The world of hospice care is deeply personal and profoundly compassionate. As a hospice clinician, your primary focus is providing compassionate care to your patients and their families during their most vulnerable moments. But the intimate nature of home-based care can sometimes expose you to unexpected risks of workplace violence.

The Growing Concern of Workplace Violence

In recent years, workplace violence has emerged as a critical issue in healthcare, particularly for homecare professionals. A survey conducted by Transcend Strategy Group (https://transcend-strategy.com/insights-workforce-safety/) revealed that over 50% of healthcare workers have witnessed or experienced a violent event.

Workplace violence extends far beyond physical assault. It encompasses a broad spectrum of threatening behaviors including verbal abuse, psychological harassment, and intimidation. These experiences can have devastating consequences — not just physically — but emotionally and professionally.

There are some steps that you can take to help reduce your risk of experiencing workplace violence including pre-visit preparation, situational awareness, and setting boundaries. Let’s explore these further.

Pre-Visit Preparation is Key

Effective safety starts with thorough preparation. Before entering a home, confirm who will be present during your visit. Don’t hesitate to ask about potential safety concerns, ask to have pets restrained, and ensure no weapons are visible. Clear communication with patients and their families can prevent many potential incidents.

Proactive Safety Strategies: Situational Awareness

On visiting a patient’s home, situational awareness is a key preventative action. Situational awareness begins before you even step into a patient’s home. As you approach, take a moment to observe your surroundings. Notice changes in the in the environment – are things different from the previous times you visited the patient’s home? Are there more or fewer cars? Did something change in appearance? This isn’t about paranoia – it’s about being prepared and alert. 

When you enter the patient’s home and say hello to the patient and family members, ask the patient or caregiver to introduce you to anyone else in the room if there are new people there. As you look around the room, note potential exit routes in case you need to quickly exit.

Setting Boundaries and Maintaining Professionalism

Your personal safety is paramount. While providing compassionate care is your mission, it should never come at the expense of your well-being. If a situation feels uncomfortable or threatening, you have the absolute right to remove yourself. Engage with management immediately if you feel that your safety is compromised.

Reporting and Documentation: A Critical Process

If you experience workplace violence, it is important that you report the event and that the event is documented. Unfortunately, clinicians are often hesitant to report the experience, citing reasons such as:

• Workplace violence is “part of the job” (acceptance)
• It wasn’t really a big deal… (acceptance)
• Nothing can be done about it anyway (acceptance)
• What will management think if I say something (fear of job loss)
• I want to avoid conflict with the patient/patient’s family (fear of job loss)
• I don’t want to be labeled as incompetent (fear of job loss)
• I was in the wrong place at the wrong time” (blame)

Although you may hesitate to report an incident, it is important that every incident of workplace violence is documented.

Documenting incidents is not just a procedural requirement – it’s a crucial step in preventing future occurrences and in protecting fellow clinical staff. Detailed, confidential reports help agencies identify patterns, implement preventive measures, and create safer working environments. It is important that fellow staff members are aware of potentially problematic situations that may arise when they visit the patient.

Contact Information / Buddy System

Make sure that you have provided your management with emergency contact information for so that someone can be contacted in the case of an emergency. Avoid after dark visits. If after dark visits cannot be avoided, use the “buddy system.” Make sure that someone knows where you are going and is anticipating your return or is anticipating contact from you and will either go out to look for you or call 911 if they do not hear from you. 

Wrapping it Up

In summary, workplace violence is a real concern for home healthcare workers but here are steps that you can take to protect yourself:

• Conduct a home assessment to identify potential risks in the home. Be sure to act on those potential risks.
• Establish boundaries: Set your personal safety boundaries. Your personal safety is most important.
• Emergency contact: Ensure your management knows whom you would like to have contacted in case of emergency
• Avoid after dark visits: Try not to visit patient homes after dark.
• Buddy system: Make sure someone knows where you are going, knows when to expect to hear from you, and will go look for you or will call 911 if they do not hear from you by the predesignated time.
• Early termination of visit: If you feel that a situation has escalated or that you are feeling threatened, terminate the visit and engage with management to notify them of the situation.

Want to Learn More?

• NIOSH Guide to Violence in the Workplace
• NIOSH: Preventing Violence in the Workplace for Home Healthcare Workers
• NAHC Workplace Violence Prevention