Ask the expert: Recognizing early signs of workplace violence

Q: In healthcare environments, incidents of verbal aggression, intimidation, or harassment often occur before physical violence. How can hospitals better recognize these early warning signals and incorporate them into their workplace violence prevention programs?

Deb Muller, founder and CEO of HR Acuity: Verbal aggression and intimidation are not precursors to workplace violence in healthcare. They are the early stage of it. The research is clear on escalation patterns, and hospitals that treat threatening language or intimidation as a soft HR issue rather than a safety event are misreading their own risk profile.

There’s a specific reason documentation fails here. Frontline staff, especially nurses, are conditioned to absorb verbal aggression as part of the job. "That's just how patients are" is a cultural norm that actively suppresses reporting. You cannot build a prevention program on data you are training your workforce not to generate.

The fix has two parts. First, reframe what counts as a reportable event. Threatening language, intimidation, and patterns of verbal aggression need to be documented with the same formality as a physical incident, regardless of whether the source is a colleague, patient, or family member. Patient-directed aggression toward staff is among the most underreported categories in healthcare and one of the most common ways things turn physical.

Second, those reports need to live in a system that lets you see across them. The same unit generating repeated verbal aggression complaints, a pattern tied to a specific shift, and a manager whose team stops reporting altogether are all signals. They only surface if your case management infrastructure connects them. A sentinel event that traces back to six prior undocumented escalations is not bad luck. It is a documentation failure, and the paper trail you do have works against you.

 Editor’s note: This Q&A was excerpted from our Healthcare Safety Leader newsletter.