Dealing with Stress and Violence in the Workplace

The Occupational Safety and Health Administration (OSHA), a division of the United States Department of Labor, describes violence in the workplace as “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site” (Occupational Safety and Health, n.d.). Violence in the workplace can range from a threat to verbal abuse or can be serious, resulting in a physical assault or even death; it affects employees, patients, customer, and clients. It is reported that approximately 2 million American workers have experienced some type of violence in the workplace and many more cases are not reported. (OSHA, n.d.).

Dealing with Stress and Violence in the Workplace

This issue has been become a highly discussed topic and has become a growing concern for health care industry leaders because all employees should be guaranteed a safe and healthy workplace environment. However, Antai-Otong (2001) reveals that 35% of all female deaths occur in the workplace and is the number one cause of mortality for females who are employed “and the second leading cause of death” for employed males according to a report released in 1995 by United States Bureau of Labor Statistics.

This paper will explore the physical, cognitive, emotional and behavioral reactions to stress, explore three professions at risk for workplace violence, discuss the purpose of using the Critical Incident Stress Debriefing (CIS) Management Tool and the expected outcomes from the utilization of this tool and lastly, take a look at whether or not this tool is useful in decreasing stress and coping with workplace violence.

Perceptions to violence in the workplace and stressful situations will differ from person to person and is dependent on the individuals’ reactions to the event. Martin (1993) states that some physical reactions related to stress include: nausea, tremors or shakes, upset stomach, profuse sweating, chills, diarrhea, rapid heart rate, muscle aches, sleep disturbances, and dry mouth. Martin (1993) goes on to state that cognitive reactions reported by employees as a result of stress take into account symptoms of confusion, decreased attention span, while other individuals experience calculation difficulties, memory problems, intrusive thoughts, distressful dreams and disruption in logical thinking.

The emotional reactions listed by Martin (1993) incorporate feelings of grief, anger, anticipatory anxiety, denial, fear, survivor guilt, depression, hopelessness, of being overwhelmed, worried to the most severe reaction of wishing one’s own death because the burden of the stress is too heavy to bear. Lastly, behavioral reactions reported by employees as a result of stress related incidents include withdrawal from people around them including loves ones and suspiciousness of others, increased or decreased appetite, increased smoking and/or alcohol intake, excessive or inappropriate sense of humor, behavior in which an individual is abnormally silent or presents with some form of unusual behavior.

The reactions described by Martin that can be potentially experienced by health care professionals, as a result of stress related incidents in the workplace have serious implications that will undoubtedly not only affect their ability to effectively deliver high, quality health care, but will also affect their ability to make clear, logical decisions because their judgment is temporarily impaired due to the crisis or event.

Hegney, Tuckett, Parker, & Eley (n.d.) state that nurses, especially those that work in psychiatric settings, are among the most common profession associated with violence in the workplace across the globe. This may be because the main source of workplace violence stems from encounters with patients and family members, as well as visitors and other nurses (Hegney et al., n.d.). The website (n.d.) reports that higher-risk workers may also include customer service agents that deal with the public, many times during the most stressful time of their lives. These health care professionals are many times ill-equipped to deal with the intense emotions displayed by the patient or family members when they present to the facility or organization.

However, an article by Lundstrom, Graneheim, Eisemann, Richter, & Astrom (2005) argues that the professions with one of the highest exposure to workplace violence are those caregivers who are working with individuals with some form of a learning disability. In fact, studies have shown that health care professionals emotional reactions in response to the difficult behavior of a patient they are treating, has been identified as a source of stress for these individuals (Lundstrom et al., 2005). Regardless of the health care profession one is employed research has proven that a perceived experience of strain at work and strain that is work related can be linked to burnout. The signs and symptoms related to burnout include but are not limited to low morale, absenteeism and increased job turnover (Lundstrom et al., 2005).

In order to prevent stress and violence in the workplace it is important for health care leaders and organizations to identify risk factors that will help prevent these events from taking place and take precautions that will help professionals deal with the symptoms that can lead to burnout and increased employee turnover.

The critical incident stress debriefing (CISD) is described “as a preventative health-promotion model that can be used to minimize adverse outcomes following a violent or traumatic event” is part of “the larger critical incident stress management (CISM) model” whose primary goal is to proactively address psychological trauma or symptoms related to post-traumatic stress disorder (PTSD) (Antai-Otong, 2001). This comprehensive program uses a number of crisis intervention procedures in order to help facilitate healing and a feeling of psychological closure as it relates to the incident or traumatic event. Antai-Otong (2001) believes that when someone experiences a violent or traumatic incident the emotions that stem from these situations are often times beyond an individual’s ability to cope and mobilize resources that can help.

The overall expectation of the CISD program is to be able to provide emotional support, encourage the person to speak for themselves, give them an opportunity to tell their side of the story, discuss their thoughts, feelings and reaction to the incident, provide them with an outlet and the resources for individuals to deal with any physical or emotional symptoms. Health care leaders and professionals also use the CISD program as an opportunity to educate employees about managing stress more effectively and lastly to provide reassurance and closure to the incident.

The critical incident stress debriefing management tool has mixed reviews; there are several researchers that have reported positive outcomes while other researchers have stated there was minimal improvement. (Antai-Otong, 2001) In my opinion the immediate emotional support offered by the CISD program and the willingness of the program to address physical and mental conditions related to the incident is beneficial. In addition, the educational component that helps employees deal with normal stress is a great preventative measure that should help facilitate a healthier work environment for everyone.

Violence in the workplace is an inevitable and a seemingly unavoidable situation and according to Antai-Otong (2001) is currently at epidemic levels. It threatens the safety and well-being of employees, patients and customers alike. Health care leaders and organizations must continue to develop and support the CISD program because it offers healthcare professionals a way in which to deal with and openly address the physical, emotional, cognitive and behavioral issues that are associated with workplace violence.

Martin (1993) believes all hospitals should implement this type of program because it gives health care professionals “a way to nurture ourselves.” Finally, the CISD program is beneficial management tool that will continue to increase awareness and teach employees how to handle stressful situations in the workplace, which may in fact prevent the violent event from ever occurring. It is my belief that preventing workplace violence and reducing stress is the key to a safe and healthy work environment.


  • Antai-Otong, D. (2001). Critical incident stress debriefing: a health promotion model for workplace violence. Perspectives in Psychiatric Care, 37(4), 125. Retrieved from:
  • Hegney, D., Tuckett, A., Parker, D., Eley, R. M. (n.d.). Workplace violence: Differences in Perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis to complete the assignment Dealing with Stress and Violence in the Workplace. Retrieved from:
  • Lundtrom, M., Graneheim, U. H., Eisemann, M., Richter, J., & Astrom, S. (2005). Influence of work climate for experiences of strain. Learning Disability Practice, 8(10), 32-38. Retrieved from:
  • Martin, K. R. (1993). Pulling Together to Cope with Stress. Nursing, 23(5), 38-41. Retrieved from:
  • Occupational Safety and Health (n.d.). Workplace Violence. Retrieved from: