Security and Safety within Hospitals for the Healthcare Workers

Healthcare workers are assaulted at work more than workers in almost any other sector. It is a long-running, measured pattern with an established regulatory framework around it, and most staff have never been walked through that framework.

This guide covers what the data shows, what OSHA and the Joint Commission actually require, which controls work, and why the reporting numbers understate the problem.

The Bureau of Labor Statistics reported that healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. That figure is widely quoted and is genuine BLS data, but it is now eight years old and should be cited with its year attached.

More recent BLS data tells the same story. The 2024 Survey of Occupational Injuries and Illnesses recorded 77,780 serious nonfatal workplace violence injuries nationally, with healthcare and social assistance showing a violence injury rate several times the private-sector average. Within healthcare, psychiatric aides consistently record the highest rate of any occupational category BLS tracks.

Workplace violence is classified into four types, and knowing which one you're dealing with determines which controls apply.

Type II is the dominant category in healthcare, which is why prevention strategies borrowed from general workplace security often miss. The person posing the risk is usually someone you are actively trying to help, frequently impaired by illness, injury, medication, intoxication, pain, fear or delirium.

That distinction is important for how staff are trained. The response to a frightened, disoriented patient is not the response to an intruder, and conflating them produces both worse care and worse safety outcomes.

There is no specific federal OSHA standard for workplace violence in healthcare. That surprises people, and it matters for understanding what leverage staff actually have.

Enforcement happens through the General Duty Clause, Section 5(a)(1) of the OSH Act, which requires employers to provide a workplace free from recognised hazards likely to cause death or serious physical harm. Where workplace violence is a known hazard in a facility and the employer has not taken feasible steps to address it, OSHA can cite under the General Duty Clause.

Alongside that, OSHA publishes Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (Publication 3148). These are guidelines, not regulation, but they define what a reasonable program looks like and are the framework inspectors reference. Five core elements:

1. Management commitment and worker participation
2. Worksite analysis and hazard identification
3. Hazard prevention and control
4. Safety and health training
5. Recordkeeping and program evaluation

Worker participation is not decorative. A program designed without input from the staff exposed to the hazard fails the first element.

The Joint Commission introduced new and revised workplace violence prevention requirements for accredited hospitals, effective 1 January 2022, spanning its Environment of Care and Leadership chapters.

In broad terms, accredited hospitals must conduct an annual worksite analysis of their workplace violence prevention program, maintain a process for continually monitoring and investigating incidents, provide education and training, and have leadership-level oversight and reporting.

Safety controls follow a hierarchy. The ones furthest from individual behaviour are the most reliable.

Engineering and environmental controls

These work without anyone remembering to do anything:

• Controlled access to clinical areas, particularly ED and behavioural health units
• Sightlines designed to eliminate blind spots, rather than corridors that create them
• Secured staff-only areas with independent egress
• Furniture and fittings in high-risk areas that cannot be readily used as weapons
• Adequate lighting in car parks and around entrances, particularly for shift changes

Technology controls

• Wearable duress badges and real-time location systems (RTLS), which let staff signal for help and, critically, tell responders where they are. A panic alarm that doesn't communicate location is substantially less useful.
• Integrated video surveillance at entrances and in high-risk areas
• Mass notification for lockdown or active-threat situations

Administrative and behavioural controls

• De-escalation training, delivered to the staff who actually encounter the risk, refreshed rather than one-off
• Flagging systems for patients with a documented history of violence, applied carefully and with clinical governance
• Staffing levels that permit a second person to be present for high-risk interactions
• Non-punitive reporting, without which the data underpinning everything above is incomplete
• Post-incident debriefing and follow-up support

The pattern across all three categories: controls that depend on an individual staff member's judgement in a stressful moment are the least reliable. Build the safety into the environment where you can.

Non-punitive reporting depends on the same conditions that determine whether staff raise any concern at all. Our guide on authority gradients and speaking up safely covers why Just Culture has to come before any reporting process.

Violence dominates the discussion, but three other occupational risks belong in any staff safety program.

Musculoskeletal injury from manual patient handling remains the most common cause of career-limiting injury in nursing. The effective controls are mechanical lift equipment, adequate staffing for safe transfers, and a culture where using the equipment is standard. Lifting technique alone does not make the loads safe.

Infectious exposure is managed through standard and transmission-based precautions, respiratory protection with annual fit testing, and time-critical post-exposure protocols for bloodborne pathogens. Exposure reporting is urgent, not administrative, because post-exposure prophylaxis effectiveness declines with delay. Our guide to preventive healthcare for healthcare workers sets out the current screening requirements in detail.

Emergency preparedness covers fire, severe weather, utility failure, and mass casualty. The relevant question for staff is not whether a plan exists but whether you know your role in it without looking it up.

After a violent incident, the support that follows matters as much as the response itself. Our guide on mental health care for healthcare workers covers confidential support routes.