Violence in Healthcare

Posted on by Dan Hartley, EdD


In the healthcare setting, workplace violence may occur in many forms including: an active shooter, a disruptive patient, or as ongoing incivility from a colleague. The most commonly reported form of violence in healthcare is from the disruptive patient or patient’s family member. In 2013, healthcare workers reported an estimated 9,200 workplace violence incidents requiring time away from work to recover, with the majority of these perpetrated by patients or their family members1. This represents 67% of all nonfatal violence-related injuries from an industry that only represents 11.5% of all workers.

In terms of fatal workplace violence, overall we have seen a decreasing trend over the past ten years while the numbers of homicides in healthcare have remained relatively stable.  In each of the past ten years fifteen healthcare workers have been the victims of workplace homicide annually. 2

A 2013 report released by the Federal Bureau of Investigations indicated an increasing trend in workplace active shooter incidents from an average of 6.4 incidents per year for the first 7 years of the study to an average of 16.4 per year in the last 7 years of the study4. Some recent studies have indicated that the healthcare environment is not excluded from the increase in this particular type of violence. One recent study on hospital-based shootings reported an increase from 9 active shooter incidents per year during the 2000 to 2005 time period to almost 17 per year during the 2006 to 2011 time period.5

The US Department of Health and Human Services (HHS) recently released a document entitled Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans.6   This document, which was released in December 2014, is designed to assist healthcare facilities in becoming better prepared to prevent and respond to active shooters in the workplace. The document aligns with the three time frames associated with an active shooter incident: pre-incident, incident, and post-incident response. The guide provides definitions of concepts related to five mission areas of preparedness related to these time frames: Pre-incident (prevention, protection, and mitigation) Incident (response and the beginning phases of recovery) and Post-incident (recovery).

The HHS guide recommends training specific to active shooter response in a healthcare environment. This training should be part of a comprehensive workplace violence prevention program. The active shooter incident is still an anomaly in the healthcare setting. However, training in how to prevent and respond to an active shooter incident is very important and should complement training in prevention and response to other more prevalent types of workplace violence.6

In 2013, the National Institute for Occupational Safety and Health (NIOSH) released an on-line workplace violence prevention training for nurses and other healthcare professionals.7 Over ten-thousand healthcare professionals have received continuing education units for completion of the NIOSH online course to date. The training provides the basis for a comprehensive workplace violence prevention program that will be even stronger when combined with information from the HHS guide.

Dan Hartley, EdD

Dr. Hartley is the NIOSH Workplace Violence Prevention Coordinator in the Division of Safety Research.


  1. Bureau of Labor Statistics, 2014. Table R4. Number of nonfatal occupational injuries and illnesses involving days away from work1 by industry and selected events or exposures leading to injury or illness, private industry, 2013. Available at Accessed on March 11, 2015.
  2. Bureau of Labor Statistics, (2004-2013). Table A-2 Fatal occupational injuries resulting from transportation incidents and homicides by occupation, All U.S. Available at: Accessed on March 11, 2015.
  3. BLS [2014]. Household data annual averages. Employed persons by detailed industry, sex, race, and Hispanic or Latino ethnicity. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics
  4. Federal Bureau of Investigations 2013. A Study of Active Shooter Incidents in the United States between 2000 and 2013. Available at: Accessed pm March 12, 2015.
  5. Kelen, G.D., Catlett, C..L., Kubit, J.G., Hsieh, Y.H. Hospital-Based Shootings in the United States,: 2000-2011. Annals of Emergency Medicine. 2012;60(6):790-798.
  6. Department of Health and Human Services, Department of Justice’s Federal Bureau of Investigations, U.S. Department of Homeland Security, and the Federal Emergency Management Agency. Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans. Available at: Accessed March 9, 2015.
  7. National Institute for Occupational Safety and Health, 2013. Workplace Violence Prevention for Nurses. Available at: Accessed on March 16, 2015.
Posted on by Dan Hartley, EdD

2 comments on “Violence in Healthcare”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Nicely pointed out, certainly factors like Shooter cannot be handled directly by hospitals but they can surely improve patient care and offer better connectivity with other healthcare organizations by adhering to the latest FHIR Implementation.

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Page last reviewed: March 27, 2015
Page last updated: March 27, 2015