Minnesota Hospital Association


January 01, 2020

Workplace violence prevention at Minnesota’s hospitals and health systems

Hospitals should be places of safety and healing for caregivers, patients and visitors. That’s why Minnesota’s hospitals and health systems have been enhancing violence prevention and response plans and training health care staff since 2013.

  • Hospitals and health systems take this issue very seriously and are striving to build a culture where violence or aggressive behavior is not considered “part of the job.”
  • Hospitals and health systems encourage and support employees in reporting violence or assaults.
  • Minnesota’s hospitals and health systems have increased the amount of training, including de-escalation techniques, for employees.
  • Hospitals and health systems have developed interdisciplinary workplace violence prevention committees within their organizations with representation from front-line staff, leaders, security staff and others.

Hospitals and health systems are actively partnering to develop and enhance workplace violence prevention practices, plans, tools and resources.

In 2013, a public-private coalition of health care stakeholders including the Minnesota Hospital Association (MHA), the Minnesota Department of Health (MDH), the Minnesota Medical Association, the Minnesota Nurses Association (MNA), Care Providers of Minnesota, LeadingAge Minnesota and a number of health care facilities throughout the state was formed to provide resources to hospitals, long-term care facilities, clinics and other facilities to help identify risks for violence and put effective prevention and response strategies in place.

In 2014, this stakeholder group published a gap analysis on workplace violence prevention that was disseminated to all Minnesota hospitals and health systems. The coalition provided a workplace violence prevention road map for health care organizations to identify risks for violence and put effective strategies in place. The road map included recommendations for hospitals to form interdisciplinary workplace violence prevention committees and conduct training for all staff.

In 2015, the Minnesota Legislature passed meaningful workplace violence prevention legislation supported by MHA and MNA. The law requires that hospitals must design and implement preparedness and incident response plans for violence that takes place on their premises and provide training for employees upon new hire and annually thereafter.

In 2016, MHA, MDH and the Minnesota Sheriffs’ Association formed a health care and law enforcement collaborative to create a common framework of how to care for patients involved with law enforcement, with the goal of enhancing communication and collaboration between health care and law enforcement. The coalition is an effort of a broad-based stakeholder group, including hospital security, police departments, county sheriff offices and hospital EMS, to build relationships and improve collaboration between health care and law enforcement organizations.

MNA’s 2019 workplace violence reporting and staffing bill creates more reporting mandates but does not prevent workplace violence.

  • MNA has introduced a bill that purposely confuses the issues of workplace violence and staffing (HF 1398). Provisions include:
    • The commissioner of health would create a database that allows health care workers to submit information regarding an act of violence or abuse, and a hospital must allow health care workers access to the violence prevention database during the hospital worker's shift. 
    • The commissioner would be directly involved with hospital decisions about security, preparedness and staffing.
    • Mandates that “a hospital shall create and implement a procedure for a health care worker to officially request of hospital supervisors or administration that additional staffing is provided.” Rather than being a violence prevention bill, this bill is a way to submit complaints about staffing to MDH.
    • Mandates that “a hospital shall make its action plans […] publicly available by posting its most recent action plan and the results of its annual review […] on the hospital’s website.” This is akin to having a bank post its security plan – such as cameras, number of security officers, where they are posted – on its website. No one believes this is sound policy.
    • Instead of building on the collaborative work of stakeholders since 2013, MNA's bill is punitive, giving the commissioner of health the power to impose a penalty.

Hospitals have procedures in place to assess aggressive patients and to respond to security and safety threats in real time.

  • Filing a report does not prevent violence or respond to a violent situation. 
  • Hospitals have processes or protocols in place for nurses and other staff to to raise safety concerns.
    • There is already a mechanism for hospital staff to report safety concerns to the state: under Minnesota's condition of licensure, nurses are obligated to report instances in which “the delegation of a nursing function […] could reasonably be expected to result in unsafe or ineffective patient care” to MDH’s Office of Health Facility Complaints.

Hospitals and health systems are continually working to improve hospital safety for patients, staff and visitors.

Hospitals take this work very seriously and have committed both funding and leadership attention to address this issue. Examples of new efforts to prevent and reduce violence in the hospital setting include: 

  • Participation by 100% of MHA member hospitals and health systems in the gap analysis on workplace violence prevention. 
  • Encouraging all incidents of violence to be reported, including verbal harassment of staff by patients.
  • Quarterly or monthly reviews of incidences of violence with safety committees that include care team members. 
  • Root cause analyses of incidences of violence that result in employee injuries.
  • Significant new funding for security staffing and facility redesign to improve staff safety. 
  • Using patient risk assessment tools to proactively identify potentially violent patients and sharing these assessments with staff.

Promising early results show that these tools are working to reduce incidents.