Worker Safety – Workplace Violence

Circular Diagram Health care providers — especially frontline 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. The current health care environment in Missouri, including a shortage in psychiatric beds resulting in boarding in the emergency department, the expanding opioid crisis which prompts unstable and combative patients seeking treatment, and the increased prevalence of weapons and narcotics among patients, creates an unstable environment for frontline staff. 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.

  • 2018 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


  • 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, will be hosting regional meetings in spring 2018 to provide joint education and policy development around HIPAA, EMTALA and Chain of Custody


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

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

This half-day workshop will provide 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 will be reviewed through facilitated discussion. Lunch will be provided. Registration closes one week prior to each workshop.

This program has been approved for 4.0 hours of Continuing Law Enforcement Education and 2.5 EMS CEUs..

Target Audience:

Hospital Security Directors, Emergency Department Directors, Risk Managers, EMS Leadership and Law Enforcement Patrol Division Leaders


8 a.m. Thursday, April 12, 2018
Blue Springs, Mo.

8 a.m. Thursday, April 26, 2018
Springfield, Mo.

11:30 a.m. Tuesday, May 1, 2018
St. Peters, Mo.

8 a.m. Thursday, May 10, 2018
Cape Girardeau, Mo.

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



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