1. Cross, Casey BSN, RN

Article Content

As a nurse with more than 11 years of experience in pediatric critical care, I would like to offer an additional perspective on the June issue article "Responding to an Active Shooter and Other Threats of Violence" by Sandra Kenney Weeks, MSN, RN, CRRN, NEA-BC; Bridget Tillman Barron, BSN, RN-BC; Marilyn Ray Horne, CEH, MESH; Gayle Perdue Sams, MSN, RN, CCRN, CEN, CNML; April Bennett Monnich, RN-BC, CMSRN; and Denise L. Alverson, RN. Although violence is undoubtedly a complex problem in adult hospitals, these issues are compounded by many factors in pediatric facilities, including whether the aggressor is the child or an adult who functions as the child's primary caregiver and, if the perpetrator is an adult, what additional steps need to be taken to ensure he or she is transferred to a facility equipped to care for him or her.


Having spent many years in the pediatric hospital setting, I'm confident pediatric facilities are equipped to stabilize adults in accordance with all applicable laws, but how far do we intervene after we're certain the child is safe? Does the situation change if the perpetrator is a child? This article was very enlightening and raised some serious questions for the nursing community related to appropriate actions when confronted with these situations in children's hospitals.


Although few reports discuss the incidence of children as violent perpetrators in the hospital setting, one study determined that exposure to violence in the media during early childhood has a significant impact on social interactions and development as children mature. Recognizing these symptoms is pivotal to the prevention of associated violent behaviors as the children we care for grow into young adulthood.


As leaders, we should always empower our nurses to first care for themselves in these violent, emergency situations. One article describes strategies to recognize signs of pending violence and additionally references the importance of annual training not only for all employees, but also for students and other nonemployee clinicians who spend time in the hospital setting. Although not explicitly stated in the article, I would propose there are inherent benefits in continuing the training program described on an ongoing or annual basis.


Casey Cross, BSN, RN