, orders her home and threatens her, with implications for not only this nurse but also for her coworkers and patients.

Work Behavior category

often sparked by unprofessional behavior, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance.

Work Organization category

involved conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources and high workload. Incidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behavior or from organizational practices or work constraints.

A patient strikes a nurse as he attempts to give the patient her medication. What type of violence does this scenario depict?

Client-on-Worker

Hailey has recently joined the hospital as a nurse in labor and delivery. Since she started, she has received verbal harassment from her colleagues. Often her possessions are moved and her paperwork goes missing. What type of violence does this scenario depict?

worker-on-worker

Nora was mugged by a stranger in the hospital parking garage as she arrived to start her shift. What type of violence does this scenario depict?

criminal intent

Margo, a newly-qualified physical therapist, has been working with her patient Simon for several weeks. He has made several comments on her appearance and clothing at previous appointments. At today's appointment he grabbed her breast and made some lewd comments. What type of violence does this scenario depict?

client-on-worker

Benjamin, a transport technician, was punched by a patient in the emergency room. He fell to the ground, hit his head on a table, he lost consciousness briefly, and required 8 stitches. Should this incident be reported to OSHA by Benjamin's employer?

Yes

During her shift Natasha, a nurse's aide, was walking one of her Alzheimer's patients to the dining hall. The patient was sundowning and acting very agitated. She pushed Natasha, knocking her off balance. Natasha hit her shoulder as she fell and irritated an old injury. As a result, she won't be able to work for 2 days. Should this incident be reported to OSHA by Natasha's employer?

Yes

Cameron is a nurse in a home health service for senior citizens and frequently visits two patients in their homes: Elise and Richard. Elise tends to forget that Cameron is her nurse, and can grow anxious and afraid due to her lapses in memory. She often points her fingers at Cameron, paces, breathes heavily, and clenches her fists. Richard, Cameron's other patient, is usually friendly, engages in conversation, and shakes Cameron's hand at the end of the visits. Which of Cameron's patients exhibits behaviors that could lead to violence?

Elise

Ava works the intake desk at an emergency room. One of the people in the waiting area comes up to her and asks how much longer the wait will be while looking at his watch. Is this person exhibiting behaviors that indicate the potential for violence?

no

Brenton is a therapist in a psychiatric ward. One day, while he's visiting with one of his patients, the patient suddenly stands up, looms over Brenton, and begins speaking loudly. Is this person exhibiting behaviors that indicate the potential for violence?

yes

Alice is getting close to the end of her shift at the ER. It's been a really hectic night and the waiting room has been full to capacity all night. She is approached by a patient who starts to complain about the wait in a loud voice. As she talks to Alice, she throws her keys on the counter. Alice notes that the patient's breathing is heavy. What would be an appropriate way for Alice to start to address the issue?

Apologize for wait time; (showing empathy is the 1st step)

Josh arrives to give Mr. Wilson his medication. As he enters the room, Josh notices that Mr. Wilson is staring fixedly at a painting on the wall. He then turns to Josh, starts cursing and accuses Josh of trying to poison him by giving him the wrong medication. He starts to flail his arms in an attempt to swat Josh. What should Josh do next?

- maintain no-threatening eye contact, smile, & keep his hands open & visible
- Ensure that he remains b/t the patient & the room exit
- Use limit setting language such as, "Mr. Wilson please control yourself or I will call security

What can you do to protect yourself from workplace violence?

- Participate in any training or violence prevention programs offered by your employer.
- Dress for safety.
- Be aware of your working environment

The consequences of acts of workplace violence against a healthcare worker can exact a heavy physical and emotional toll. Beyond the immediate trauma, negative outcomes may also include which of the following?

- Diminished productivity.
- Lack of trust in management.
- Loss of team cohesiveness.
- Increased job stress.
- Absenteeism.
- Worker turnover