Prevention and Management of Violence in the Workplace
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Violence against health workers is already endemic and growing rapidly. To stem and reverse that risk, the Registered Nurses’ Association of Ontario (RNAO) has issued an updated edition of its Workplace Violence, Harassment and Bullying Against Health Workers best practice guideline (BPG).
The BPG provides 15 evidence-based recommendations for health service organizations and academic institutions so they can recognize, prevent and manage violence, harassment and bullying in the workplace, changes that will enable nurses and other health professionals to focus even more care on patients. Recommendations focus on: (1) risk assessment tools and strategies; (2) organizational policies, procedures, and responsibilities; and (3) educational approaches and strategies.
The second edition of this guideline builds upon the most recent and relevant evidence to improve earlier guidelines issued in 2008 and 20
Registered Nurses’ Association of Ontario. (2019). Preventing violence, harassment and bullying against health workers. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/VPW_FINAL_WEB_July_2.pdf This work is funded by the Ontario Ministry of Health and Long-Term Care
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A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2022)Gap Analysis-Preventing Violence, Harassment and Bullying Against Health Workers. Toronto. ON
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The College of Nurses of Ontario provides an e-learning opportunity for Abuse Prevention that includes videos, participant workbook and facilitators guide.
One Is One Too Many is a valuable tool for any organization employing nurses that is concerned about issues involving client abuse. The One is One Too Many program provides powerful re-creations of situations in which abuse occurs, as well as guides and materials to facilitate discussion about what tools nurses need to stop abuse.
Reference: College of Nurses of Ontario. (2005). Abuse Prevention: One is one too many Toronto, ON: College of Nurses of Ontario. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/
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A handbook to raise awareness about the prevalence and effects of domestic violence in the workplace. It also provides suggestions on how to address this issue for the employer, supervisor, union, joint health and safety committee/health and safety representative, co-workers and victims.
All Material Copyright 2010 © Public Services Health & Safety Association (PSHSA).
Public Services Health & Safety Association. (2010 August). Addressing Domestic Violence in the Workplace: A Handbook, Second Edition. Toronto, ON, Canada: Author. Retrieved from http://www.pshsa.ca/products/addressing-domestic-violence-in-the-workplace/.
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This booklet provides practical suggestions for the employer, supervisor and worker to participate in the reduction of bullying in the workplace. © 2019 Public Services Health and Safety Association (PSHSA).
Public Services Health & Safety Association (2019). Bullying in the Workplace: A Handbook, Date Retrieved June 2, 2022, https://www.pshsa.ca/resources/bullying-in-the-workplace
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This is a link to the Canada Labour Code, which is to be used by organizations under federal jurisdiction. The section that pertains to this guideline is section 125.1 (z.16) under Duties of Employer.
Canada Labour Code (R.S.C., 1985, c. L-2). (2014 April 1). Retrieved from Government of Canada. Published by the Minister of Justice at the following address: http://laws-lois.justice.gc.ca.
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This checklist from the RNAO guideline (Appendix D-1) that allows the user to assess which components of their organizational workplace violence program are in place and will help to highlight which areas require further attention. This checklist was used to guide the gap analysis and can be found under the planning tools section. Registered Nurses’ Association of Ontario. (2009).
Reference: Ontario Safety Association for Community and Healthcare (2006), Violence Program Assessment Tool - RNAO Key Elements Checklist for Workplace Violence, Date retrieved June 8 2015, http://ltctoolkit.rnao.ca/sites/default/files/resources/HWE/violenceprevention/AppD1_Preventing_and_Managing_Violence_in_the_Workplace.pdf
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Taken from the RNAO guideline (Appendix D-8), this checklist identifies factors which could trigger an aggressive episode in clients or caregivers. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 116-117.
Reference: Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, Resident/Client Risk Assessment - Checklist Of Risk Factors for Aggressive Behaviour (OSACH 2006), Date retrieved June 4, 2015, http://ltctoolkit.rnao.ca/sites/default/files/resources/HWE/violenceprevention/AppD8_Preventing_and_Managing_Violence_in_the_Workplace.pdf
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Taken from the RNAO guideline (Appendix D-6), this tool has two sections: (a) a work environment assessment, and (b) pre-visit client assessment for community workers.
Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 111-112 Date retrieved June 4, 2015,
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Use this form for pre-visit assessments of violence risks. This tool has two sections: (a) a work environment assessment, and (b) pre-visit client assessment for community workers.
Registered Nurses’ Association of Ontario. (2009). Appendix D-6 of Preventing and Managing Violence in the Workplace. Toronto, ON: Author. p.113.
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This guideline outlines the key factors associated with conflict with clients, colleagues and in the workplace, and offers strategies for preventing and managing conflict that has escalated. It also highlights the role of nurses in formal leadership positions, as well as the importance of the debriefing process in the prevention and management of conflict.
College of Nurses of Ontario. (2018). Conflict Prevention and Management. Toronto, ON: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf © 2019 College of Nurses of Ontario
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This is a link to the Criminal Code of Canada. The sections that pertain to this guideline are: Section 214 = part VIII Offences Against the Person and Reputation – Assaults: sub section 264.1 and 265.
Criminal Code (R.S.C., 1985, c. C-46). (2013 December). Retrieved from Government of Canada. Published by the Minister of Justice at the following address: http://laws-lois.justice.gc.ca.
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This article describes abuse and abusive relationships, its management with strategies for dealing with domestic violence. Authors - Smith, Melinda; Segal, Jeanne July 2013 retrieved on Sept 25, 2013
Reference: Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: June 2015, HelpGuide.Org, http://www.helpguide.org/articles/abuse/domestic-violence-and-abuse.htm
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This booklet is for coworkers. It addresses domestic violence that extends to the workplace. It develops awareness and provides supportive tips. It is part of the workplace violence prevention series developed by the Occupational Health and Safety Council of Ontario in partnership with the Ontario Women’s Directorate. Retrieved on Sept 26, 2013 from www.pshsa.ca © Public Services Health and Safety Association (PSHSA) 2013.
Public Services Health & Safety Association, 2010, PSHSA's Domestic Violence Doesn’t Stop When Your Worker Arrives at Work: How to get Help or Support a Colleague who may Need Help, Date retrieved June 8 2015, https://www.pshsa.ca/products/domestic-violence-doesnt-stop-when-your-worker-arrives-at-work-how-to-get-help-or-support-a-colleague-who-may-need-help/
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A quick reference sheet that provides facts about domestic violence, recognizing signs of domestic violence, and suggestions for co-workers and employers.
All Material Copyright 2010 © Public Services Health & Safety Association (PSHSA).
Public Services Health & Safety Association. (2010). Domestic Violence Fast Facts. Toronto, ON, Canada: Author. Retrieved from http://www.pshsa.ca/products/domestic-violence/.
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Taken from the RNAO guideline (Appendix D-5), this tool assesses different areas of the workplace environment that may influence overall safety – such as parking lot, building perimeters, etc. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 101-115.
Registered Nurses’ Association of Ontario. (2009). Appendix D-5 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. pp.101-115.
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This resource provides suggestions for ensuring safety for various building areas.
Registered Nurses’ Association of Ontario. (2009). Appendix D-13 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. pp. 129-131. Retrieved from rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
Reference: Ontario Safety Association for Community and Healthcare www.osach.ca/
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This guide explains what every worker, supervisor, employer needs to know about workplace violence and workplace harassment requirements in the Occupational Health and Safety Act.
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This is a joint position statement from The Canadian Nurses Association (CNA) and the Canadian Federation of Nurses Unions (CFNU) on workplace violence and bullying.
Copyright ©, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario, K2P 1E2 CANADA, 2010-2011 all rights reserved.
Reference: Canadian Nurses Association (n.d.). Joint Position statement – Workplace Violence and Bullying. Retrieved from http://cna-aiic.ca/~/media/cna/page-content/pdf-en/workplace-violence-and-bullying_joint-position-statement.pdf
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Cette ligne directrice sur les pratiques exemplaires en soins infirmières et infirmiers est un document détaillé comportant les ressources nécessaires au soutien de la pratique basée sur des données probantes. Un milieu de travail sain, c’est un milieu de pratique qui maximise la santé et le bien-être des infirmières, des résultats de qualité chez le patient ou client, le rendement de l’organisation et du système, et les retombées sociales, y compris des collectivités en meilleure santé.
Association des infirmières et infirmiers autorisés de l’Ontario (2013). Lignes directrices sur le développement et le maintien du leadership infirmier, (2em Ed.). Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/language/lignes-directrices-sur-le-d%C3%A9veloppement-et-le-maintien-du-leadership-infirmier Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée d'Ontario
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This Tips and Tools guide, is designed to help you better understand how to prevent and manage conflict in your work environment.
The information is based on the RNAO Healthy Work Environment,Best Practice Guideline: Preventing and Mitigating Conflict in Health-Care Teams.
Retrieved from: http://rnao.ca/bpg/resources/managing-and-mitigating-conflict-tips-and-tools-nurses
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This is a link to the OHSA, which sets out the rules in relation to health and safety in the workplace. Bill 168 is an amendment to this act and is included within the OHSA link under violence and harassment (Part III.0.1). © Queen's Printer for Ontario.
Occupational Health and Safety Act, R.S.O. 1990, CHAPTER O.1. (2011). Retrieved from Government of Ontario, Canada ServiceOntario e-Laws: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm.
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This link contains the provincial law that gives everybody equal rights and opportunities without discrimination. The sections that pertain to this guideline are:
- Part 1 – freedom from discrimination;
- Section 5 – employment & harassment in employment
- Section 7 – sexual harassment – accommodation (part 1), workplace (part 2), solicitation (part 3)
Copyright © Queen's Printer for Ontario.
Human Rights Code, R.S.O. 1990, CHAPTER H.19. (2012 June). Retrieved from Government of Ontario, Canada ServiceOntario e-Laws: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h19_e.htm.
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Taken from the RNAO guideline (Appendix D-4), this tool can be used to summarize the incidents of workplace violence as reported.
Registered Nurses’ Association of Ontario. (2009). Appendix D-4 of Preventing and Managing Violence in the Workplace. Toronto, Canada. Registered Nurses’ Association of Ontario, p100.
Originally taken from Ontario Safety Association for Community and Healthcare. (2006). A guide to the development of a workplace violence prevention program. Toronto, ON: Ontario Safety Association for Community and Healthcare.
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Taken from the RNAO guideline (Appendix D-9), this tool highlights areas for consideration to reduce the incidence of violence between clients and caregivers. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 118
Reference: Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, Resident/Client Risk Assessment - Point-of-Care Staff Work Practice Assessment (OSACH 2006), Date retrieved June 4, 2015, http://ltctoolkit.rnao.ca/sites/default/files/resources/HWE/violenceprevention/AppD9_Preventing_and_Managing_Violence_in_the_Workplace.pdf
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This resource provides a summary of the evidence-based system, organizational and team/individual recommendations in the RNAO Preventing and Managing Violence in the Workplace best practice guideline.
Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, ON, Canada. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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This guideline provides evidence-based recommendations for RNs and RPNs on best nursing practices for developing and sustaining effective staffing and workload practices. When effective staffing and workload practices are not followed the risk for conflict within teams increases. Learn how the decision making process must ensure that appropriate structures and supports are in place to maximize the nursing effort resulting in the best possible care and positive outcomes for the patients/clients, nursing personnel, and the organization
Registered Nurses’ Association of Ontario. (2017, ). Developing and Sustaining Effective Staffing and Workload Practices. Toronto, ON, Retrieved from: http://rnao.ca/bpg/guidelines/developing-and-sustaining-effective-staffing-and-workload-practices.
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This Best Practice Guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was managing conflict among nursing and healthcare teams with the view that while some conflict is preventable, healthy conflict can also be beneficial.
For the purpose of this document, conflict is defined as: a phenomenon occurring between interdependent parties as they experience negative emotional reactions to perceived disagreements and interference with the attainment of their goals (Barki & Hartwick, 2004).
Registered Nurses’ Association of Ontario. (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, ON: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams
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This is an example of a policy that can be adapted for your organization.
Registered Nurses’ Association of Ontario. (2009). Appendix D-17 of Preventing and Managing Violence in the Workplace. Toronto, Canada. Registered Nurses’ Association of Ontario, pp 141-145 .
Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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The link takes you to the COllege of Nurses of Ontario webcast on Therapeutic Nurse-Client Relationship – Maintaining Boundaries
College of Nurses of Ontario. (2011). Therapeutic Nurse-Client Relationship – Maintaining Boundaries. [Webcase]. Retrieved from https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/therapeutic-nurse-client-relationship/ -
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This document is taken from the RNAO guideline (Appendix D-19) that lists suggested steps for developing an emergency response plan.
Registered Nurses’ Association of Ontario. (2009). Appendix D-19 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada. pp.148-149. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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Tips on how to manage and mitigate conflict (e.g. how to be “self-aware” during conflict, five responses to conflict, steps to resolve conflict, questions to ask when conflict arises, barriers to resolution, etc.).
Registered Nurses’ Association of Ontario. (2012, September). Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. pp. 86-88. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.
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Taken from the RNAO guideline (Appendix D-3), this tool is used to analyze the incidents of violence on a particular unit/work area.
Registered Nurses’ Association of Ontario. (2009). Appendix D-3 of Preventing and Managing Violence in the Workplace. Toronto, Canada. Registered Nurses’ Association of Ontario, p99.
Originally taken from Ontario Safety Association for Community and Healthcare. (2006). A guide to the development of a workplace violence prevention program. Toronto, ON: Ontario Safety Association for Community and Healthcare.
Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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This tool is from the RNAO guideline (Appendix D-7) that can be used to help identify the risk factors that affect employees within their workplace. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 114-115.
Reference: Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, Work Setting and Client Risk Factors Checklist (OSACH 2006), Date retrieved June 4, 2015, http://ltctoolkit.rnao.ca/sites/default/files/resources/HWE/violenceprevention/AppD7_Preventing_and_Managing_Violence_in_the_Workplace.pdf
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Taken from the RNAO guideline (Appendix D-15), this document provides tips for workers in relation to travel in relation to: (a)public transit, (b)safety and travelling by care, (c) parking lot safety tips, and, (d)staying at a hotel. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 134-138.
Reference: Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, Work-related Travel Procedures (OSACH 2006), Date retrieved June 4, 2015, http://ltctoolkit.rnao.ca/sites/default/files/resources/HWE/violenceprevention/AppD15_Preventing_and_Managing_Violence_in_the_Workplace.pdf
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The WSIA provides employees with health-care benefits in the event that they have suffered an injury while at work. The section that pertains to this guideline is: Part 1, Section 1 – Purpose of the act.
Copyright © Queen's Printer for Ontario.
Workplace Safety and Insurance Act, 1997, CHAPTER 16. (2013 January). Retrieved from Government of Ontario, Canada ServiceOntario e-Laws: www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_97w16_e.htm.
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This website has information and documents for workers/employers who have experienced an injury at work.
© 1998-2011, Workplace Safety and Insurance Board of Ontario. All rights reserved.
Reference: WSIB Ontario (n.d.). Retrieved from http://www.wsib.on.ca
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This guide explains what every worker, supervisor, employer in Ontario needs to know about workplace violence and workplace harassment requirements in the Occupational Health and Safety Act. Updated October 18, 2023.
https://www.ontario.ca/page/preventing-workplace-violence-and-workplace-harassment
© King’s Printer for Ontario, 2012–to24 -
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Taken from the RNAO guideline (Appendix D-2), this tool is used to analyze the incidents of violence in the workplace.
Registered Nurses’ Association of Ontario. (2009). Appendix D-2 of Preventing and Managing Violence in the Workplace. Toronto, Canada. Registered Nurses’ Association of Ontario, p98.
Originally taken from Ontario Safety Association for Community and Healthcare. (2006). A guide to the development of a workplace violence prevention program. Toronto, ON: Ontario Safety Association for Community and Healthcare.
Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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Taken from the RNAO guideline (Appendix D-10), this survey should be used to identify staff safety concerns. Registered Nurses’ Association of Ontario. (2009). Preventing and Managing Violence in the Workplace. Toronto, Canada, 119-123.
Registered Nurses’ Association of Ontario. (2009). Appendix D-10 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. 119-123.
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This is an example of a violence reporting procedure which can be adapted for your organization.
Registered Nurses’ Association of Ontario. (2009). Appendix D-18 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada. pp.146-147. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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Taken from the RNAO guideline (Appendix D-12), this is an incident report to be used to evaluate the aggressive event.
Registered Nurses’ Association of Ontario. (2009). Appendix D-12 of Preventing and Managing Violence in the Workplace. Toronto, Canada. Registered Nurses’ Association of Ontario, pp 125-127.
Originally taken from Ontario Safety Association for Community and Healthcare. (2006). A guide to the development of a workplace violence prevention program. Toronto, ON: Ontario Safety Association for Community and Healthcare.
Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.
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As of June 15, 2010, the Ontario Occupational Health and Safety Act includes employer responsibilities for addressing violence, harassment and domestic violence in the workplace. This edition of PSHSA Fast Facts provides organizations with guidance on complying with the changes.
All Material Copyright 2010 © Public Services Health & Safety Association (PSHSA).
Public Services Health & Safety Association. (2010). Complying with the Occupational Health & Safety Act. Toronto, ON, Canada: Author. Retrieved from http://www.osach.ca/products/ffacts_e/PH-FVIO0-E-012510-TOR-001.pdf.