Workplace Violence: Where Do We Start?

I recently went through training to be a volunteer, and part of the pre-work was a course on managing workplace violence, including how to respond to an active shooter. It stopped me in my tracks – how on earth did we get to a place where we are focused on responding to violence in a space that is supposed to be about healing?

Press Ganey recently reported that more than two nurses were assaulted every hour in the second quarter of 2022. On top of all the challenges of delivering excellence in patient care with a depleted workforce that has given 110% throughout the pandemic, we are additionally needing to deal with a notable increase in workplace violence.

While the issues we face are complex and challenging, the physical and psychological safety of nurses is foundational. How do we, as nurse leaders, take steps to improve the safety of our work environment while also maintaining a high standard of care? While numerous plans and resources are available detailing how to tactically and strategically address workplace violence, we must declare as leaders that we are prioritizing preventing and responding to workplace violence. I think these are some good places to start:

1. Let your team know that you care about the issue. Although you may not have an answer to this complicated issue, it is vital for nurses to know that you are concerned about it and consider their safety as a top priority.
2. Create and enforce the expectation of civility. In everything from Patient’s Rights and Responsibilities documents to signage throughout the facility, we need to remind people of the cultural expectation to always be respectful. As Indiana University Health reminds their visitors as they enter, “Your words matter. Your behaviors matter. Our patients and our teams matter. Take a slow, deep breath and make sure your energy is in check before entering.” Colleague-to-colleague, patient-to-caregiver, all throughout the system, civility should be expected and incivility should be nipped in the bud. No excuses.
3. Distinguish workplace mistreatment (incivility, harassment, and bullying) from workplace violence. While both are problematic, these terms are often used interchangeably–confusing our understanding and approach to the issue. These forms of mistreatment have serious consequences and require isolated comprehensive measures to create a safe and respectful work environment distinct from acts of violence.
4. Treat acts of violence–even small acts of violence–swiftly! Certainly, the intervention should be in proportion to the action and the circumstances. But, in all cases, there should be clear standard procedures to encourage reporting, following-up, and post-incident support to ensure that nurses feel protected and cared for.
5. Encourage reporting. Workplace violence, especially in health care, is often underreported. Fear, stigma, and a lack of accurate data hinder us from having a clearer picture of the violence that is happening and offering an effective solution. As leaders, it is critical to establish an environment where reporting is simple to complete and encouraged. Tell your team to tell you about it!
6. Obviously, ask for input. Discuss what your team thinks will reduce the likelihood of violence. Ensure that nurses are well-represented on workplace violence committees or task forces. You may not have full control over making all of these changes, but together you can develop and contribute to a plan.
7. Think beyond education. While we certainly teach nurses to be on the alert for violence, helping them hone their empathy skills, learn de-escalation techniques, and teach them how they can keep themselves safe, we also need to acknowledge that these measures do not do anything to eliminate the source of the violence and are not a singular solution.

These are legitimately challenging times, and with all that is going on, we may not have all of the answers. But we can start where we are and with what we know. And we know that we need to address this issue with clarity, compassion, and an eye to making our spaces one of safety, healing, and well-being.