Understanding the Four Types of Workplace Violence in Health Care

Workplace violence is a significant concern in health care environments, where staff regularly interact with patients, visitors, and coworkers under high-stress conditions. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “any physical assault, threatening behavior, or verbal abuse occurring in the work setting.” NIOSH further classifies workplace violence into four categories based on the relationship between the perpetrator and the workplace (NIOSH, 2013).

Types of Workplace Violence

The following definitions are provided by the National Institute for Occupational Safety and Health (NIOSH), via the CDC.

Type I – Criminal Intent
In Type I incidents, the perpetrator has no legitimate relationship to the business or its employees. Violence typically occurs during the commission of a crime such as robbery, shoplifting, or trespassing.

Type II – Client-on-Worker Violence
Type II is the most common form of workplace violence in health care settings. It involves patients, family members, or visitors who become violent while receiving services. A common example includes assaults on health care workers by patients experiencing dementia or disorientation.

Type III – Worker-on-Worker Violence
Often referred to as lateral or horizontal violence, Type III involves employees threatening or harming other employees. This frequently takes the form of verbal or emotional abuse, bullying, or humiliating behavior and is often directed toward individuals perceived as having less authority, such as supervisor-to-employee, physician-to-nurse, or peer-to-peer situations.

Type IV – Personal Relationship Violence
Type IV violence occurs when an individual with a personal relationship to a health care worker brings that conflict into the workplace. While the perpetrator has no direct relationship to the organization, the impact on staff safety can be serious.

Types II and III are the most frequently encountered in health care environments. Understanding these classifications helps organizations better assess risk, develop prevention strategies, and create safer workplaces for staff, patients, and visitors.

In healthcare settings, weapons detectors such as OPENGATE can support violence prevention efforts. Because health care facilities experience frequent Type II and Type III incidents, detection of weapons at entrances or sensitive locations can help reduce risk to staff, patients, and visitors without disrupting the care environment. When implemented as part of a broader safety strategy that includes training, policies, and incident response planning, weapon detection supports deterrence, and intervention, while helping hospitals maintain a welcoming atmosphere focused on care rather than security.

Reference: Centers for Disease Control and Prevention. “Violence, Bullying, Incivility,” NIOSH Safety Culture in Healthcare module.