A Brief Guide for Managing Workplace Violence in Healthcare

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Before the start of the pandemic, acts of healthcare violence were on an upward trend; and even now, the industry is still scrambling on how to adjust. Unfortunately, there is still a high tendency for healthcare professionals to overlook negative patient body language, even though these signs can easily signal a looming act of violence.

So how can we help prevent workplace violence? One solution is to take the proactive approach: engage in workplace violence prevention training that illustrates how to recognize the early signs of conflict, triggers, and patient anxiety, so every worker can better mitigate risk before significant incidents occur.

Workplace violence prevention training is available in many forms for all types of industries—from interactive sessions like seminars, webinars, and on-site training to learn-at-your-own-pace options like ebooks, toolkits, and guidebooks. In this article, we will take a look at some simple ways to recognize potential aggression (or anxiety that can lead to aggression) and review response tactics you can use to de-escalate.

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What Are Common Triggers of Patient Aggression?

Some of the biggest triggers of anxiety and patient aggression are frustration, anger, and fear. Here are some of the typical root causes of those triggers to look for in your encounters:

• Extensive Waiting. Long lines and patient wait times, although less common in a physician's office, are typical in the Emergency Department.
• Fatigue. Someone who is not feeling well is probably not sleeping very well. Fatigue becomes a big driver of anxiety when coupled with the patient’s feeling of losing control.
• Fear of injury or pain. Patients can sometimes fear treatment more than their injury. Fear of an unknown procedure can act as a trigger.
• Drugs. Prescriptions, missed medications, or illegal drugs can play a big role in a patient’s behavior.

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Identifying the Beginning Stages of Conflict Via Anxiety

Just like other behavioral patterns, the stages of conflict can typically be recognized. Stages of conflict (also referred to as the spectrum of violence) first begins with anxiety. For example, a patient is upset about an appointment starting late. Even while they sit and wait, they could quickly begin to show verbal aggression that could eventually become physical.

However, with close observation, you can identify early warning behaviors by looking for signs of patient anxiety at initial contact.

Common signs of patient anxiety include:

• Head down
• Flushing of the skin
• Rubbing of the hands
• Shallow breathing
• Sweaty hands and brow
• A nervous laugh
• Veins appear
• Dry mouth and swallowing
• Bouncing finger tapping
• Touching of the nose
• Playing with the hair

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How to Prevent Challenging or Aggressive Behaviors

How you approach challenging behavior may vary based on your personal experience and past training. Generally, here are some agreed-upon steps to follow to limit these behaviors in patients and visitors:

1. Pause. Stand back, take a moment before approaching and assess the situation.
2. Speak slowly and clearly in a calm voice.
3. Explain your care actions.
4. Try not to rush the person. Act calmly.
5. Show respect and treat people with dignity at all times.

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Communication Is Key for Managing Challenging Behavior

Sometimes, the unintentional ways we say or do things can further escalate aggression or violence in the workplace. This can be especially true in healthcare. With this in mind, we suggest avoiding harsh, aggressive or abrupt statements when speaking to anxious or upset individuals. Commands can come across as controlling or aggressive from your end, so it’s better to lead with softer “I” language that clearly communicates how you feel and what you’d like them to do.

Don’t say things such as “You must….”, “Don’t…..”, or “Stop…….”. Instead, use alternatives that utilize “I’ language like “I would like you to…” or “It would help me if……” or “ I feel scared when…….”. You can see our complete checklist of phrases to avoid when dealing with aggressive patients.

When challenging behavior happens:

• Back off when possible.
• Keep calm.
• Call for help.
• Let the person calm down, if possible.
• Remove others from the environment.
• Be aware of your own body language and tone of voice used.

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Specialized Training for the Management of Aggressive Behavior

Sometimes all the best dialogue won’t be enough to ward off an unexpected attack. That’s where MOAB (Management of Aggressive Behavior) training for healthcare comes in. MOAB training in healthcare focuses on principles, techniques, and skills for recognizing, reducing, and managing violent and aggressive behavior in medical environments such as hospitals, clinics, and private practices.

During one of these programs, healthcare professionals can pick up valuable skills and strategies for safely managing and de-escalating aggressive or potentially violent situations in healthcare settings.

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What Are the Benefits of MOAB Training for Healthcare Professionals?

• Enhanced Safety: MOAB training equips healthcare workers with non-violent techniques to protect themselves, their colleagues, and patients in situations involving aggressive or disruptive behavior. This reduces the risk of injury or harm.
• De-escalation Skills: Professionals learn to recognize the early signs of aggression and use verbal and non-verbal techniques to de-escalate potentially volatile situations. This is crucial for maintaining a calm, controlled environment, especially in high-stress areas like emergency departments.
• Improved Patient Care: By managing aggressive behavior more effectively, healthcare providers can minimize disruptions and ensure that all patients receive the attention and care they need, even in challenging situations.
• Stress Reduction: Having the tools and confidence to handle aggressive behavior reduces stress and anxiety among healthcare workers, leading to better job satisfaction and mental well-being.
• Teamwork and Communication: MOAB training emphasizes the importance of clear communication and teamwork during tense situations. It encourages healthcare teams to work cohesively to ensure safety and resolve conflicts smoothly.
• Legal and Ethical Knowledge: Training includes understanding the legal and ethical aspects of managing aggressive patients, helping professionals adhere to regulations while maintaining respect and dignity for the patient.
• Crisis Management: MOAB techniques can be applied during crises, allowing healthcare professionals to maintain control and provide effective care in high-pressure environments.

With these skills, healthcare professionals can ultimately reduce risk in the patient care environment and compassionately handle aggressive visitors and patients—all while delivering a high level of care. This is why we highly recommend MOAB training for all healthcare workers and facility leaders.

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Who Should Consider MOAB Training?

Considering that most healthcare employees will encounter an anxious or aggressive visitor to their facility at some point in their career, MOAB training can realistically benefit anyone who works in a healthcare environment, from the intake staff and receptionists all the way up to facility administrators. However, there are some groups that face a higher-than-average risk of dealing with challenging behavior. Here are some key groups who should prioritize taking MOAB healthcare training:

Nurses: Because nurses work on the front lines of patient care, they are frequently exposed to patients or family members who may be agitated or aggressive due to illness, pain, or stress.

Primary Care Physicians & Specialists: Physicians (especially those working in emergency departments, urgent care or behavioral health settings) may face volatile patients on a regular basis.

Mental Health Professionals: Psychiatrists, psychologists, counselors, behavioral health professionals, and therapists frequently work with individuals dealing with mental health crises or emotional disturbances that can lead to aggressive or violent behavior.

Emergency Room (ER) and Trauma Staff: ER and trauma departments often handle high-stress situations where patients or visitors might experience severe anxiety, panic, or anger and become aggressive.

Healthcare Facility Security Personnel: Security staff working in hospitals or clinics often need to respond to aggressive situations or individuals. MOAB training equips these workers with non-violent methods to lower aggression and ensure a safe environment.

Assisted Living Facility & Home Health Professionals: Caregivers working in nursing homes, assisted living facilities, or private residences may experience aggression from family members or patients with dementia, Alzheimer’s, or other mentally debilitating conditions.

Social Workers: Clinical social workers often have to manage emotionally distressed or aggressive clients, whether in healthcare facilities or home settings. These professionals can benefit from learning strategies to manage and de-escalate confrontations.

While these groups may benefit the most from these skills, any healthcare professional or staff member who regularly interacts with patients, family members, or the public should consider some type of workplace violence training to help make their facilities safer for everyone.

Need More Resources?

Learn more here about MOAB training offered by LHA Trust Funds here.

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About The Author

Glenn Eiserloh, CHSP
Senior Risk Consultant, LHA Trust Funds

Glenn Eiserloh has more than 17 years of loss prevention and risk management experience. Mr. Eiserloh has a Bachelor’s of Science degree from the University of New Orleans in Finance with a concentration in insurance. He provides consultation services relative to workplace loss prevention, safety training, general liability risk reduction, worksite safety inspections, and trend analysis.