Worker Safety – Workplace Violence

Circular Diagram Health care providers — especially front-line staff within hospital emergency departments — increasingly are faced with violent encounters by patients and visitors. The U.S. Bureau of Labor Statistics found that 52 percent of all workplace violence incidents recorded are in health care. MHA has developed resources to assist member hospitals with mitigating workplace violence through advocacy, reducing regulatory burden, strengthening partnerships and implementing evidence-based strategies through policy development and staff skill building.

Workplace Violence Definition

MHA facilitated the review and adoption of a definition of workplace violence with the intent of providing clarity and scope, and establishing parameters for future data collection.


An act or threat of violence involving an explicit or implicit challenge to personal safety, well-being or health, and/or other threatening disruptive behavior that occurs within health care facilities. Workplace violence includes the following.

  1. The threat or use of physical force, sexual assault, harassment or intimidation against a caregiver or employee that results in, or has a high likelihood of resulting in, injury, psychological trauma or stress, regardless of whether the employee sustains an injury.
  2. An incident involving the threat or use of a firearm or other dangerous weapon, including the use of common objects as weapons, regardless of whether the employee sustains an injury.

View the full definition, including assumptions and types of workplace violence.
  • 2019 Priorities
  • Education
  • Regulatory
  • Resources

As a component of the S.A.F.E.R Initiative, MHA has prioritized the following actions to assist Missouri hospitals with reducing the incidence of workplace violence.


  • Advocating for urgent awareness and reasonable regulatory interpretation from the Centers for Medicare & Medicaid Services — formal communication to Health and Human Services leadership to include CMS, the Assistant Secretary of Preparedness and Response and the Assistant Secretary for Mental Health and Substance Abuse was sent by MHA on behalf of member hospitals.
  • MHA sent a letter to each Missouri county prosecutor informing them that hospital personnel were added to the definition of “special victim” in Section 565.002, RSMo., thereby enhancing the penalties for assault of hospital staff. The new provision broadens the scope of protected health care workers from the emergency department to the entire hospital facility.
  • Formal communication to request leadership and attention also was sent to Governor Greitens and Dr. Randall Williams, Director of the Missouri Department of Health and Senior Services.

Program Improvement Through Evidence-based Practice

To develop long-term actions, MHA staff conducted a listening tour of members in fall 2017 to better understand first hand experiences of workplace violence in member hospitals. Look for additional information in the following areas as developed:

  • identification and dissemination of “best-practice” policies related to:
    • warrantless blood-draws
    • use of security/law enforcement worn body cameras
    • appropriate and permissible use of TASERs (Thomas A. Swift’s Electric Rifle)
    • reporting violent incidents to law enforcement
    ­ ­ ­
  • development of education and training related to:
    • de-escalation for different patient and visitor profiles
    • management of substance-related encounters with patients and their visitor
    • prevention of sexual violence against health care employees
    • incorporating security personnel into the care team
  • development of criteria to evaluate different de-escalation training programs
  • data to monitor trends and evaluate initiatives

In 2019, MHA launched a statewide data collection initiative to capture the prevalence of workplace violence in Missouri hospitals. A recording and user guide are available.


  • Workplace violence issues and identified solutions will require partnerships to effectively reduce occurrences within health care facilities.
  • MHA staff, in partnership with the Missouri Department of Public Safety, hosted regional meetings in spring 2018 to provide joint education and policy development around HIPAA, EMTALA and Chain of Custody.


MHA is participating in a two-year OSHA Alliance program for technical assistance to promote safe and secure workplaces. Benefits of this partnership include the following.

  • increases worker access to effective workplace safety and health tools and to information about worker rights
  • leverages resources to maximize worker safety and health protection
  • establishes progressive dialogue with the agency and others committed to worker rights and worker safety and health


Regional Meetings – Community Partnerships and the Patient: Understanding the Legal Environment

MHA, in partnership with the Missouri Department of Public Safety, offered complimentary regional workshops to convene hospital, EMS and law enforcement personnel. The workshops, a component of our broader S.A.F.E.R. initiative, reviewed the legal requirements of each discipline on hospital grounds.

The half-day workshop provided education and resources to promote the safe hand-off of patients from law enforcement and EMS to hospital personnel. HIPAA, EMTALA and Chain of Custody requirements were reviewed through facilitated discussion.

Promoting Safe Environments of Care - December 14, 2017


S.A.F.E.R. Listening Tour Update - November 16, 2017

PowerPoint | Recording

Federal and State Laws Related to Blood Draws and Requests from Law Enforcement - November 14, 2017

PowerPoint | Recording | Issue Brief

CMS Will Show No Mercy: Ensuring EMTALA Compliance for Psychiatric Patients in the ED - September 14, 2017

PowerPoint | Recording

CDC’s Workplace Violence Prevention for Nurses Course

CMS Standards


The Joint Commission


Hospital Signage


Life Safety/NFPA 99


Patient Safety Organizations



Heightened Security Awareness for Healthcare and Public Health Community

The Departments of Homeland Security and Health and Human Services have issued a joint resource for health care providers to support situational awareness and preparedness in the wake of the terrorist attacks in Brussels. They emphasize that no specific credible threats in the US are known, but that current events provide the opportunity to reinforce with staff the importance of and strategies for vigilance and security in health care settings; links to numerous resources are provided. View publication.

ASHRM Healthcare Facility Workplace Violence Risk Assessment Tool

The American Society for Healthcare Risk Management has developed a toolkit with resources, policies, checklists and training aids that helps health care organizations work with their staffs to identify, mitigate, and respond to workplace violence. Learn more.

Personal Safety and Preparedness

Organizational Safety

Community Safety

Standardized Codes


Trauma-Informed Care

Armed Violent Intruder

Click here for information on AVIR.

Civil Unrest Planning

On-Demand Education

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