As a nurse, I vividly recall my first encounter with violence in the workplace. A patient, intoxicated and agitated, attempted to strike me while I was inserting an IV. Fortunately, his impaired motor function spared me from harm that day, but the incident left a lasting impact, in part because it highlighted a culture in which experiences with violence are normalized, or even seen as a rite of passage. The experience also made me acutely aware that my safety as a nurse was delivering care was far from protected.
Sadly, this kind of violence has become alarmingly prevalent in health care, but there are steps we can and must take to move toward a safer work environment for all of us. According to a 2019 survey by the American Nurses Association, one in four nurses reported being physically assaulted at work. Furthermore, a 2022 Press Ganey report revealed that two nurses were assaulted every hour during the second quarter of that year. These statistics paint a troubling picture of the widespread and persistent issue of workplace violence in nursing.
Workplace violence is a tragic problem that demands change on multiple fronts. We must begin to prioritize the physical and psychological safety of our nurses. This reason is sufficient on its own, but it is also worth considering the far-reaching impact violence also has on morale, patient care, retention, and even costs.
But with such an overwhelming problem, where do we even start?
The De-Normalization of Violence
We, as healthcare workers, must take a hard look at the normalization of expected violence in our work environment. This burden does not lay solely on the individual employee, but we each carry the responsibility to speak up, publicly acknowledge what we are experiencing, and no longer accept violence as part of the job. This responsibility for a culture shift also lies with our leaders and institutions to be unwavering in their communication and enforcement of zero tolerance and a dedication to involving stakeholders from across the organization in creating and continuously improving a plan dedicated to workplace violence prevention.
Where do we start? How is your zero-tolerance policy communicated and what could be improved? Seek out or offer input or find a workplace violence prevention committee and get involved.
Reporting Violence (Or Lack Thereof)
It is estimated that up to 60% of workplace violence incidents are not reported, meaning the actual number of violent encounters is significantly higher than the already harrowing statistics. Fears of backlash or an assumed lack of response, coupled with complex and cumbersome reporting systems, often discourage nurses from reporting incidents. To address this issue, it is crucial to make the reporting process more accessible and ensure it is meaningful. Evaluating your reporting mechanisms to ensure they are efficient and frictionless is an important first step. Verbally encouraging your teams and your colleagues to always report can also make an impact. Finally, transparency around the data collected is the only way to truly evaluate the problem effectively and solicit targeted strategies for solutions and support.
Where do we start? Evaluate your reporting system for efficiency and transparency. Seek opinions from colleagues on why they may not report and what could be done to improve the likelihood of reporting violence.
Giving Nurses the Skills to Handle Violence
With prevention as the ultimate goal, it is imperative to equip nurses with the necessary skills to recognize early warning signs of violence and effectively handle volatile situations. Education and training programs should be implemented to teach tactical empathy, which involves using deliberate influence and meaningful connections to understand and address patient wants and emotions, thereby fostering trust-based relationships. Nurses need to not just learn, but practice a robust set of tools and skills, just as we methodically practice codes and other clinical skills, to optimize our ability to de-escalate threatening situations and mitigate the risk of violence.
Where do we start? Examine the cadence and content of your workplace violence training. Where are the gaps? Establish a time to practice scenarios with your team regularly to ensure the skills learned are top of mind.
The Time Is Now
Creating a safe and secure workplace for nurses does not mean eliminating all threats; but there is much that can be done – even if small steps – to get us closer to a work environment where we can practice safely. Our safety matters for our own well-being as members of the healthcare team. But it also results in us providing the best care possible to our patients. Workplace violence is admittedly a complex problem, but we cannot wait. It’s time to begin.
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Britt DiNatale, BSN, RN, is an ER nurse that is passionate about nursing workforce advocacy and well-being. She joined us at Practicing Excellence as a Client Success Advisor and serves as Director of the Nursing Experience Project to bring effective, actionable support to nurses nationwide in the face of growing challenges in healthcare.
