Threat Assessment Strategies to Mitigate Violence in Healthcare


Several states have enacted specific legislation to address workplace violence in healthcare in the absence of federal regulations.  The focus of state legislation is in one of two areas – either to mandate that employers develop a workplace violence program and/or to include healthcare workers in statutes previously designated for first responders that carry an increased penalty for assault. 

California, Connecticut, Illinois, Maryland, Minnesota, New Jersey, Oregon and Washington each require employer run workplace violence programs.  New York requires a program for public employers only.  There are several states that have established heightened penalties for assaults on nurses, sometimes including other healthcare workers.  A few of these states (notated with an asterisk) apply only to specific settings such as the emergency department or a behavioral health unit.  States include Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida*, Georgia*, Hawaii*, Idaho, Illinois, Iowa, Kansas*, Kentucky*, Louisiana, Mississippi*, Missouri, Montana, Nebraska, Nevada, New Mexico, New York8, North Carolina, Ohio, Oklahoma*, Oregon, Rhode Island, South Dakota*, Tennessee, Texas, Utah, Vermont, Virginia and West Virginia.[29],[30]

California has the most comprehensive legislation pertaining to healthcare.  Effective in April 2017, S.B. 1299 required hospitals to develop, adopt and train employees on comprehensive workplace violence prevention plans.  Some of the many requirements include maintaining a violent incident log, making records available to Cal/OSHA and employees upon request and reporting violent incidents to Cal/OSHA.  Organizations must also develop and implement procedures to identify environmental and patient-specific risk-factors; correct workplace violence hazards, including engineering and work practice controls; and, conduct post-incident response and investigation, including providing trauma counseling to employees.[31]

International Considerations

Workplace violence is not just a problem in the United States.  It affects workplaces all over the world with issues like bullying and harassment in addition to assault. Healthcare workers are at heightened risk in other countries as well;[32] however, there appears to be little legislation globally addressing the healthcare sector specifically.  Table 2 (on the following page) provides some information about the protections from violence for workers in Canada and Great Britain as an example of international laws.

Perhaps the greatest progress addressing workplace violence globally was a new convention by the International Labor Organization to combat workplace violence and harassment.  The convention, adopted in June 2019, acknowledges that violence and harassment at work constitute human rights violations and threaten equal opportunities.[33]  Governments that ratify the treaty must develop national laws prohibiting workplace violence and implement preventive measures, such as educational campaigns and require companies to have workplace policies addressing violence.  Governments must also monitor the issue and provide complaint mechanisms, witness protection measures and victim services.[34] 

Law & Regulation Reference(s) Notes
Canada Labour Code, Part II R.S.C. 1985, c. L-2 



Part II, “Occupational Health and Safety”

     “Duties of Employers”

    Section 124, “General duty of employer”

    Section 125, “Specific duties of employer”; Subsection 125(z.16)

Canada Occupational Health and Safety Regulations, SOR/86-304

    Part XX, “Violence Prevention in the Workplace”


Proposed: Workplace Harassment and Violence Prevention Regulations

Most Canadian jurisdictions have a “general duty provision” in their Occupational Health & Safety legislation which requires employers to take all reasonable precautions to protect the health and safety of employees.  This includes protecting employees from a known risk of workplace violence.  In jurisdictions that do not have explicit legislation dealing with violence in the workplace, the general duties of an employer under the Canadian Labour Code would apply.  There are more specific laws in the all territories and provinces except Yukon.   




There is also a proposed new stand-alone Workplace Harassment and Violence Prevention Regulations that would apply to all federal workplaces covered under Part II of the Canada Labour Code.  The new regulations would replace Part XX (the violence prevention section) of the Canada Occupational Health and Safety Regulations, as well as portions of two other regulations that include violence prevention provisions. The proposed regulations would include provisions to prevent harassment and violence through comprehensive policies, training, and improved data collection; respond to occurrences through a resolution process that requires communication and provides options for resolution; and make support service information available to employees.


Great Britain[37]
The Health and Safety at Work Act 1974 (HSWA) 




The Management of Health and Safety at Work Regulations 1999



The Corporate Manslaughter and Corporate Homicide Act 2007


Employers have a legal duty under this Act to ensure, so far as is reasonably practicable, the health, safety and welfare of their workers when at work. 




Under this Act, employers must consider the risks to workers (including the risk of reasonably foreseeable violence); decide how significant these risks are; decide what to do to prevent or control the risks; and develop a clear management plan to achieve this.


Introduced a new offence, so that companies and organizations can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care, i.e. where serious failures in the management of health and safety result in a fatality.


[28] Workplace Violence Prevention for Health Care and Social Service Workers Act, H. R. 1309, 116th Cong. (2019-2020).

[29] All efforts to accurately capture state laws have been made, but due to a constantly changing environment, exclusions and/or errors are possible.

[30] Workplace Violence, (American Nurses Association, 2019) [online].

[31] Workplace violence prevention plans: hospitals, S.B. 1299, (2013-2014) [online].

[32] Malgorzata Milczarek, Workplace Violence and Harassment: A European Picture, (European Agency for Safety and Health at Work: European Risk Observatory Report, 2009).

[33] Convention Concerning the Elimination of Violence and Harassment in the World of Work, International Labour Conference: Convention 190, 108th sess., (2019).

[34] Gustavo Guerra, International Labor Organization: Convention to Combat Workplace Violence and Harassment Adopted, (The Law Library of Congress: Global Legal Monitor, 2019).

[35] Malini Vijaykumar & Jason Hanson, Impending federal regulations on workplace violence and harassment, (Osler, 2019).


[37] Preventing Workplace Harassment and Violence: Joint guidance implementing a European social partner agreement, (Health and Safety Executive, et. al.).