1. Virkstis, Katherine ND
  2. Taylor, Jennifer MSN, RN
  3. Bala', LouAnn MSN, RN


A leader should create an environment in which everyone feels safe. Yet, there is a rising, deadly epidemic in healthcare on the heels of the COVID-19 pandemic: workplace violence. Healthcare workers, particularly nurses, are at a far higher risk of violence on the job compared with most other professions. Leaders have the power to reverse this trend by sounding the alarm, doubling down on their commitment to workplace safety organization-wide, and taking a comprehensive approach that integrates high-tech with high-touch strategies.


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Nurses and other members of the healthcare team strive to promote a safe, healing environment. Ironically, they experience the highest rates of injuries caused by workplace violence and are 5 times as likely to get injured at work than all other workers.1 These incidents have risen nearly every year since the Bureau of Labor Statistics began tracking them in 2011.2 While tragic stories about hospital shootings continue to make news headlines, less visible safety threats are both pervasive and underreported, indicating that the actual rate of violence is even higher. Safety threats can impair effective patient care and lead to psychological distress, job dissatisfaction, absenteeism, high turnover, and higher costs.1


The degree to which the COVID-19 pandemic has exacerbated the problem is not yet clear, but some factors could be contributing to an environment in which everyone is at greater risk. For example, the mental strain experienced by many during this time has lowered thresholds for confrontation.3 Social distancing and personal protective equipment have negatively affected interpersonal connections, muffling sounds and covering facial expressions that facilitate comprehension during live communication,4 thus affecting the ability to spot nonverbal cues or early warning signs of escalating behavior.


The Joint Commission revised workplace prevention standards in January 2021. The accreditation manual now defines workplace violence as "an act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors."1


Technology an Important Tool for Improving Workplace Safety

Given the size and scope of the challenge, leaders will not be able to decrease violence and point-of-care safety threats without the use of technology. The next wave of digital and smart technology can help reduce the risk of manual errors and missed reports, make safety and security more transparent, enable more effective communication, help track the location of individuals, add a layer of fail-safe security measures in case incidents do occur, and make it easier and faster to understand lessons learned.5


* Rounding tools and electronic smart room monitors can be integrated with the electronic health records to identify early warning signs and alert staff of safety risk indicators or interventions before they walk into a patient's room.


* Consumer-centered mobile apps improve patients' experience, keep them informed, and provide another channel for communicating with care teams.


* Wearable devices can monitor employees' vital signs and provide real-time information about the health and safety of employees working in various locations. They can alert a network of emergency contacts, avoiding the need to unlock a mobile phone, open an app, or make a call in high-risk situations. Duress buttons combined with press patterns can differentiate early warning signs from urgent threats.


* Artificial intelligence (AI) uses algorithms on historical data to recognize patterns, detect anomalies, and facilitate early identification of safety threats. Video analysis software can use existing video cameras and AI to predict hazardous situations and use alerts to protect staff from incidents before they occur.


* Mass notification software can alert entire units, floors, or facilities of an incident or hazard. Keeping people informed before, during, and after critical events can make the difference between a hazard and a serious incident.


* Workplace safety reporting software and mobile apps enable teams to streamline and speed up their reporting, including hazards and near-misses, by logging the information quickly and accurately. The smooth execution of these activities improves transparency of safety concerns and can significantly improve overall safety by reducing the likelihood of incidents occurring.


* Immersive and virtual reality training tools use advanced machine learning models to simulate the reality of the work environment and allow employees to receive training from anywhere and at any time. Sessions consist of real scenarios without real-life risks, and a gamified structure increases engagement.



Combine High-Tech With High-Touch

Even the smartest technology is only effective with targeted human intervention. For example, a critical component of an alarm system is the ability to always respond when an alarm is triggered. Leaders should build a comprehensive plan that combines "high-tech" with "high-touch" strategies.


* Raise awareness. Communicate a zero tolerance policy that outlines standards of unacceptable behavior and appropriate consequences. Educate patients, families, and staff about safety policies. Collect data on point-of-care violence and inform leaders of incidents and trends with a monthly report. Follow every incident with an assessment to learn what could have been done differently.6


* Empower staff to recognize and report toxic, threatening, and abusive behavior. Provide training and tools that help identify early warning signs and intervene before behavior escalates. Train all staff about de-escalation techniques, and make resources readily available when needed.7


* Reduce response time to safety threats by positioning responders nearby. Formalize a process for security personnel to "round" on units and where potential safety issues have been flagged. Embed a rapid response team of trained staff who can respond in the moment.7



Make Workplace Safety a KPI for All Leaders

Leaders have an opportunity that is powered to a meaningful degree by technology yet centered on human connection and one that explicitly rejects the notion that violence and safety threats are "part of the job." Healthcare executives must elevate the safety of the care environment to the top of their organization's system-wide strategic plan and make it a key performance indicator for leaders at all levels.




1. The Joint Commission. Workplace violence prevention standards. In: R3 Report. Accessed November 12, 2022. [Context Link]


2. US Bureau of Labor Statistics. Injuries, illnesses, and fatalities. Accessed November 12, 2022. [Context Link]


3. Michail J. Strong nonverbal skills matter now more than ever in this "new normal". Forbes. Accessed November 12, 2022. [Context Link]


4. Griffiths J. Why embracing tech can boost safety and productivity for your team. Security. Accessed November 12, 2022. [Context Link]


5. Bala L, Taylor J, Virkstis K. Get Well Incivility Toolkit: Creating a Culture of Respect. Bethesda, MD: Get Well Network; 2022. [Context Link]


6. Meier A, Evans R, Erickson J. Strengthening a culture to address bullying and incivility in the care environment. J Nurs Adm. 2021;51(10):475-477. Accessed November 12, 2022. [Context Link]


7. Lucea M, Virkstis K. Rebuild the foundation for a resilient workforce. Accessed November 12, 2022. [Context Link]