Workplace violence is not simply an issue for healthcare organizations. For many, it is the issue. Workplace violence (WPV) enormously impacts mission-critical challenges facing healthcare organizations, such as patient satisfaction, staff retention and recruitment, and payer reimbursement.
Workplace violence isn’t unique to healthcare organizations, yet healthcare is far and away more impacted by WPV than other industries, as highlighted by the Bureau of Labor Statistics: incidents are four times more common in hospital settings. Although healthcare workers account for less than a fifth of all workplace injuries, they endure over half of all assaults. And the threat is escalating.
A Center for Disease Control and Prevention (CDC) report indicates a doubling in reported abuse and violence among healthcare workers from 2018 to 2022. By 2023, over 80% of nurses experienced some form of workplace violence, according to a National Nurses United (NNU) report.
These alarming numbers underline the impact that workplace violence (WPV) has on healthcare workers and organizations. Workplace violence occupies the nexus of healthcare organizations’ core challenges, including recruitment and retention, burnout, patient outcomes, and financial sustainability. According to an American Hospital Association report, workplace violence’s consequences represent a billion-dollar threat to the healthcare industry.
What’s clear is that healthcare organizations must continue taking action to protect healthcare workers and staff. Here, we’ll explore WPV’s implications for healthcare organizations’ bottom lines, the breadth of workplace violence, and share five key strategies to enhance organizational safety.
The Financial Impact of Workplace Violence in Healthcare
The impact of workplace violence on a healthcare organization’s finances can be divided into two broad categories: direct and indirect costs. Let’s take a closer look at those costs.
Direct Costs of Workplace Violence
When violence occurs in the healthcare setting, it may have psychological and physical impacts. Treating staff injuries generates significant expenses for healthcare organizations. Beyond that, violence puts financial pressure on healthcare organizations as they face workers’ compensation claims and legal fees.
Additionally, there are distinct operational costs directly associated with workplace violence. To combat the risk of violence and attempt to mitigate it, security measures (including equipment like metal detectors and security personnel) must be implemented, representing as much as $846 million in annual costs.
Equipment costs related to workplace violence aren’t limited to proactive measures either. In some instances, damage and vandalism that result from workplace violence can necessitate costly replacements.
The direct costs of workplace violence are readily observable. However, they are by no means the most significant costs of workplace violence in healthcare. The largest — and longest-lasting — financial impacts of workplace violence in healthcare are the indirect costs.
Indirect Costs of Workplace Violence
Indirect costs of workplace violence are less likely to be noticed immediately and are significantly harder to address. While certain direct costs of workplace violence — like damaged equipment or medical expenses — can be remedied quickly, it’s considerably more challenging to create prompt turnaround when addressing its indirect costs.
1. Workplace Violence Drives Costly Turnover in Healthcare Organizations
Absenteeism and turnover represent two of workplace violence’s most significant costs. According to a report for the American Hospital Association, in-facility violence drives an estimated industry-wide turnover cost of $234.2 million each year. When employees who are victims of workplace violence do stay at an organization, they’re more likely to be absent. Indeed, 13% of absences — and the estimated $53.7 million per year those absences cost — can be attributed to workplace violence.
The turnover that workplace violence causes is exceptionally unhealthy for healthcare organizations’ finances, as it runs the risk of creating a cycle. When violence occurs and staff leave an organization, it increases the workload of other clinicians and leaves them with fewer resources to cope with violent patients and visitors. As a result, they, too, may leave the organization.
Turnover costs millions, yet it represents just one way in which workplace violence impacts healthcare organizations’ staffing.
2. Workplace Violence Damages an Organization’s Ability to Attract Talent
In addition to the immense turnover costs workplace violence causes, it also makes it increasingly difficult for organizations to attract talent. Healthcare organizations that have a reputation for being unsafe places to work will have extreme difficulty attracting clinicians—a task that’s a significant challenge even for nationally recognized organizations.
Job listings and distribution can cost as much as $900.
Travel nurses cost as much as $160 an hour.
Advertising campaigns to rehabilitate or grow an employer brand can cost tens of thousands.
Together, these costs can have a draining effect on the organization’s bottom line before new clinicians are eventually hired. If the organization’s approach to mitigating workplace violence hasn’t improved by the time the hire is made, they could find themselves back in the hiring process in as few as three months.
3. Lowered Reimbursement and Malpractice Costs Can Financially Damage Organizations
If a healthcare organization is experiencing turnover due to workplace violence, its care quality may also suffer. If an organization is short-staffed or if its clinicians are preoccupied with anxieties about recent violent incidents, patients won’t have the full attention of their clinicians.
This can lead to an increased risk of medical errors, which can expose healthcare organizations to malpractice suits, which are becoming increasingly costly. In fact, over 57 cases were settled for more than $10 million each in 2023.
$10 million settlements and shocking yet rare numbers like a $261 million verdict in Florida steal the headlines regarding the financial impact of patient outcomes and satisfaction. However, healthcare organizations are more likely to be impacted by countless non-payments, lower reimbursement rates, or a failure to retain accreditation, making it increasingly more difficult to sustain an organization.
How to Reduce Workplace Violence and Its Impact on Healthcare Finances
Kirby Bates Associates has identified five critical strategies for mitigating workplace violence in the healthcare setting. Let’s explore them in depth here.
1. Create a Safe Physical Environment
Healthcare organizations can safeguard their frontline clinicians by enhancing physical security measures. Remarkably, up to 20% of patients in emergency departments carry weapons, posing increased risks to both healthcare providers and other patients.
Implementing deterrence measures such as metal detectors, securing furniture, and auditing potential hazards in waiting and triage areas significantly improves safety. While these steps do not eliminate the threat of workplace violence, they are crucial in mitigating risks and minimizing the likelihood of severe injuries.
2. Foster a Culture of Safety and Civility
Patient-to-nurse abuse is a significant concern, yet it represents just one facet of the challenges nurses face. Verbal abuse, bullying, and psychological assaults also emanate from fellow nurses, physicians, and hospital staff. A workplace culture that permits such incivility can cultivate a toxic work environment, drive valuable staff away, and compromise the quality of care delivered.
Leadership plays a pivotal role in fostering a civil environment. The attitudes and actions of an organization’s leadership set the tone for addressing issues like workplace violence. When nurse leaders model professionalism and maintain a zero-tolerance stance toward incivility and violence, it sets a standard that encourages all clinicians to emulate these values.
Find five additional strategies for promoting civility in the workplace in our recent article, including insights from leaders at UnityPoint Health and UNC Rex Healthcare.
3. Advance from Awareness to Empowerment
Nurse leaders must cultivate a culture that unequivocally rejects workplace violence. Beyond establishing this foundational stance, effective leaders empower their teams to actively promote civility and safety, both among themselves and in patient interactions.
Training staff to de-escalate potentially violent or abusive situations is crucial. Integrating this training into regular meetings or through dedicated sessions reinforces its importance. Additionally, introducing clinicians to conflict resolution tools, strategies, and resources during these sessions — and as a key component of onboarding new clinicians — establishes clear expectations and preparedness for managing workplace violence.
Patient care thrives when clinicians are focused and equipped. However, without the necessary tools to address or de-escalate conflicts, or if distracted by internal disputes, clinicians can’t deliver the high standard of care the patient community expects and deserves.
4. Make Workplace Violence Easy to Report
Healthcare organizations across the country acknowledge workplace violence is a critical challenge, and while many have adopted preventive measures, the problem persists at scale. Underreporting incidents is a significant factor that allows WPV to thrive. The American Nurses Association highlights that only a small percentage of violent or abusive incidents are reported. Even when incidents are reported, it doesn’t guarantee action: only a third of healthcare organizations have a clear process for reporting such incidents.
Underreporting hurts healthcare organizations’ ability to prevent violence. Why aren’t staff reporting these incidents? A few common factors deter reporting:
- A belief that abuse is part of the job
- Varying perceptions of what constitutes abuse
- Fear of retaliation, especially in cases of clinician-on-clinician violence
For healthcare leaders to combat workplace violence effectively, they need a comprehensive understanding of the issues—knowing what happens, where it occurs, and who is involved is crucial. Visibility is key; you can’t address what you can’t see. Leaders must prioritize creating an effortless and accessible reporting process.
Clinicians overwhelmed with their work won’t report incidents they deem ‘minor.’ They’re unlikely to take steps to report violence or abuse if it involves cumbersome processes, if they believe it will lead to no concrete action, or if they fear it could negatively impact their careers.
To encourage reporting, the process must be quick, easy to access, transparent, and safeguarded to protect those who come forward.
Tips for Implementing Better Incident Reporting Systems
- Clarify Post-Incident Procedures: A major source of frustration for healthcare workers regarding workplace violence is the perceived lack of follow-through after incidents. According to the NNU report, over half of healthcare organizations do not investigate incidents of workplace violence, and only a fifth make changes to enhance safety post-incident.It is critical for healthcare organizations to clearly articulate their WPV incident reporting process to build trust, retain staff, and improve patient care. This should include specifics on who reviews and responds to reports, how and when the victim will be communicated with, and what definitive measures will be implemented to prevent similar incidents in the future.
- Define Workplace Violence and Abuse: Contrary to some common beliefs among clinicians, workplace violence and abuse are not ‘part of the job’ and should never be treated as such. WPV and abuse have a direct negative impact on patient outcomes, clinician retention, and the sustainability of healthcare organizations.Nursing and hospital leadership must provide clear, unambiguous definitions of what constitutes workplace violence and abuse to eliminate confusion and improve reporting accuracy.
- Establish and Reinforce Expectations: The onboarding of new staff presents a pivotal opportunity to influence perceptions of workplace violence and abuse within your organization. Establishing a zero-tolerance policy from the outset — and consistently reinforcing this stance — sends a strong message to all personnel, regardless of tenure.Remember, adopting a zero-tolerance policy toward WPV requires demonstrable action following reported incidents. Without visible enforcement, the desired cultural shift within the organization will likely fall short of expectations.
5. Get Buy-in From Executive Leadership
Whether your organization is increasing staffing to enable a buddy system for escalated incidents or implementing security measures like metal detectors and cameras, addressing workplace violence in healthcare demands a substantial investment.
Before requesting investment in staff, equipment, or infrastructure, CNOs and other clinical leaders should do their homework to paint a picture of workplace violence’s holistic impact on the organization. Consider illustrating the cost of maintaining the status quo:
- 13% of absences are attributable to workplace violence (WPV).
- 20% of victims report changing jobs or leaving the profession due to WPV, contributing to the average hospital turnover cost of $4.82 million in 2023.
- Vacancy rates hover around 10%, pushing hospitals to rely on travel nurses at rates up to $160 per hour.
While presenting hard data is crucial for securing investments, connecting this data with personal stories can create a compelling case for investment. Encourage CNOs and executives to listen to the experiences of staff who’ve faced workplace violence, detailing how these incidents have reshaped their professional lives. Combining quantitative data and emotional testimony can powerfully advocate for more significant steps toward a safer workplace.
The Bottom Line: Workplace Violence in Healthcare Demands Attention and Prevention
Estimates put the cost of workplace violence in the healthcare industry over $1.5 billion. That’s far too much. However, it makes one thing clear: the price of inaction is even greater.
For the contemporary healthcare industry, challenges are coming from every direction. With everything from recruitment challenges and cybersecurity threats to workplace violence, healthcare organizations need to be proactive to reach fiscal sustainability.
When your organization struggles to address issues with organization-wide impacts, you need leaders with a proven ability to drive turnaround. Where do you find them? There’s no single solution. Fortunately, Kirby Bates Associates’ team of executive recruiters has decades of experience and an exclusive focus on the healthcare industry.
Our team of recruiters leverages their personal experiences and professional networks to identify the ideal leaders. By translating your organization’s challenges into leadership competencies, we can identify passive candidates that traditional executive search strategies wouldn’t find.
Need executive leaders? We can help. To start the conversation and find a leader who can stop the financial losses caused by workplace violence, contact Kirby Bates today.