Workplace Violence in Health Care: It Is Time to Move From Awareness to Action

Workplace Violence can often be considered an expected part of being a nurse. It should not be. Threats, harassment, verbal abuse and assault should never be normalized as “part of the job”.

Through my work in studying WPV, the goal is to create awareness that puts in place a system of PREVENTION! Yes, teaching de-escalation techniques is important. But, there are many other things that need to happen before you get to that point with a patient or family member.

The first step is institutional support whether it is in academia or the clinical setting. This includes

1.        Public Recognition of the issue and a commitment to safety

2.        Signs throughout the building stating there is a No Tolerance policy for violence

a.        Includes academia posting signs about psychological safety and a judgement free environment; language throughout curriculum

3.        Rooms & furniture arranged to allow quick exit and no trapping of staff

4.        Risk assessment of all patients on arrival

5.        Individual reporting system just for WPV incidents including incivility among all staff

a.        We need data!!! We don’t have data because most incidents are not reported.

6.        Initial and yearly training on WPV risk assessment, prevention, de-escalation, public safety protocols, and reporting mechanisms.

7.        Institutional commitment to protecting people who report incidents and are victims of violence

Nursing students and Nurses in practice should be involved in policy at their institution but also through state and national advocacy. The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2531) would require each employer to develop a workplace violence prevention plan, promptly investigate incidents of workplace violence, and provide relevant training and education to employees. The Save Healthcare Workers Act (S.1600) was just introduced and would protect healthcare workers and supports jailtime penalties of up to 10-20 years for assault of healthcare workers while they are trying to fulfill their duties depending on severity.

In South Carolina, the Healthcare Workplace Security Act, (H. 3480), would strengthen penalties for assault and battery against health care workers in health care facilities and protect a victim’s personal address by using the facility address in related legal documents. This act defines offenses and outlines penalties including financial and jailtime requirements based on the offense.

The Helping Alleviate Lawful Obstruction (HALO) Act would make it illegal for someone to impede the job of a first responder. If a person is threatening or harassing a first responder, they would be charged with a misdemeanor, face fines, and jailtime. Recently Senator Jeff Zell took to social media to advocate for the work that Prisma is doing with simulation to train their staff. We need to all follow Jeff Zell and keep this momentum going as this support is very encouraging and hopefully the bill will pass this year.

What can academia do to help?

Nursing education has an important role in preparing students for reality without teaching them that abuse is acceptable.

·      Integrate workplace-violence prevention throughout the curriculum, rather than limiting it to a single lecture.

·      Use simulation to help students recognize escalating behavior, communicate therapeutics, call for assistance early, use personal safety strategies, and document incidents.

·      Debrief violence-related simulation experiences in a psychologically safe way, helping students distinguish between compassionate care and tolerating unsafe behavior.

·      Teach students how and when to report threats, verbal aggression, physical assaults, and near misses.

·      Partner with clinical agencies so students understand the safety procedures, reporting pathways, and support resources available at each practice site.

·      Model a clear professional message: a patient’s illness, trauma, intoxication, or distress may help explain behavior, but it does not excuse violence.

We must give future nurses the language and confidence to say, “This behavior is not acceptable.” Hospitals cannot possibly train all their staff but if we all commit to preparing the future nurses of SC and beyond, we can work to improve prevention.

What can clinical practice do to help?

Clinical leaders and organizations should treat workplace violence as a safety and quality issue. OSHA recommends a comprehensive prevention program built on leadership commitment, employee participation, hazard assessment, prevention and control measures, training, recordkeeping, and program evaluation.

·      System of reviewing incidents per unit for quality improvement.

·      Adequate staffing including public safety support and ability to support each other

·      Implementing panic alarms, accessible exits, lighting, visibility, visitor-management practices, and unit-specific safety planning.

·      Providing regular, scenario-based simulation training on prevention, de-escalation, team communication, and emergency response.

·      Offering prompt medical, emotional, and administrative support after an incident.

·      Closing the loop: staff must know that reports lead to review, action, and follow-up.

The call to action

The goal is not to make nurses fearful of caring for people in crisis. The goal is to create health care environments where compassion and safety exist together.

Nurses are advocates for patients every day. We must also advocate for the people who provide that care. Workplace violence prevention belongs in nursing education, organizational leadership, policy conversations, and daily clinical practice. Awareness is necessary, but it is no longer enough. It is time to build systems that make safety visible, expected, and nonnegotiable.