It's Time to Remove "Zero Tolerance" from Violence Prevention Policies
A common phrase for healthcare these days is to have zero tolerance for violence. This is recommended by professional organizations and is encouraged to be in violence prevention policies.
While noble, this is problematic for a number of reasons.
Definitions of “zero tolerance”:
Wikipedia: “A zero-tolerance policy is one which imposes a punishment for every infraction of a stated rule. Zero-tolerance policies forbid people in positions of authority from exercising discretion or changing punishments to fit the circumstances subjectively; they are required to impose a pre-determined punishment regardless of individual culpability, extenuating circumstances, or history.”
Oxford Languages: “Refusal to accept antisocial behavior, typically by strict and uncompromising application of the law.”
Merriam-Webster: “A policy of giving the most severe punishment possible to every person who commits a crime or breaks a rule.”
Are hospitals in the business of “punishing” patients, visitors, or staff? Do they impose punishment for patients whose violence is a symptom and manifestation of their illness?
Prematurely discharging a violent patient can lead to EMTALA issues.
Staff tolerate violence despite a zero tolerance policy.
Tolerance hurts people. Using a patient’s history as an excuse to tolerate violent behavior and not report it internally or to law enforcement can allow patients to go on to assault other staff.
Zero tolerance can contribute to a “care paradox”. Patients are violent, yet staff have to and want to care for them.
Zero tolerance is inconsistently applied. Perhaps when a staff member reacts to violence with breakaway techniques, the zero tolerance policy is now utilized to sanction or terminate them. Does the staff member have a right to defend their life?
Zero tolerance sounds powerful, forceful; like you’re taking a stand. Zero tolerance policies do nothing to decrease violence, may increase legal risk, and can create more issues than they solve.
Zero tolerance is reactive, not preventative.
Recommendations:
Remove “zero tolerance” language from violence prevention policies.
Assume there’s a medical/psychological origin for violent patients until proven otherwise.
Treat every incident as unique. Investigate, find out the whys, and address the problems. Allow due process.
Allow for self-defense if warranted.
Create an active and comprehensive violence prevention policy. And live it.
Sources:
Beattie, J., Innes, K., Griffiths, D.,& Morphet, J. (2020). Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance. Health Care Management Review, 45(3), E13-E22. https://doi.org/10.1097/HMR.0000000000000286
Copeland, D., & Henry, M. (2017). Workplace violence and perceptions of safety among emergency department staff members: Experiences, expectations, tolerance, reporting, and recommendations. Journal of Trauma Nursing, 24(2), 65-77. https://doi.or/10.1097/JTN.0000000000000269
Holbrook, C. M., Bixler, D. E., Rugala, E. A., & Casteel, C. (2019). Workplace violence: Issues in threat management (p.p 7-8). Routledge.
Morphet, J., Griffiths, D., Beattie, J., Velasquez Reyes, D. & Innes, K. (2018). Prevention and management of occupational violence and aggression in healthcare: A scoping review. Collegian, 25(6), 621-632. https://doi.org/10.1016/j.colegn.2018.04.003