Violence, harassment and aggression (VHA)

The HSE follows the EU definition of work-related aggression and violence as ‘any incident where staff are abused, threatened, or assaulted in connection with their work. This includes challenges to their safety, wellbeing, or health'.

Work-related aggression and violence can take many forms:

verbal abuse or threats (in person or by phone)
disruptive or threatening behaviour
physical threats or assaults
written abuse, through communication platforms including social media or messaging apps

Aggressive behaviour, whether verbal or physical, is unacceptable.

According to the Employment Equality Acts 1998-2015, harassment is any unwanted behaviour that violates your dignity for discriminatory reasons. The Dignity at Work Policy for the Public Health Sector aims to protect employees from bullying, harassment and sexual harassment by both employees and non-employees.

Behaviours – clinical and non-clinical

Behaviours that challenge can be unintentional (clinical), requiring compassionate care. Others are intentional (non-clinical), or even criminal. Responses should be tailored to the situation, ranging from compassionate management to non-tolerance as necessary.

Who is at greater risk?

You may be at greater risk if you:

work alone or late hours
work and travel in the community
provide or withhold services
exercise authority
care for service users with risk factors
are new to the role with less experience, training or skills
handle valuables or medication

Managing risk

A strong proactive risk management approach and risk assessment helps to protect staff.

You should consider:

service user and others
service providers
the task and interaction taking place
the physical space and social setting

Figure 1 of the policy describes risk factors that may contribute to incidents of aggression and violence in healthcare.

Risk Assessment Prompt Sheet re Work-Related Aggression and Violence (Word, 40 KB, 8 pages)

Clinical Risk Assessment

If a service user is aggressive or prone to violence, their care plan must include a clinical risk assessment that is reviewed regularly.

Dynamic Risk Assessment

In healthcare, risks can change unexpectedly. Dynamic risk assessment involves making quick, informed decisions based on what’s happening in the moment. Staff may need to assess issues on the spot and respond quickly to ensure everyone’s safety.

Examples include when a person:

becomes agitated
is under the influence of alcohol or drugs
must be escorted alone

This approach allows staff to respond to emerging risks, even if they are not part of a formal risk assessment.

Manager responsibilities

Complete a hazard identification and risk assessment process in consultation with employees. Check that they accurately reflect daily work activities and potential exposures for employees and others.
When individual clinical risk assessments are completed, use the information to inform service department risk assessments. Share the relevant updates promptly with staff.
Employees identified at risk should get training based on the training needs assessment.
Be informed of the supports available to staff. Actively communicate these to encourage staff engagement and wellbeing.

Employee responsibilities

Comply with local procedures, safe systems of work, and associated risk assessments designed to protect staff and service users.
Use the recommended risk-reduction measures, such as emergency response procedures and other protective measures.
Complete training based on a training needs assessment to stay prepared and informed.
Inform management about potential risks, concerns, and incidents of work-related aggression and violence.

HSE Policy on the Prevention and Management of Work-Related Aggression and Violence

Site security

Security personnel can have a key role in preventing and managing workplace aggression and violence. Local protocols must be developed for security personnel, including staff and contractors. These should include roles, responsibilities, and training requirements.

Managers must ensure that security teams are aware of potential risks and how to address them. Give security personnel your local ancillary safety statement to ensure they understand and comply with safety standards.

Relevant staff members must be fully informed about the responsibilities and expectations of security personnel. This encourages collaboration and appropriate responses in critical situations. Service level agreements with external security providers must include emergency response procedures and locally-tailored aggression management procedures.

Aggressive phone calls

You are not expected to deal with aggressive or abusive callers but we must consider our service users' needs. They may be annoyed and stressed. We should aim for a balance between the rights of the employee and the rights of service users.

What to do if you receive an abusive call

If a caller is abusive during the call you can:

tell them you find their language offensive and you will end the call if it does not stop
hang up if the abuse continues despite your warning - this decision must be made in the context of risk assessment
make a detailed note of the call
inform staff members who are involved with the caller
report abusive language or threatening behaviour to your manager

How to avoid ending a call

There are things you can do to try to keep control of a call and avoid, if possible, hanging up.

These include:

keep calm and try to remain as open minded as possible
do not respond with aggression
try not to take what the caller is saying personally
ask as much as is necessary for the facts
try to keep the tone of your voice calm and measured
let the caller 'vent and have their say'
listen and then question and confirm what they are saying
remain positive and confident and do not allow the caller to take over the call
follow through on agreed actions

Incident management

All incidents must be reported, and managed in accordance with the HSE Incident Management Framework

Support

If you are exposed to aggression and violence you will be given sensitive and practical support to help you cope with the incident. See also Employee Assistance Programme and Occupational Health.

For more guidance, see HSE Policy on the Prevention and Management of Work-related Aggression and Violence

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