Nurses are on the frontlines of healthcare and are uniquely vulnerable to verbal and physical abuse in the workplace. The American Association of Critical-Care Nurses (AACN) is dedicated to creating a safe and healthy work environment, where acute and critical care nurses make their optimal contribution. The AACN Standards for Establishing and Sustaining Healthy Work Environments calls for zero tolerance regarding bullying, verbal abuse, and other forms of institutional violence. Sadly, the incidence of verbal abuse and physical assaults, including shootings and other physical violence, is at a level that requires focused attention.
The U.S. Occupational Safety and Health Administration reports that from 2002 to 2013, incidents of serious workplace violence were, on average, four times more common in healthcare than in private industry. Patients are the primary source of violence in healthcare settings, but assaults by visitors and coworkers were also reported. According to AACN’s 2018 Critical Care Nurse Work Environment Survey, 88 percent of respondents who worked in hospitals that had not implemented the Healthy Work Environments Standards experienced at least one incident of sexual harassment, discrimination, verbal abuse, or physical abuse. Unfortunately, research indicates that many violent incidents go unreported, even when policies and procedures for reporting are in place. Nurses not only face the danger of violence during interpersonal interactions, but the hospital environment is also subject to violent incursions such as hostage situations, terrorism, and active shooters.
Healthcare facilities are responsible for ensuring the safety and security of staff, patients, and visitors. AACN calls upon healthcare institutions to have clear and widely circulated policies and procedures regarding both the violence that occurs within the daily functioning of the hospital and the threat from outside incursions. Institutions nationwide should require violence prevention plans to be in effect at all times in all patient care units, including inpatient or outpatient settings and clinics. Additionally, we urge all nurses, physicians, and allied health professionals to report every incident of workplace violence and to maintain their knowledge of safety policies, procedures, and crisis plans.
Recommended Actions for Healthcare Institutions:
- Educate staff on how to recognize the potential for violence, how to employ de-escalation techniques, and how to seek assistance to prevent or respond to violence.
- Establish a clear and consistent reporting structure for workplace violence, with specific policies and procedures on how to report violent incidents to law enforcement.
- Encourage employees to press charges against persons who assault healthcare workers, and support staff who do. Many states have established laws with enhanced penalties for these offenses.
- Provide resources and support programs for employees to help them cope with violent incidents.
- Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.
- Ensure the presence of sufficient security systems, including alarms, emergency response, and available security personnel.
- Barden C, Cassidy L, Cardin S, eds. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments. Accessed December 22, 2018.
- Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical care nurse work environments 2018: findings and implications. Crit Care Nurse. 2019;39(2):67-84.
- U.S. Department of Labor, Occupational Safety and Health Administration. Worker safety in hospitals: caring for our caregivers. https://www.osha.gov/dsg/hospitals/workplace_violence.html. Accessed December 22, 2018.
- The Joint Commission. Workplace violence prevention resources for health care. https://www.jointcommission.org/workplace_violence.aspx. Accessed December 22, 2018.