Four Types of Workplace Violence in Healthcare


The National Institute for Occupational Safety and Health (NIOSH), (1996) defines workplace violence is defined as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty”.


Workplace violence takes many shapes and has multiple sources. It isn’t only reduced to the horrific acts we often see on the news but also includes more common occurrences such as verbal abuse and bullying.


To better understand the causes of workplace violence and seek possible solutions, occupational researchers at The Injury Prevention Research Center (2001) classified it into four basic types: criminal intent, client-on-worker, worker-on-worker, and personal relationship.


Type 1: Criminal Intent

In this type of violence, the perpetrator doesn’t have a legitimate relationship to the business or its employees and commits a crime in combination with the assault. Some of these acts include but are not limited to robberies, shoplifting and trespassing.




  • A social worker is mugged while riding the train on her way to a home visit.
  • A pharmacist is held at gun point while two men steal oxycodone from the pharmacy.


Criminal intent violence is the most common in worker homicide. About 85% of all workplace homicides fall into this category, according to the Injury Prevention Research Center.


Type 2: Client-on-worker violence

This type of violence involves a customer/client relationship. In healthcare settings includes patients and their families and other visitors. Here, the perpetrator has a relationship with the business (hospital, clinic, etc.) and becomes violent while receiving care.

Client-on-worker violence is the most common on healthcare settings and occurs most frequently in emergency and psychiatric treatment settings, waiting rooms and geriatric settings (Centers for Disease Control and prevention [CDC], 2013)



  • A distraught family member assaults a triage nurse in the emergency room because his spouse has been waiting a long time to be seen and is in pain.
  • An agitated dementia patient hits the doctor examining him.
  • A patient threatens to harm the psychiatrist who will not refill a prescription for benzodiazepines.


Type 3: Lateral or Worker-on-worker violence

In worker-on-worker violence the perpetrator is a co-worker frequently results from power imbalance (Hamblin et al., 2015). For example, from a doctor to a nurse or from a charge nurse to another nurse under his or her supervision.  Type 3 violence is often manifested as bullying and ranges from verbal abuse and intimidation to homicide.


“The circulating nurse placed an incorrect instrument onto the surgeon’s sterile table during surgery. The surgeon was so angry, that he picked up his scalpel and threw it at the male circulating nurse. This scalpel, this razor, missed the nurse’s face by 1/2 of an inch”. (Moore-Black, 2016).


Although this type of violence is not physical for the most part, it can still cause serious health consequences for both employees and employers. For instance, verbal violence between nurses has been associated with high levels of stress and psychological problems. On the other hand, worker-on-worker violence has been found to be associated with poor retention and low work satisfaction of nursing staff (Hamblin et al., 2015).



Type 4: Personal Relationship

When this type of violence occurs, the perpetrator does not necessarily have a relationship with the business but has a personal relationship to the employee outside of work that spills over to the work environment. For example, an abusive boyfriend comes to the hospital and assaults his girlfriend, a physical therapist, after she was unable to take his calls.


Knowledge is power

Knowing the different types of violence can help employers design strategies to prevent workplace violence since each type of violence requires a different approach for prevention. Moreover, both employers and workers need to be aware that that certain workplaces and groups may be more vulnerable to specific types of violence. For instance, first responders, nurses and ER doctors are particularly vulnerable to client-on-worker violence. On the other hand, nurses have been found to be more involved as either the perpetrator or victim in worker-on-worker violence (Hamblin et al., 2016). Here’s one example of the latter:


“(…) (Patty) started to receive the worst assignments. The nurse-patient ratio was one nurse to four patients. Patty was given six patients at a time. All of the time.

When she called out for help, no one was there. When she needed help to pull up a 400-pound patient, no one was there. When she needed an RN to witness her mixing a vasopressin drip stat, no one was there. Patty could normally handle any situation, but now she felt overwhelmed.

She overheard a staff nurse say to the charge nurse: “Well she makes all of that money. She can do it herself. Give her the worst.” (Moore-Black, 2016)



Workplace violence has reached epidemic levels in health care settings and has serious consequences for both employees and organizations. Knowing the different ways workplace violence may manifest itself can help us identify it and prevent it before it happens.





Centers for Disease Control and Prevention. (2013). Occupational violence. Workplace violence prevention for nurses. Retrieved from


Hamblin, L., Essenmacher, L., Ager, J., Upfal, M., Luborsky, M. Russell, J. & Arnetz, J. (2016). Worker-to-worker violence in hospitals. Perpetrator characteristics and common dyads. Workplace Health & Safety. 64(2). doi: 10.1177/2165079915608856



Injury Prevention Research Center. (2001). A report to the nation. University of Iowa. Retrieved from


Moore-Black, D. (2016). We are nurses: Stop the bullying in health care. Medpage Today’s KevinMD. Retrieved from


National Institute for Occupational Safety and Health (NIOSH). (1996). Current Intelligence Bulletin 57. Violence in the workplace: risk factors and prevention strategies. Retrieved  from: