Mitigating The Impact Of Resident & Patient Aggression On Employee Burnout

In post-acute care, the physical and emotional toll on staff can be compounded by the challenging behaviors of patients or residents, particularly acts of aggression. Ranging from verbal abuse to physical confrontations, it’s estimated that nearly 70% of post-acute care employees will experience aggressive behaviors, especially if they are serving those with cognitive impairments, dementia, or mental health conditions. 

Studies show that resident aggression can negatively impact an employee’s feelings of safety and confidence in the workplace. Aggressive behaviors can also impact overall job satisfaction, as repeated exposure to such incidents can lead to not only physical harm but also emotional distress, contributing to higher levels of stress and ultimately, burnout. 

While there is little your organization can to do completely prevent residents or patients from displaying aggressive behaviors, with the right protocols and support, you can help reduce their impact on the well-being of your staff. 

1. Comprehensive Training on De-Escalation Techniques

Competence breeds confidence. Employees who are well-trained in handling aggression are more likely to navigate these situations effectively and with composure. Comprehensive training should cover the following:

• Recognizing triggers that may lead to aggressive behavior, such as pain, confusion, or environmental stressors.
• De-escalation techniques, including active listening, maintaining non-threatening body language, and using calming tones to diffuse tension.
• Scenario-based learning, which helps staff practice responding to challenging situations in a controlled environment.

Additionally, consider offering specialized modules tailored to populations with unique needs, such as dementia patients. The goal is to ensure staff feel empowered and equipped to de-escalate tense situations while prioritizing their own safety.

2. Implementing Safety Protocols

Clear safety protocols are essential for protecting staff when aggressive or violent behaviors occur. Because when employees know they have tools and protocols to fall back on, their confidence and sense of security improve significantly. 

Common safety protocols include:

• Behavioral risk assessments: Identifying those at high risk for aggressive behaviors can help inform care plans and prepare employees for the possibility of an incident. It can also help you identify team members who are best suited to work with those patients or residents based on their skill set. 
• Emergency response tools. Establishing safety alerts, panic buttons, and clear guidelines for when to call for help ensures that employees know how to respond to incidents. Wearable alert devices have become more commonplace, particularly in home-based settings, where caregivers may be alone. 
• Defined reporting procedures. Encourage staff to document incidents promptly and thoroughly. This is important to monitor trends and address recurring issues and also to ensure managers can provide the support team members need following an aggressive episode. 

Be sure to review your safety protocols with employees as part of their onboarding process and on an annual basis to ensure they understand what’s in place to ensure their safety. 

3. Offering Mental Health Support 

The emotional trauma resulting from repeated exposure to aggression often goes unnoticed and untreated, especially in home-based settings. Providing access to mental health resources is a simple way to support the well-being of your employees. 

• Employee Assistance Programs (EAPs) that provide free and confidential counseling can help employees better cope with burnout and its root causes. While many EAPs offer access to therapy either in-person or over the phone, many organizations are opting for more modern options such as Headspace, which offers support online and even via text. 
• Monthly debriefing sessions can allow staff to discuss their experience, share coping strategies, and receive guidance on how to cope with or address a similar situation going forward. These sessions can also remind employees that they are not alone in feeling stressed or burned out. 
• Promoting a culture of mental health is another simple, but significant step your organization can take to ensure the well-being of all your employees. Your team should feel comfortable seeking support without stigma and leaders should continuously address stress levels during team meetings and one-on-ones. 

These initiatives not only support those who may encounter aggressive patient or resident behaviors, but anyone on your team who may be experiencing stress, compassion fatigue, or burnout.

4. Maintaining Balanced Staffing Levels  

In an ideal world, you would have more employees than you needed. But in reality, many in post-acute care are battling ongoing staffing shortages that seem to have no end. Understaffing has a snowball effect, impacting everything from quality of care to employee satisfaction and burnout. To combat this, providers must implement creative staffing strategies that allow them to maximize their resources. 

• Distribute workloads based on acuity. In general, the acuity of those entering post-acute care is higher than even five or ten years ago. Because of this, many organizations are factoring in acuity when assigning employees to patients or residents. Doing so can ensure caregivers are not overwhelmed while also promoting the highest in quality care for those they serve. 
• Allow for wellness breaks. Whether working in a home-based or community-based setting, finding time to reset during the day can feel impossible. If not already required by your state, encourage employees to take up to two 15-minute breaks per 8-hour shift, on top of any meal breaks. Recommend that employees use this time for a simple act of self-care such as eating a healthy snack or meditating. 
• Staff up at peak times. If you are operating in a facility-based setting, staffing up during peak times or high-stress periods like sundowning, can offer much-needed back-up and relief for your staff. To achieve this, many providers are increasing their number of PRN staff and strategically scheduling in 2-4 hour increments when they are most needed. 

5. Promoting Staff Empowerment and Autonomy  

Empowering staff to make decisions about their safety can greatly enhance overall job satisfaction and well-being. Comprehensive training, as noted above, can help employees feel more comfortable and confident in how they handle situations both in the moment and in the aftermath. However, knowing they are trusted and supported with the decisions they make is just as critical. Protocols that can empower your team include: 

• Allowing employees to step away from interactions they perceive as unsafe
• Providing flexibility to request patient reassignment when needed
• Encouraging staff to voice concerns about safety without fear of judgment or reprisal

Giving your staff the autonomy they need to prioritize their safety and wellness builds trust and demonstrates your organization’s commitment to employee satisfaction. 

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Aggression from patients or residents is an unavoidable reality in post-acute care, but it doesn’t have to lead to burnout. By investing in training, implementing clear safety protocols, and fostering a supportive environment, organizations can protect their staff’s well-being. These efforts not only improve employee satisfaction and retention but also enhance the quality of care, creating a better environment for both patients and caregivers alike.