Last Day On the Job
Workplace Violence and Occupational Homicide
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Many industrial hygienists don’t understand how to address the hazard of workplace violence. It is easier to focus on traditional exposures because we have quantified means of assessing them. You can’t sample aggression or set an acceptable decibel threshold for an employee yelling on the work floor. However, aggression and violence are by no means novel to our workplaces, and as professionals, it is our job to prevent exposures to these hazards. Like many traditional exposures, the unfortunate reality is that exposure to workplace violence is surprisingly fatal.
WHO VIOLENCE HURTS Violence is on the rise in workplaces in general, but just as violence disproportionately affects certain members of the wider community, various groups of workers experience workplace violence in different ways. Globally, healthcare is one of the industries most affected by workplace violence. In the United States, injuries inflicted on nursing assistants and registered nurses increased by 250 percent and 290 percent, respectively, in the pre-pandemic years of 2018–2019. Women are more likely to die from occupational homicide, the technical term for a fatality caused by workplace violence. In 2020, according to the U.S. Bureau of Labor Statistics, approximately 15 percent of the workers (or 705 individual workers) who died nationwide from work-related traumatic injuries lost their lives due to occupational homicide; however, occupational homicide accounted for approximately 25 percent of the deaths of working women. In the most recent dataset, motor vehicle accidents are the leading cause of fatal occupational injuries for American women, but in some years, occupational homicide ranks the highest. This trend is present at the level of some individual states as well. The many reasons why the leading cause of occupational mortality for women vacillates between occupational homicide and motor vehicle accidents have to do with the primary industries women work in, their status as employees or independent contractors, trends in community violence, and how occupational deaths are reported. Historical reports from the Census of Fatal Occupational Injuries and state workplace fatality data show that, in most years, there truly is contention between the leading causes of death. However, when community violence data show that homicide is trending upwards, this trend will be reflected in the data for occupational homicide. Workplace violence also affects racial groups differently. In 2021, injuries due to violence were the second highest cause of occupational fatalities to Black or African American workers and comprised just under a quarter of all Black or African American workplace fatalities (23.7 percent), compared to 14.7 percent for all workers. THINKING LIKE AN INDUSTRIAL HYGIENIST When addressing workplace violence, industrial hygienists must remember that violence is a hazard. As with any other hazard, the effects of violence in the workplace can be limited by applying the hierarchy of controls familiar to all industrial hygienists. We can complicate or simplify our controls for the hazard as the situation and our professional backgrounds may allow, but it may be beneficial to err on the side of simplification. Controls for the hazard of workplace violence may be as simple as writing programs or as complicated as introducing completely new technology into the workplace. Workplace violence is classified into four types based on the relationship between the perpetrator and the workplace. Type 1 violence: criminal intent. The perpetrator has no legitimate relationship with the workers or business. The violence usually takes place during another type of crime, such as robbery or trespassing. Type 2 violence: customer or client. The perpetrator has a direct business relationship with the workers or business and becomes aggressive or violent with a worker while conducting business. The perpetrator may also be someone in the employer’s custody, such as a student, patient, or person otherwise detained. Type 3 violence: peer to peer. The perpetrator is employed at the workplace and shows aggression or violence toward another employee. Violence can occur between coworkers, workers and their supervisors or managers, former and current employees, or employees and their representatives, such as union officials. Bullying and toxic workplaces may fall loosely into this category, and these behaviors are red flags for future incidents of Type 3 violence. Type 4 violence: known person or intimate partner violence. The perpetrator may be an employee’s current or former partner, family member, neighbor, or friend who comes to the victim’s workplace and causes violence. Stalking and harassing are included in the category of Type 4 violence. PERSONAL PROTECTIVE EQUIPMENT In certain high-risk scenarios, such as when healthcare workers put patients in restraints or law enforcement officers don tactical gear to enter combative situations, personal protective equipment (PPE) might prevent injuries. However, PPE may be the most complicated form of protection against workplace violence and is the least protective layer of the hierarchy of controls. Employers should use PPE strategies with caution due to behavioral safety concerns associated with high-stress events.
The employer must put deliberate thought into policies and documents intended to address workplace violence, just as for any other standard operating procedure.
First, wearing PPE may give workers a false sense of security, much like how workers who wear back belts may incorrectly believe they can lift unsafe loads. Workers must know the limitations of their PPE and use safe work practices and de-escalation techniques to deal with aggressive and violent persons. For example, a healthcare worker wearing a Kevlar sleeve to avoid getting bitten or scratched by a patient will still get bitten and scratched if they do not attempt to calm the patient down. The sleeve will only lessen the injuries, with the worker potentially leaving the situation with contusions instead of lacerations, and the patient may be able to bypass the PPE to injure the worker’s unprotected skin.
Moreover, during a violent incident, the parties involved are in an aroused state. Certain concepts in social psychology posit that when someone in a state of aggravated arousal sees their opposing party act in ways they perceive as threatening behavior, such as by arming themself—even with protective gear—the aggressor may escalate their behavior to a heightened state of hostility or violence in response. When doing a PPE hazard analysis for workplace violence, industrial hygienists should evaluate the potential aggressor and the worker’s expected response.
ADMINISTRATIVE CONTROLS Every workplace needs written programs and training to inform employees, contractors, and volunteers on how to prevent or respond to workplace violence. Unfortunately, there are no federal codes or minimum standards to assist employers in creating that program. Fourteen states have requirements for workplace violence programs or policies in some capacity; however, these requirements tend to focus on the healthcare and social services industries. Federal OSHA and some state plans have cited versions of the general duty clause to employers who have not made appropriate efforts to protect employees from workplace violence, so implementing workplace violence programs and training is still necessary for regulatory compliance.
In many cases, incidents of workplace violence fall under OSHA recordkeeping requirements. A stalker stabbing an employee in the parking lot, a disgruntled employee enacting a mass shooting at the workplace, or a customer beating an employee to the point that they are hospitalized and ultimately succumb to their injuries all fall under federal recordkeeping requirements for workplaces with more than 10 employees that do not belong to exempt industries. Between 2017 and 2022, federal OSHA and state plans investigated 26 stabbings, 148 shootings, and four beatings that resulted in workers dying from their injuries. In many of those inspections, violations were issued to employers.
The content of written programs and training needs to be appropriate to the type of violence expected to happen in the employer’s industry; one way to start customizing these documents is by examining your injury and fatality data for trends. For example, the employees of a rural yarn shop may not need to go through the active shooter training that is popular on corporate campuses. However, an office complex or school could benefit from incorporating a video on responding to an active shooter into their safety training program’s rotation. Any business that requires employees to handle cash should have policies and training for robberies in place, and any business that deals with the public must ensure that employees know how to de-escalate a situation involving a person in distress. Furthermore, workplaces should implement and communicate clear policies that the employer allows no weapons at work, permits zero tolerance for threats of violence, and will support employees who bring safety concerns to management.
Employers should consider what employees should do when they become aware that violence may take place and put these expectations in writing. Does a cashier have the authority to kick out a disgruntled customer? Are there alarm buttons on site that employees can press to notify security or law enforcement that they are in danger? If an argument breaks out in the conference room, how should employees deal with that in the moment, and what will the consequences be for this behavior? What should a manager do if an employee comes to them with a protective order that must be enforced while they are at work? Women are particularly vulnerable to being murdered in the workplace by ex-partners who gain access to them in parking lots or public buildings, so enforcing restraining orders is a critical component of any comprehensive workplace violence program or plan. It’s not as simple as creating signs that say, “We are a weapons-free workplace,” “We don’t allow bullying here,” or “This is a respectful place of work.” The employer must put deliberate thought into policies and documents intended to address workplace violence, just as for any other standard operating procedure.
ENGINEERING CONTROLS Since industrial hygienists currently do not have any means of eliminating violence from the workplace, engineering controls are the best option for reducing workers’ exposures. Some of the tools available for this purpose encompass both prevention and harm reduction. In the 1960s, criminologist C. Ray Jeffery developed the theory of crime prevention through environmental design (CPTED), which combined key concepts from the fields of criminology, architecture, and urban planning to emphasize the importance of the environment in crime prevention. Basically, CPTED concepts ensure that buildings do not look like places where crimes can be easily and successfully committed. If a workplace is public facing, for example, and the employer is concerned about a disgruntled person accessing the business from the back entrance, how could the workplace be designed to prevent the assailant from physically attacking the workers? Is the workplace wide open and airy? Is the front desk positioned so that the perpetrator must get past the receptionist, who could use de-escalation skills or call for assistance? Are there any doors that workers could secure between the point of entry and the main work area? During the COVID-19 pandemic, it became common for retailers to put up partitions between guests and cashiers. Although these partitions are incomplete barriers, which create more of a mental than physical barrier between guests and workers, there are safety benefits for employees working behind security glass, especially in establishments with histories of robbery.
Employees in well-populated, centralized workplaces are not the only ones who can be protected by implementation of engineering controls. Lone workers comprise another segment of the workforce that deserves special attention. This group includes independent contractors, drivers, social workers, hospitality employees, field inspectors, late-night workers, and people in a plethora of other employment situations whose work requires them to be alone with clients or customers for significant periods of time. Without an employer’s obvious supervision, lone workers may be exposed to violence from the individuals they encounter on the job. For example, Chicago passed the “Hands Off, Pants On” ordinance to combat the rampant violence and sexual harassment that housekeepers and other hospitality workers face from guests. This action and similar measures across the country require hotels to provide distress buttons to housekeepers and other staff. These buttons may be accessed in a variety of ways, such as on a cleaning cart, in a discrete location in the hotel room, on a wearable pendant, or via an app on the employee’s phone. Regarding wearable pendants, it is best practice for workers to wear clip-on buttons attached to their belt loops, keychains, undershirts, or bra straps. Assailants may use necklaces and long straps to choke workers, especially if the perpetrator sees them pressing a button.
Distress buttons come in a range of designs for both on- and off-campus needs. If a person is working on campus, their employer can assign them a pendant with a central base that enables the pendant to be geolocated when the wearer presses a button. If a person is working in the field, their employer may issue them a pendant that, when the distress button is pressed, pings to their cell phone and initiates a call to 911 or their emergency contact. While it is best practice for employees working off site to keep their cell phones on their persons in case of emergencies, they may struggle to unlock their phone and dial 911 when they are being assaulted. These pendants can be literal lifesavers.
Video monitoring that uses algorithms to warn employers of suspicious activity can also help prevent workplace violence. In 2021, the National Safety Council published Workplace Violence: Using Technology to Reduce Risk as part of the organization’s Work to Zero program, which aims to eliminate occupational fatalities through technological innovation. NSC’s white paper focused on new technologies on the market and their roles in preventing, mitigating, and reacting to workplace violence. The solutions highlighted in the white paper include using software to screen job applicants before hiring, managing visitors’ access to the workplace, and implementing smart video monitoring to flag warning signs of violence, such as running, verbal aggression, loitering, and falls.
Finally, although not strictly a form of engineering control, virtual or augmented reality technologies can serve as aids for training, since these technologies may allow employees to more easily work through training scenarios they may experience on the job compared to roleplaying these same scenarios in a classroom full of their peers. The workforce is full of people with diverse learning styles, and virtual and augmented reality technologies are tools that could benefit many learners.
Be Proactive When addressing violence, many workplaces find themselves acting reactively instead of proactively. A reactive approach is poor risk management. In many cases, it can be downright negligent. But just like any other hazard, it’s much better to control and contain violence than it is to respond to it, and industrial hygienists can become far more proactive in managing the risk of violent incidents in the workplace. By approaching workplace violence as a hazard within the realm of industrial hygiene, we can do our part to help control this not-so-novel problem. Applying the hierarchy of controls, using new technologies, and maintaining consistent communication between employers and workers will help people go home safe and healthy in all industries.
EVA M. GLOSSON, MS, is an industrial hygienist in the Puget Sound area of Washington State.
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Annals of Epidemiology: “Workplace Homicides Among U.S. Women: The Role of Intimate Partner Violence” (April 2012).
Bureau of Justice Statistics: Indicators of Workplace Violence, 2019 (2022).
Bureau of Labor Statistics: “Illness, Injuries, and Fatalities.”
Bureau of Labor Statistics: National Census of Fatal Occupational Injuries in 2021 (PDF, 2022).
Hands Off Pants On.
National Safety Council: “Use Technology to Prevent Workplace Violence.”
NIOSH: “Back Belts – Do They Prevent Injury?” (1996).
OSHA: “Fatality Inspection Data.”
University of Iowa Injury Prevention Research Center: Workplace Violence: A Report to the Nation (PDF, 2001).