1. Stockwell, Serena


Document includes steps institutions can take to protect and prepare staff.


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The Joint Commission has issued a Sentinel Event Alert to help health care workers recognize, prevent, and manage physical and verbal violence from patients and visitors. The document, released in April during Workplace Violence Awareness Month and directed mostly at Joint Commission-accredited organizations, notes that health care workers are four times more likely to experience violence than workers in private industry.

Figure. Nurses gathe... - Click to enlarge in new window Nurses gather at Kane County Judicial Center in St. Charles, Illinois, last summer for the Stop Assaults on Medical Professionals Rally in response to an incident in which two nurses were assaulted by a patient. Photo by Sandy Bressner / Shaw Media.

The alert lists risk factors that increase the likelihood of violence. These include patients with altered mental status owing to dementia, delirium, intoxication, or mental illness; long wait times or overcrowding in health care facilities; understaffing; lack of workplace policies and training in how to recognize and deescalate hostile situations; inadequate emergency communication systems; and the presence of firearms or potentially volatile patients in police custody.


"Leadership needs to make the safety of health care workers a top priority," Joint Commission chief medical officer Ana Pujols McKee said in a statement. "When violence occurs, it should be immediately reported to leadership, internal security, and, as needed, to law enforcement. Such reporting can help health care organizations analyze what happened and inform actions that need to be taken to minimize risk in the future."


The American Nurses Association (ANA) applauded the alert. ANA president Pamela F. Cipriano said it reinforced "the urgency to halt the cycle of harm," adding that the Joint Commission's recommendations to employers were especially welcome. "Evidence indicates that barriers to reporting exist and hamper progress despite the presence of 'zero tolerance' policies," Cipriano said.


Cipriano also noted that the association has long spoken out about the problem and worked to solve it. Examples include a professional issues panel convened in 2015 to address incivility, bullying, and workplace violence (, the 2017 launch of the #EndNurseAbuse campaign (, and, most recently, a panel in the works that will focus on barriers to reporting abuse against nurses.


Donna Fountain, associate professor at the Long Island University School of Nursing in Brooklyn, New York, and a member of the advisory committee for the ANA's 2015 panel, says incidents and threats of workplace violence, particularly against nurses, can undermine patient care quality and safety. "Since RNs are vital in the provision of frontline patient care, nursing leaders, administrators, and human resources personnel must promptly address incivility and all forms of bullying such as cyberbullying, verbal and physical assaults, and other negative attacks," she told AJN.


Fountain's own research suggests that nurses who experience bullying may be less likely to engage with their work, which has consequences for patient care.-Serena Stockwell




Sentinel Event Alert. Oak Terrace, IL: Joint Commission 2018 Apr 16;