Violence in the Healthcare Workplace ___________________________________________________________
The figures for social workers admitting to perpetrating vio- lence or abuse toward clients were lower. It is not clear whether this was due to their reluctance to disclose such incidences. For example, approximately one-quarter of the sample disclosed to perpetrating an aggressive act toward a client during their career; 13% admitted to having engaged in an aggressive act within the last 12 months [31]. In an Australian study, 67% of surveyed social workers reported being the victim of at least one form of violence in the last year. Like many other studies, verbal abuse was the most common form, followed by intimidation [116]. An integrative review of literature about social workers, particularly child and fam- ily social workers, confirmed that verbal abuse was the most common form of workplace violence [117]. In another study with child welfare workers, 10% reported workplace bullying by their supervisors, and more than 75% experienced workplace violence by their clients [181]. PSYCHIATRIC SETTINGS Psychiatric personnel are also at an increased risk for work- place violence, particularly in facilities involved in the care of patients experiencing illnesses that involve hallucinations and delusions [182]. According to the U.S. Department of Justice, mental health occupations had the second highest average rate of workplace violence between 2005 and 2009 [118]. Lawoko et al. noted that psychiatrists often become victims of workplace violence perpetrated by their clients when they are perceived as having the power to make decisions regarding care, particularly when services are deemed poor [21]. Nurses in psychiatric settings have reported that peak times of patient-perpetrated violence occurred during the time of admission, a relapse, or when a discharge plan had to be modified [182]. In a study that involved Veterans Health Administration psychiatric units, a higher case load of patients with personality disorders was a predictor of significantly higher risk of verbal and physical aggression against nurses [119]. In one meta-analysis, predictors of patient violence perpetrated against healthcare workers in psychiatric inpatient facilities included schizophrenia diagno- sis, younger age, a history with alcohol and drug use, and a history of violence [147].
at some point in their lives, 10% to 50% of women experience physical violence perpetrated by an intimate male partner [32]. Worldwide, the World Health Organization reports lifetime domestic violence rates ranging from 25% to 75% [148]. In 2010, the Centers for Disease Control and Prevention (CDC) conducted a large-scale survey and found that 35.6% of women and 28.5% men in the United States had been raped, stalked, or physically abused by an intimate partner [97]. Among victims of rape and sexual assault in the workplace, 80% are female and 20% are male. In 2003, homicide was the second leading cause of death on the job for women [35]. Overall, domestic violence incidents account for slightly more than one-quarter of all workplace violence incidents [35]. When domestic violence extends into the workplace, it becomes a concern for businesses and other organizations. It can interfere with the victim’s job performance and/or lead to disruptions at work, including the abuser harassing the victim at their place of employment [183]. A large-scale Canadian study examined the level of awareness of domestic violence in the workplace among 8,429 men and women [120]. Approximately 40% of participants recognized someone at their workplace as being a domestic violence victim, based on identification of at least one warning sign. Of these par- ticipants, half believed that it had an adverse impact on their colleagues’ work. In a survey study involving 1,390 employees at 32 companies, more than 50% of female workers and almost 25% of male employees disclosed having experienced intimate partner violence [149]. In total, 16% of all employees surveyed had experienced partner abuse in the past year [149]. In a 2023 study, approximately 50% of their participants experienced work loss due to domestic violence and stalking [183]. On an annual basis, lost productivity and healthcare costs due to domestic violence are estimated to be $8 million in the United States alone, translating to 7.9 million lost workdays annually [36; 150; 184]. Injuries stemming from domestic violence are approximated to yield healthcare expenses of about $4.1 billion, most of which is paid by employers [37]. Among employees who reported lifetime intimate partner violence, 41% acknowledged it nega- tively affected their work performance (resulting in late arrivals, absenteeism, and disruption/violence at the workplace) [149]. Other workers may also be reluctant to work near the affected individual(s), which may then result in additional indirect costs on the organization [35]. Domestic violence in the workplace is also a liability issue for employers. It is estimated that, in the United States, $1.2 million have been awarded to individuals as the result of civil lawsuits regarding lack of workplace secu- rity [36]. Legal cases associated with domestic violence in the workplace have included charges of negligent security, failure to warn when an employer is aware of a specific threat made to an employee, or violations of OSHA and Title VII of the Civil Rights Act [38].
DOMESTIC VIOLENCE IN THE WORKPLACE
Another type of violence that may occur in the workplace is domestic violence, also referred to as intimate partner violence. Domestic violence is a worldwide problem and predominantly affects women. Although women can be perpetrators of domes- tic violence and violence does occur in some same-sex relation- ships, the World Health Organization (WHO) confirms that the overwhelming burden of partner violence is borne by women at the hands of men [88]. Therefore, this section of the course will focus on domestic violence against women. Results of 50 different population surveys around the world show that,
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