A simulated emergency department triage desk at night. A triage nurse in the headset sits at the desk while a man stands at the counter, agitated but not aggressive.

Learn / Standards

Workplace violence training in the United States, rule by rule

An accreditor, federal rules and a growing list of states each ask for it. Find the ones that reach your staff.

The moment

Every rule is written about a moment like this

A relative raising his voice at a hospital triage desk. A customer who will not calm down at the register. A passenger who turns on a bus driver late at night. United States employers are asked to prepare staff for each one.

A consultant speaks with a family member in a hospital corridor, one of them wearing a headset. — A family member in the hospital corridor.

A retail customer waits for a reply. A first person VR training scenario for workplace and enterprise, seen through the headset. — A customer waits for your answer.

Inside the simulation: the cab of a bus at night seen from the driver's seat, plain dark dashboard with only soft abstract colour, a windscreen onto a wet empty street under streetlights. A passenger stands in the aisle beside the driver's position facing the viewer, asking something. — A passenger at the cab, late at night.

Who asks for it

Federal, accreditor and state rules reach one workforce

OSHA has no specific workplace violence standard and relies on its General Duty Clause. The detailed training duties come from an accreditor, from federal rules for particular settings, and from the states.

A long hospital ward corridor at night, lit by low floor lighting and the cool spill from open doorways, a simulated environment for the settings this practice happens in — The hospital corridor every rule covers.

The accreditor

Every hospital accredited by the Joint Commission trains leaders, staff and licensed practitioners at hire, annually and whenever the program changes, including in de-escalation and nonphysical intervention skills.

A simulated bus depot, rows of plain buses under a high roof, dusty light through skylights. An older driver wears the headset; a supervisor faces him with a clipboard. — A driver and supervisor, before the shift.

Federal rules for particular settings

Transit agencies run safety training that includes de-escalation training. Psychiatric residential treatment facilities have staff demonstrate in practice the techniques they have learned.

State by state

What each state asks, in a line or two

Most of the detail sits in state law. Each entry links to our guide to that rule, or to the statute itself.

A frontline staff member wearing a headset stands with both hands open at waist height, facing a simulated agitated adult. — Open hands and a low voice, rehearsed.

California

Most employers train staff on a written plan under SB 553. Health care employers also work to a health care rule that names de-escalation and practice with colleagues.

Nevada

Nevada medical facilities let patient-facing staff practise de-escalation with colleagues, debrief each session, and keep a record of it.

A duty manager listens to a retail customer. A VR training scenario for workplace and enterprise. — A duty manager hears a customer out.

Washington

Health care settings in Washington train within ninety days of hire, including strategies to prevent physical harm with hands-on practice or role play.

New York

Retail employers in New York train on de-escalation tactics, active shooter drills and emergency procedures, and the State’s model program must be interactive.

A simulated community mental health room. A man in his mid-twenties sits forward, elbows on his knees; a clinician in the headset sits back, giving him room, holding the silence. — A clinician gives a young man room.

Oregon, Minnesota, Ohio and Virginia

Oregon names verbal and physical techniques to de-escalate. Minnesota trains hospital staff before a first independent shift, and annually. Ohio keeps someone trained in de-escalation in the emergency department at all times. Virginia names de-escalation in hospital security training.

A simulated primary school playground under a shade sail. A teacher wearing the headset crouches between two children. — A teacher kneels between two pupils.

Schools

Massachusetts asks for the simulated experience of administering and receiving physical restraint. Illinois allows online training for every area except physical restraint. See de-escalation training for school staff.

Records

Each rule sets its own record and retention period. See workplace violence training records.

How to train

Several rules say how, and not only what

A slide deck can cover a list of topics. These rules ask staff to practise the skill and show it.

A nurse educator briefs a nursing student in a simulation laboratory, one of them wearing a headset. — A practice run, talked through afterwards.

Rehearsal, then a debrief

California and Nevada ask for practice with the colleagues staff work with, then a meeting to debrief it. Federal home health rules define a pseudo-patient as a person trained to take part in a role-play, or a computer-based mannequin.

Two prospective students talk in a campus courtyard. A first person VR training scenario for education, seen through the headset. — Two prospective students talk in a campus courtyard.

A record of each session

Nevada requires a record of each training session, and the Joint Commission asks for documentation. A register of who practised what, and when, answers both.

Beyond the United States

The same duty, under other names

Employers in Australia, the United Kingdom and Canada prepare staff for the same moments.

A palliative care nurse talks with a visitor. A VR training scenario for healthcare. — A nurse faces a visitor at the desk.

Australia

Hospitals are assessed on the NSQHS action on de-escalation and on the action on mandatory training. Other employers manage it as occupational violence and as a psychosocial hazard.

A parent and clinician conversation, one of the recreated Mater settings. — A parent and clinician, in a recreated Mater setting.

United Kingdom and Canada

NHS England’s violence prevention and reduction standard asks for suitable and sufficient training for all staff. Canada’s federal regulations require training specific to the culture, conditions and activities of the work place.

How it runs

Practice that feels like the shift

Staff rehearse in a VR headset or with an AI roleplay partner, then run it again until it holds. See it on a ward in the Mater Education case study.

A customer stands across a plain service counter. A first person VR training scenario for immersive training and roleplay, seen through the headset. — A customer at the counter, in the headset.

A headset-wearing coach leans towards their practice partner. An AI roleplay scenario for AI roleplay and practice. — A practice partner, face to face.

A PTR facilitator stands beside a person wearing a headset as they raise their hands. — A facilitator beside the first attempt.

Questions

What employers ask first

Short answers to the questions that follow a first reading of the rules.

A hospital tea room, two colleagues talking across a table. — A nurse alone after a hard shift.

Does OSHA require workplace violence training?

OSHA has no specific workplace violence standard. The training duties come from the Joint Commission, from federal rules for particular settings, and from state law.

A community nurse greets an older woman. A VR training scenario for healthcare. — A community nurse greets an older woman at her door.

How often is it repeated?

At hire and annually in most of these rules, including the Joint Commission, both California rules, Nevada and Minnesota.

A pregnant woman attends a maternity checkup. A first person VR training scenario for healthcare, seen through the headset. — A maternity checkup, seen through the headset.

Does online training meet these rules?

Several rules ask for more than a module: practice with colleagues and a debrief in California and Nevada, and hands-on practice or role play in Washington. See what the research on VR training shows.