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Nurses describe their experience as victims of, or as witnesses of, violence in the workplace
Deborah R. Collins, a survivor of workplace violence in the 1988 shooting at Electromagnetic System Labs, discusses the consequences of workplace violence.

Workplace violence,[1] violence in the workplace,[2] or occupational violence refers to violence, usually in the form of physical abuse or threat, that creates a risk to the health and safety of an employee or multiple employees.[3] The National Institute for Occupational Safety and Health defines worker on worker, personal relationship, customer/client, and criminal intent all as categories of violence in the workplace.[4] These four categories are further broken down into three levels: Level one displays early warning signs of violence, Level two is slightly more violent, and level three is significantly violent.[5] Many workplaces have initiated programs and protocols to protect their workers as the Occupational Health Act of 1970 states that employers must provide an environment in which employees are free of harm or harmful conditions.


According to data from the US Bureau of Labor Statistics, in 2011 violence and other injuries caused by persons or animals contributed to 17% of all US occupational fatalities, with homicides contributing to 10% of the total.[6] From 1992 to 2010, there were 13,827 reported workplace homicide victims, averaging over 700 victims per year, in the United States.[7] Examination of the 2011 data shows that while a majority of workplace fatalities occurred to males, workplace violence disproportionately affects females. Homicides contributed to 21% of all occupational fatalities for women, compared to 9% for men.[6] Of these homicides, relatives or domestic partners contributed to 39% of female homicide cases; male homicide cases were most likely to be perpetrated by robbers, contributing to 36% of male homicide cases.[6]

The Occupational Safety and Health Administration ("OSHA") a department of the United States Department of Labor defines workplace violence as "any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide."[8]

2,000,000 US workers per year report workplace violence[8]

Most cases of workplace violence are non-fatal. From 1993 to 1999, an average of about 1.7 million people reported occupational violence.[7] About 75% of these cases are considered simple assault, while 19% of cases are considered aggravated assault.[7]

Workplace violence is at epidemic proportions. "There used to be a time when an employee shooting someone in the workplace would be a shock. Now it's becoming common," states Kathleen M. Bonczyk, Esq. a researcher and expert on workplace violence prevention.[9]

Following a June 2017 shooting spree when a former employee returned to his Orlando, Florida workplace to murder five co-workers before committing suicide Kathleen M. Bonczyk, Esq. stated "You hear it again and again. People always say 'We didn't think it (workplace violence) would happen here,' but it can happen anywhere and anytime. It shouldn't be a question of if; employers should operate under the question of when."[10]

There are four categories used to classify workplace violence: worker on worker, personal relationship, customer/client, and criminal intent.[11] Worker on worker violence occurs when two people of the same occupation are violent towards one another, either physically, verbally or emotionally. A common example of this is when one worker has some sort of authority over another, such as a supervisor position over a supervisee. Personal relationship violence at the workplace occurs when an employee's personal relationship is brought into the workplace and causes disruption for the employee, his/her co-workers, and possibly the customers of that business.[12] Victims of personal relationship violence are typically women. Customer/client violence occurs when there is violence between a customer or client of a workplace and an employee. The violence could be performed by the customer onto the employee or vice versa. Finally, criminal intent violence in the workplace occurs when there is no relationship between the person committing the violent act and the workplace or its employees.

The four categories listed above are further classified into three levels, depending on the situation. Level one includes signs such as the person bullying others, being rude or abusive, and uncooperative. At this level, one should carefully take note of the behaviors and report them to a supervisor. The supervisor may want to meet with the potential perpetrator to discuss his/her behaviors. Level two includes the potentially violent subject stating that he feels victimized and verbalizing threats, verbalizing wanting to hurt others, frequently arguing with others, seeking revenge, and refusing to follow workplace policies. In response to this behavior one should document observed behaviors, directly contact a supervisor, ensure that one's own safety is put first, and, if needed, contact first responders. The third level of workplace violence are currently violent situations such as threatening to harm one's self or others by either physical means or using weapons, demonstration of extreme anger, or destruction of property. In case of level three violence, one should ensure the safety of themselves followed by the safety of others, stay calm, cooperate with law enforcement, and leave the situation if possible.[4]

In the case of personal relationship violence, it is often hard to recognize levels one and two of violence because they typically occur outside of the workplace. Most personal relationship violence situations occur at level three, in which case the level three approach for handling the situation should be in place.[4]

Perline and Goldschmidt [13] contend that the present definitions of workplace violence are simply descriptive and not based on motivation of the perpetrator.[13] Understanding the motivation underlying these crimes is important in developing preventative strategies. Perline & Goldschmidt define two types of workplace violence: 1) Object-focused workplace violence is violence that occurs to obtain some object, such as money, drugs, jewelry, etc., and 2) non-object-focused violence, which is emotionally based, and mostly associated with anger. Anger generally requires frustration and perceived injustice. Mitigating anger or perceived injustice will mitigate or prevent a violent episode, and people can be angry without perpetrating violence. Whether or not anger results in violence depends, in part, on the potential perpetrator's focus, and associated risk factors (see below). Eight different types of focus that can result in workplace violence have been identified. (Table 1) [13]

Table 1. Anger-Focus Model of Non-Object-Focused Workplace Violence
Anger Healthy Non-violent anger


Conference; Legal redress; Work harder;

Job change; etc.

Anger Work-related issues Retribution Workplace targeted
Anger Non-work related


Retribution; Inflict

pain/suffering on others

Workplace convenient; Opportunistic;

Injury &/or Signif. damage

Anger Depressive issues;



Reduce emotional

pain/suffering in self

Signif. damage; Unknown victims;

Random violence

Anger Anxiety issues;

Perceived threat

Control Terrorism; Domination
Anger Personality issues:


Self-enhancement Bias crimes; Humiliation;

Domination; Sex crimes

Anger Personality issues:


Acceptance Attachment; Stalking; Following; Random violence;



Drug states

Irrational Irrational Irrational
Accident Unintentional Unintentional Carelessness; Uninformed; Neuropsych. status
Other Not otherwise

specified (NOS)

The anger-focus model: 1) characterizes workplace violence according to the focus of the perpetrator; 2) allows for the gathering of separate statistics for object-focused crime and non-object-focused crime; and 3) shows that domestic violence, school shootings, terrorist activities, and non-object violence that occurs in the workplace are similarly motivated.[13] Consequently, understanding the factors driving one type of non-object-focused violence should help us to develop strategies for mitigating the other types of non-object-focused violence. Thus, we can see that these crimes can be mitigated by reducing the frustration level of the potential perpetrator, reducing the level of the potential perpetrator's perceived injustice, or changing the focus the potential perpetrator to a more healthy focus.[13]

A very large percentage of non-object-focused perpetrators are either arrested, killed by police, or killed themselves after committing their violent act. If we consider suicide-by-cop, it has been suggested that somewhere between 25-50 percent of non-object-focused workplace homicides result in suicide.[14][15] Suicide is virtually unheard of following an object-focused crime, it just doesn't make sense. Non-object-focused workplace violence is purposeful, occurs in stages, and is seldom if ever a spontaneous event.[13]

The five stages of non-object-focused violence that have been identified are:

Thirty risk factors have been identified. Fourteen of these risk factors are social & situational; twelve are psychological, and four are behavioral.[13]

Signs of potential threats

There is little information on what certainly causes workplace violence, however it is agreed that a combination of personal factors, workplace factors, and individual interactions contribute to violence in the workplace. The Federal Bureau of Investigation (FBI) recognizes the following behaviors as warning signs for potential perpetrators of workplace violence:[16]

The National Safety Council also recognizes excessive use of drugs or alcohol as well as absenteeism, or change in job performance that is unexplained. Paying attention to these warning signs and reporting them may help prevent events of workplace violence.[17]


The United States Department of Labor's purpose is to " promote a safe environment for our employees and the visiting public, and to work with our employees to maintain a work environment that is free from violence, harassment, intimidation, and other disruptive behavior". Hemati-Esmaeili (2018) supports,“As worksites for healthcare providers and related occupations vary in purpose, size, and complexity, WVPP should be designed to specifically target the unique nature and varied needs of each organization” (par. 5)[18] Therefore, the DOL has provided information in order to work towards their purpose of keeping the workplace safe for individuals. The information is provided in order to help the people of the workplace to be able to identify potentially harmful behaviors as well as recognize their responsibilities to prevent violent behavior. The DOL administered the Workplace violence program in order to help employees respond to and prevent workplace violence through better understanding. They have also identified seven key factors to help prevent workplace violence:[4]

  1. Work Environment- As the work environment directly and heavily influences the employees and clients, it is crucial that the environment remains positive and open. This encourages better communication and positive attitudes in the workplace.
  2. Security- Additional safety measures such as security may help deter possible violent events from occurring. This could include security guards, cameras, or other technological machines such as metal detectors.
  3. Education- educating employees on current policies and procures as well as on possible warning signs of workplace violence.
  4. Performance / conduct indicators- ways to be aware of changes in employee behavior, such as absenteeism or change in performance.
  5. Employee support services- services available for employees to express concerns
  6. Early intervention- not letting symptoms go unnoticed or unresolved
  7. Take appropriate actions- notify authorities when needed

It is also recommended that employers treat terminated employees with respect in order to avoid the feeling that they are being victimized. Additional precautions may be alerting security that there will be job termination that day.[5]


According to the Department of Homeland Security in the situation of workplace violence, while staying calm, one should run, hide, or fight. It is suggested to only fight if there are no other safe options.[19] In the event of having to handle a violent or potentially violent person, there are five steps to follow. First demonstrate concern for the employee and show that you care. Second, do not judge the person, but observe their behaviors. Third is to demonstrate empathy. Fourth is to engage in conversation with them, let them express what will help them. Finally, work with them to create a solution that will not put anyone at risk.[17]

Deadly examples

See also: List of workplace killings by number of victims


Dr. Arnold H. Buss, of the University of Texas at Austin (1961),[33] identified eight types of workplace aggression:

In a study performed by Baron and Neuman,[34] researchers found pay cuts and pay freezes, use of part-time employees, change in management, increased diversity, computer monitoring of employee performance, reengineering, and budget cuts were all significantly linked to increased workplace aggression. The study also showed a substantial amount of evidence linking unpleasant physical conditions (high temperature, poor lighting) and high negative affect, which facilitates workplace aggression.[35] Individuals who resort to mass shootings at work often threaten to kill before any actual violence takes place.[36]

Risk assessments

The examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (September 2009) (Learn how and when to remove this template message)

In the United Kingdom there is a legal obligation to complete risk assessments for both physical and psychosocial workplace hazards. Other countries have similar occupational health and safety legislation in place relating to identifying and either eliminating or controlling for hazards in the workplace. Workplace violence is considered to be a significant hazard in its own right. Regulation 3 of the Management of Health and Safety at Work Regulations 1999 states that, "every employer shall make a suitable and sufficient assessment of:

Occupational groups at higher risk

The Canadian Centre for Occupational Health and Safety lists the following higher risk occupations.[37]

Health care workers are at high risk for experiencing violence in the workplace. Examples of violence include threats, physical assaults, and muggings. According to estimates of the Bureau of Labor Statistics (BLS), the rate of nonfatal occupational injuries and illnesses involving days away from work was 15.1 per 10,000 full-time workers in 2012.[38] This rate is much higher than the rate for total private industries, which is 4.0 per 10,000 full-time workers.

There are many contributing factors that can lead to health-care workers, specifically nurses, experiencing workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. A few environmental factors may include the specific setting, long waiting times, frequent interruptions, uncertainty regarding the patients' treatment, and heavy workloads.[39] Organizational factors may include inefficient teamwork, organizational injustice, lack of aggression management programs, and distrust between colleagues.[39] This may also include inadequate security procedures. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills and/or awareness of how to interpret aggressive situations.[39]  Misunderstandings may also occur due to the communication barrier between nurses and patients.[40]  A few examples of this are a lack of privacy for the patient, background noise, and the patient's condition being affected by medication, pain, and/or anxiety.

See also


  1. ^ Employment and Social Development Canada (12 December 2018). "Violence prevention in the work place". Government of Canada. 943-1-IPG-081.
  2. ^ "Violence in the Workplace (VIW)". California Department of Food and Agriculture.
  3. ^ "Occupational Violence". WorkSafe. Retrieved February 25, 2024.
  4. ^ a b c d "HRC - DOL Workplace Violence Program - Office of the Assistant Secretary for Administration and Management (OASAM) - United States Department of Labor". Retrieved 2019-03-08.
  5. ^ a b Flynn, Gillian (July 2000). "Employers can't look away from workplace violence". Legal Insight. ProQuest 219819396.
  6. ^ a b c "Census of Fatal Occupational Injuries, 2011" (PDF). US Department of Labor, Bureau of Labor Statistics. Retrieved January 8, 2013.
  7. ^ a b c "CDC - Occupational Violence - NIOSH Workplace Safety and Health Topic". Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Retrieved January 8, 2013.
  8. ^ a b Source:
  9. ^ Louis, Errol (27 June 2017). "At work and in grave danger: We must combat the national scourge of on-the-job violence". Retrieved September 25, 2019.
  10. ^ Brinkmann, Christal Hayes, Paul (5 June 2017). "Orlando shooting is latest in growing trend of workplace violence, expert says". Retrieved September 25, 2019.((cite web)): CS1 maint: multiple names: authors list (link)
  11. ^ "NIOSH-WPVHC-Workplace Violence Types". Retrieved 2019-03-09.
  12. ^ "Workplace Violence". Retrieved 2019-03-09.
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  14. ^ White, T. W. (1996). Violence on the job: Identifying risks and developing solutions. American Psychological Association. pp. 87–99.
  15. ^ Fessenden, F. (April 9, 2000). "They threaten, seeth and unhinge, then kill in quantity". New York Times.
  16. ^ Barling, Julian (1996). "The Prediction, Experience, and Consequences of Workplace Violence". Archived (PDF) from the original on December 20, 2020. Retrieved March 8, 2019.
  17. ^ a b "Workplace Violence". Retrieved 2019-03-04.
  18. ^ Hemati-Esmaeili, Maliheh; Heshmati-Nabavi, Fatemeh; Pouresmail, Zohre; Mazlom, SeyedReza; Reihani, Hamidreza (2018). "Educational and managerial policy making to reduce workplace violence against nurses: An action research study". Iranian Journal of Nursing and Midwifery Research. 23 (6): 478–485. doi:10.4103/ijnmr.IJNMR_77_17. ISSN 1735-9066. PMC 6178581. PMID 30386399.
  19. ^ Sheely, Gary (May 2018). "Know When to Act to Prevent Workplace Violence". Professional Safety. 63: 42, 43. ProQuest 2035637018.
  20. ^ Lamar Jr, Jacob V. (June 24, 2001). ""Crazy Pat's" Revenge". Time.
  21. ^ Allen G. Breed and Ramit Plushnick-Masti (11 August 2013). "Terror act or workplace violence? Hasan trial raises sensitive issue". Arizona Daily Star. Associated Press. Retrieved September 25, 2019.
  22. ^ Fernandez, Manny; Blinder, Alan (April 8, 2014). "At Fort Hood, Wrestling With Label of Terrorism". The New York Times. Retrieved October 11, 2023.
  23. ^ "Army Approves Awards for Victims of 2009 Fort Hood Attack". U.S. DEPARTMENT OF DEFENSE. Retrieved September 25, 2019.
  24. ^ Magnuson, Ed (June 24, 2001). "David Burke's Deadly Revenge". Time.
  25. ^ a b "Three keys to reducing workplace violence risks". Retrieved 2016-05-09.
  26. ^ a b c "The Growing Epidemic of Deadly Workplace Violence and Three Ways to Prevent It -- Occupational Health & Safety". Retrieved 2016-05-09.
  27. ^ Almasy, Steve; Lah, Kyung; Moya, Alberto (2 December 2015). "14 killed in San Bernardino shooting; suspect ID'd". CNN. Retrieved 2016-05-09.
  28. ^ "Retired state trooper kills two in Pennsylvania toll plaza shooting". Reuters. 2016-03-21. Retrieved 2016-05-09.
  29. ^ "Two airmen shot dead in 'workplace violence' at Texas air base". Reuters. April 8, 2016. Retrieved September 25, 2019 – via
  30. ^ White, Tyler; Express-News, mySA com / San Antonio; Parker, Kolten; Christenson, Sig (April 8, 2016). "Air Force tech sergeant kills commander before disciplinary hearing at Lackland Air Force Base". Mysa. Retrieved September 25, 2019.
  31. ^ "Fired employee kills co-worker and himself at Katy area business". ABC13 Houston. May 4, 2016. Retrieved September 25, 2019.
  32. ^ FELDMAN, KATE (5 May 2016). "Texas man killed by former coworker once caught a home run alongside his wife at St. Louis Cardinals game". Retrieved September 25, 2019.
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  39. ^ a b c Zhang, Liuyi; Wang, Anni; Xie, Xia; Zhou, Yanhong; Li, Jing; Yang, Lijun; Zhang, Jingping (July 2017). "Workplace violence against nurses: A cross-sectional study". International Journal of Nursing Studies. 72: 8–14. doi:10.1016/j.ijnurstu.2017.04.002. ISSN 0020-7489. PMID 28412581.
  40. ^ Alkorashy, Hanan A. Ezzat; Al Moalad, Fawziah Bakheet (June 2016). "Workplace violence against nursing staff in a Saudi university hospital". International Nursing Review. 63 (2): 226–232. doi:10.1111/inr.12242. PMID 26830364.