As the demand for home healthcare grows, so does the risk of workplace violence for home health nurses. 

U.S. Bureau of Labor Statistics reports that home healthcare is one of America’s fastest-growing industries, with a projected compound annual growth rate of 5% for 2014–2024, which equals approximately 760,400 new jobs. With patients’ continued preference to remain at home and advances in telemedicine, home health nurses will continue to be a major area of growth within the healthcare industry.

Workplace violence  has long been a challenge in health care, with healthcare workers accounting for 73% of all nonfatal workplace injuries and illnesses due to violence in the U.S. prior to 2019. Unfortunately, studies continue to show that incident rates increased during the COVID-19 pandemic. And although certain clinical settings, such as emergency departments or psychiatric/behavioral health units, have high rates of incidents, home healthcare workers are often placed in situations that make them particularly likely to encounter workplace violence.

Home health risk factors

Home health nurses are often the only caregivers present while delivering home healthcare. This can result in an unprotected environment, depending on the patient’s behavior. Other people in the home, such as a friend or family member may also be responsible for causing workplace violence.

Verbal abuse from the patient, family members, or others in the care setting is considered a form of workplace violence, along with physical abuse, stalking, or threats of abuse.

Cara Lunsford, RN, Founder and CEO of HOLLIBLU and Vice President of Community at Relias, has long understood the physical and mental implications of providing home health nursing care.

Impacts of workplace violence

The nursing profession is challenging on its own, but workplace violence incidents can bring added stress and difficulties to the role.

One study involving home care nurses found that exposure to violence was associated with greater stress, depression, sleep problems, and burnout. Of the participants, 50% reported incidents of verbal aggression, 26% noted workplace aggression, 23% experienced violence, and 25% encountered sexual harassment — just from the previous year.

The study noted that confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes. This factor is key to taking steps to reducing violence incidents and their effects on the nursing workforce. Increasing nurses’ support of reporting workplace violence can help to better identify where, when, and what types of violence are present to better address the issue.

Addressing workplace violence in home healthcare

An article from The Joint Commission Journal on Quality and Patient Safety discussed a study evaluating recent data from peer support programs from adverse clinical events to workplace violence. Leveraging databases from the forYOU Team at University of Missouri Health Care (MU Health Care) and the RISE Team (Resilience in Stressful Events) at Johns Hopkins Hospital (JHH), researchers found that nurses are the most frequent victims seeking peer support.

And, unsurprisingly, the study noted a recent significant increase of violent episodes against healthcare staff and a parallel rise in number of calls for peer support associated with violence. While ensuring adequate support and resources for nurses who experience workplace violence is necessary, further action to prevent violence is an effort that nurses need now more than ever.

It’s important that proper assessment is done prior to sending anyone into the home. If a nurse requests that they be paired with another nurse for the visit due to potential concerns, the home health agency should accommodate that request,” Lunsford said.

At a time when the U.S. cannot afford to lose more nurses during the ongoing nursing workforce shortage, the threat of violence to nurses cannot be ignored. Throughout COVID-19, nurses have been placed in extremely difficult positions, increasing moral injury, burnout, and consideration for leaving the profession altogether. As politics and local mandates have influenced patients’ frustrations with healthcare delivery, nurses have been subjected to even greater rates of workplace violence.

When providing care in an unfamiliar environment with many unknown factors, home care nurses face a unique risk for workplace violence. Those called to care for others deserve to have the respect, support, and resources to first and foremost keep themselves safe.

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