Purpose and scope
The purpose of this best practice guideline (BPG) is to enhance the safety of health service organizations and academic institutions through the adoption of evidence-based practices. Safe and healthy work environments are an enabler for nurses and other health workers to optimize clinical outcomes for those receiving care. Such environments also optimize teaching and learning in academic settings. Specifically, the guideline will address how to recognize, prevent, and manage violence, harassment and bullying in the workplace.
This guideline is applicable to:
- all health service organizations, and
- academic institutions
and it can be utilized by
- all health workers, and
- and students
who may experience, encounter or have knowledge of workplace violence, harassment and bullying from
- formal leaders (such as management and faculty),,
- colleagues, and
- visitors, persons and their families.
Registered Nurses’ Association of Ontario (RNAO). Preventing violence, harassment and bullying against health workers. 2nd ed. Toronto (ON): RNAO; 2019.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Preventing Violence, Harassment and Bullying Against Health Workers.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: The expert panel recommends that health service organizations establish an implementation plan for integrating a violence risk assessment tool for persons. This plan should include the following:
- selection of a risk assessment tool that is applicable to the clinical population and setting; and
- education and training on the chosen tool for all health workers who provide direct care.
Recommendation 1.2: The expert panel recommends that health workers conduct a violence risk assessment on all persons using a validated tool.
Recommendation 1.3: The expert panel suggests that health service organizations and academic institutions support the use of validated risk assessment tools to measure and develop a quality improvement plan to address horizontal and/or vertical violence.
Recommendation 2.1: The expert panel recommends that health service organizations provide education and training to health workers on addressing violent behaviours from persons (see Recommendations 3.1 to 3.3 for specific education content).
Recommendation 2.2: The expert panel recommends that health service organizations implement protective and security measures, such as the following:
- documentation and communication of a person’s previous incident(s) of violence;
- equipment to protect against violent behaviours, and a standardized approach for deciding what, when, and how to use these;
- environmental security measures, including locked doors, closed-circuit cameras and alarm systems; and
- formal reporting systems that are simple to use.
Recommendation 2.3: The expert panel recommends that formal leaders within health service organizations support health workers in preventing and addressing workplace violence by doing the following:
- understanding and implementing policies against workplace violence; and
- reviewing and acting on reported workplace violence incidents.
Recommendation 2.4: The expert panel recommends that health service organizations implement a process for formal incident reviews immediately following a violent event to discuss the details of what occurred, the approach that was used, and the strategies for violence prevention in the future.
Recommendation 2.5: The expert panel suggests that health service organizations and academic institutions provide education and training to health workers and students on addressing workplace harassment and bullying (see Recommendations 3.4 and 3.5 for specific education content).
Recommendation 2.6: The expert panel recommends that health service organizations and academic institutions implement appropriate policies and codes of conduct to address harassment and bullying in the workplace and learning environment.
Recommendation 2.7: The expert panel recommends that formal leaders in health service organizations and academic institutions be actively involved in preventing and addressing harassment and bullying to support health workers and students by doing the following:
- understanding and reinforcing policies that address harassment and bullying; and
- providing mentorship and role modelling of professional behaviour.
Recommendation 3.1: The expert panel recommends that health service organizations provide education to health workers on the risk factors and triggers for violent behaviours from persons.
Recommendation 3.2: The expert panel recommends that health service organizations provide training to health workers on de-escalation techniques, including communication and re-direction strategies, to prevent and/or reduce violent incidents within their organizations.
Recommendation 3.3: The expert panel recommends that health workers are provided training in breakaway techniques and when to safely use breakaway techniques in violent incidents.
Recommendation 3.4: The expert panel suggests that health service organizations provide education to health workers on how to identify harassment and bullying, understand the impact of harassment and bullying, and use effective communication strategies.
Recommendation 3.5: The expert panel recommends that, as part of an interactive learning approach, students learn to use guided communication responses to address harassment and bullying from multiple sources within an academic institution or clinical learning environment.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
Current edition published: July 2019.
This BPG replaces the RNAO BPGs:
- Preventing and Managing Violence in the Workplace (2009), and
- Workplace Health, Safety and Well-being of the Nurse (2008)