Improvement Insights

A critical look at latest academic and publications research including The Joint Commission Journal on Quality and Patient Safety as well as Health Research Services initiatives with partner organizations.

Peer Support for Health Care Workers Emotionally Affected by Workplace Violence


By Isolde M. Busch, PhD, Postdoctoral Researcher, Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

Workplace violence against health care professionals is a pervasive and growing problem. In the United States, approximately 75% of all workplace violence happens in health care. The persons engaging in physical and psychological violence against health care workers can be visitors, patients, patients’ caregivers and even coworkers. 

Aside from physical injury, affected health care workers may experience a wide range of these short- and long-lasting psychological responses: 

  •  emotional distress 
  • residual psychological stress, anxiety, depression, burnout and post-traumatic stress disorder
  • physical manifestations of stress (e.g., tachycardia, increased blood pressure, insomnia, stress-related chronic conditions)

These symptoms can lead to avoidance behavior, absenteeism, reduced job satisfaction, increased turnover and decreased quality of care. 

Despite this substantial emotional impact, research is scarce on psychological support interventions for workplace violence-exposed health care workers. 

In recent years, two long-standing peer support programs – the forYOU Team at University of Missouri Health Care (MU Health Care) and the RISE Team (Resilience in Stressful Events) at Johns Hopkins Hospital (JHH) – have seen an increase in requests for support from health care workers emotionally affected by workplace violence. 

In an article from the March 2021 issue of The Joint Commission Journal on Quality and Patient Safety, “The Role of Institution-Based Peer Support for Health Care Workers Emotionally Affected by Workplace Violence,” my co-authors and I describe the expansion of the forYOU and RISE peer support programs from adverse clinical events to workplace violence. We retrospectively summarize data related to peer support encounters for cases of workplace violence and provide two case studies. 

What We Found 
Performing a retrospective extraction and summary of the forYOU and RISE databases and MU Health Care and JHH hospital-wide data on workplace violence, we identified: 

  •  a significant increase of violent episodes against health care staff in both academic health systems 
  •  a parallel rise in the number of calls for peer support linked to workplace violence exposure
  • the emergency department (adult and pediatrics), psychiatry/behavioral health units and medical/surgical departments as most common locations for workplace violence
  • nurses as the most frequent victims seeking peer support 

Our detailed case studies, which describe violent episodes against nurses when caring for patients, illustrate the traumatic impact workplace violence can have on health care workers and the beneficial effects of peer support structures within a health care organization. 

Next Steps
The entire health care community should make concerted efforts to tackle the problem of workplace violence. This is a global problem.

System-wide initiatives to increase awareness of workplace violence’s psychological impact on health care staff and to destigmatize being a victim of violent behaviors include:

  • taking a holistic approach to workplace violence
  • investing in psychological support structures for affected health care workers
  • guaranteeing prompt and easy access to psychological first aid and emotional support 

The timely processing of emotions with peer responders may help mitigate the emotional distress and foster a more resilient workforce, thus contributing to a high level of patient safety and quality of care. 

Isolde M. Busch, PhD, is a Postdoctoral Researcher in the Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, at the University of Verona in Verona, Italy. Her research interests include the mental health of health care providers involved in stressful clinical situations or affected by workplace violence, as well as patient empowerment.