Violence in the Healthcare Workplace

As a nurse leader, you constantly assess, evolve, and coordinate efforts across clinical settings to mitigate workplace violence and keep your risk management framework current. After all, healthcare workers experience workplace violence at rates five times higher than other industries.

Covering all your bases, you plan for external threats–like violent intruders, patients, their family, and guests–consider internal team conflicts, and anticipate domestic violence against staff inside of or outside of the workplace. You also lead assessments, stand up rapid response teams, engage stakeholders, vet tools, and READ - all of the resources.

Ensuring your team has the latest guidance on countering workplace violence can feel incredibly daunting. Knowing this, The Nurses Legacy Institute curated the guide below. 

It includes tactical steps to create a culture of safety, prevent violence, connect with stakeholders, anticipate high-risk challenges, design safe environments, and adopt relevant tools and technology. Save this resource and refer back to it to inform strategic updates!

❤️🩹 CREATE A CULTURE OF SAFETY

Many healthcare professionals view widespread “zero-tolerance” violence policies as lip service. Nurses want to know their employers will stand up for and protect them if they take the brave step of reporting an incident, even if it impacts the hospitals numbers.

To overcome systemic underreporting, nurse leaders need to gain buy-in from executives, ensure that investigations are initiated, and follow through on consequences for perpetrators.

Also paramount? Preventing actual retaliation or fear of retaliation for those who report. 

1. Develop a reporting protocol, select an easy-to-use reporting system, & train staff on usage.
2. Alleviate fear of retaliation around reporting by following through with investigations/debriefs.
3. Provide trauma counseling to staff, prioritizing physical, emotional, and psychological health. 

📝 PREVENT VIOLENCE

Create a Prevention strategy informed by an evidence-based risk assessment. This should be based on data regarding violent populations, past incidents, risk factors, and stakeholder perspectives. Tactics can include but are not limited to the following:

1. Establishing visitor policies and a code of conduct contract for patients, families, guests, & staff. 
2. Developing a threat assessment team (administration, security, frontline clinical, legal, comms, IT). 
3. Providing ongoing training in de-escalation (role play, simulation), and self-defense maneuvers.

🫂 CONNECT WITH STAKEHOLDERS

Plan, sponsor, or attend local events to counter violence in the community and meet stakeholders where they are. Use these opportunities to get to know neighbors and discuss the need for legislation to protect healthcare workers. Examples include the Workplace Violence Prevention for Health Care and Social Service Workers Act, H.R. 2531/S. 1232.

1. Meet people where they are to foster compassionate and empathetic approaches to prevention.
2. Connect with law enforcement to increase connectedness and crisis response times. 
3. Build rapport with elected officials to advance legal protection for healthcare workers.

🚨 ANTICIPATE HIGH-RISK CHALLENGES

Some of the highest rates of healthcare violence occur in psychiatric units (37% hospital incidents) and in the Emergency Room (31% of hospital incidents). Nurse leaders can proactively implement lower staff-to-patient ratios and provide specialized training for unique challenges across clinical settings, including but not limited to the Emergency Rooms, Psychiatric floors and facilities, and long-term and memory care environments.

ER: 

1. Employ STAMP screenings and/or Brøset Checklist to identify physically threatening behavior and get ahead of potential violence.
2. Introduce a patient liaison (to manage wait time expectations and alleviate frustration).
3. Brief incoming teams on violent patients/visitors during shift change huddles. 

Psychiatric Care: 

1. Employ trauma-informed care (TIC), identify and avoid triggers, and use therapeutic interventions. 
2. Conduct frequent assessments, train a rapid Behavioral Emergency Response Team (BERT).
3. Exercise restraint techniques &/or turn to seclusion as a last resort.

Long Term/Memory Care: 

1. Use soothing techniques to diffuse agitation (violence trigger).
2. Leverage validation therapy when patients exhibit signs of paranoia (violence trigger).
3. Establish and maintain predictable routines to prevent confusion (violence trigger).  

🏥 DESIGN SAFE ENVIRONMENTS

The layout of a healthcare environment can contribute to safety or create dangerous opportunities for violence. For new facilities, intentional design can contribute to patient wellbeing. For existing settings, installing new safety features, and securing objects that can be used as weapons are best practices. Examples of concrete tactics to use include:

1. Hospitals: Bolt furniture, secure sharps, restrict access, create barriers, designate safe rooms.
2. Memory Care: Install ambient lighting, volume dampening, and visual cues (murals etc).
3. Home Health Care: Train for situational awareness, scan for weapons, identify escape routes.

🖲️ ADOPT TECH & TOOLS 

Technological advancements increase efficiency, enhance staff morale and sense of well-being, and reduce response times to incidents of healthcare violence, providing a valuable return on investment. Beyond metal detectors and surveillance cameras, nurse leaders can implement emerging tools like:

1. Wearable, Bluetooth-enabled panic buttons connected to security & colleagues.
2. Electronic chart flagging systems, intercoms & PAs for code communication/to notify teams. 
3. GPS trackers/mobile comms devices for home health staff that alert local law enforcement.