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Preventing Staff-on-Staff Violence Starts at the Top


Mark G. Pelletier, RN, MS, chief operating officer, Accreditation and Certification Operations, and chief nursing executive

At The Joint Commission’s recent Chief Nurse Executive Council meeting, I was captivated by the story of Katie Blanchard, a former army nurse who was doused in gasoline, set on fire and cut with scissors by an employee she supervised.

Blanchard was verbally intimidated and harassed for over a year from this individual she supervised.
The warning signs of violence were there:

  • refusal to accept criticism
  • incidents of rage
  • history of co-workers refusing to work with him

Despite reporting incidents numerous times to leadership and indicating she felt unsafe, leadership did nothing to protect Blanchard from this individual. Ultimately, she was left with severe burns and nearly died from the incident.

If a proper workplace violence prevention program had been in place to protect health care workers, people like Blanchard and the thousands of others who experience workplace violence every year would never need to feel unsafe at work.

Violence Epidemic

Health care workers experience more acts of violence than any other industry. According to the Occupational Safety and Health Administration (OSHA), approximately 75% of nearly 25,000 workplace assaults reported annually occurred in health care and social service settings. Furthermore, death by workplace violence accounted for 16% of all fatalities at work in 2017, according to the National Safety Council.

Incidents of workplace violence in health care occur at rates four times higher than in the private sector. Despite this, widespread systems are not in place to effectively protect health care workers who become victims of workplace violence or punish perpetrators of workplace violence. Only nine states have laws requiring certain health care facilities to have a workplace violence prevention program, and these laws are not all-encompassing.

Current processes in health care organizations do not support prompt action taken on behalf of someone who perpetrates verbal threats of violence in health care, which not only make a health care worker feel unsafe, but if left unchecked, can escalate to physical acts of violence.

Lack of Reporting

Like Blanchard mentioned, many health care workers do not report workplace violence. Studies suggest only about 30% of nurses and 26% of emergency department physicians report incidents of workplace violence, allowing the issue to continue as outlined in The Joint Commission’s Sentinel Event Alert 59: Physical and Verbal Violence Against Health Care Workers. However, victims of workplace violence cannot take the blame for not reporting these issues to leadership. The American Nurses Association cites several common barriers to reporting workplace violence. Among these barriers, nurses report:

  • Workplace cultures that consider violence a “part of the job”
  • Lack of understanding of what is considered workplace violence as well as reporting procedures
  • Fear of retaliation or being blamed for the incident. 
Changes need to be made throughout health care to prevent workplace violence, including culture and policy changes. Organizations with effective workplace violence prevention programs incorporate: 
  • Shared language around discussing workplace violence, including formal training for all employees. 
  • Reporting procedure that includes a culture of accountability. Health care workers need to feel comfortable reporting threats and know those receiving and acting on reports should take reports seriously. Incident reporting systems that share results with the person reporting the issue go a long way toward communicating the organization’s commitment.
  • Top down leadership responsibility for zero-tolerance policies. 
  • New employee training on about acceptable language and behavior for the workplace and workplace violence reporting procedures. 


The Joint Commission considers acts of workplace violence as sentinel events, even when no patients are involved.  Health care still has a long way to go, but for the better of all staff, health care leaders cannot afford to allow workplace violence to spread throughout their organizations. For more information, visit The Joint Commission’s Workplace Violence Prevention Portal. Mark G. Pelletier, RN, MS is the chief operating officer, Accreditation and Certification Operations, and chief nursing executive for The Joint Commission. Prior to his current position, Pelletier served as the executive director for the Hospital Accreditation Program and was also responsible for business development in the Hospital, Critical Access Hospital and Laboratory accreditation programs. Mr. Pelletier has more than 30 years of experience in hospital operations, performance and quality improvement, process redesign, and program development. Previously, he was the senior vice president and chief operating officer of Condell Medical Center, Libertyville, Illinois. He has also served in executive positions for several hospitals in the Chicago area including Resurrection Health Care, Northwestern Memorial Hospital, Children’s Memorial Medical Center and Mercy Hospital Medical Center. Mr. Pelletier earned a Bachelor of Science in nursing and a Master of Science in administration from DePaul University, Chicago.