By Dawn Whiteside
Nearly a decade ago, the American Nurses Association (ANA) updated its position on workplace violence, declaring that “nurses must be afforded the same level of respect and dignity as others” (ANA, 2017). In the seven years since the ANA launched its #EndNurseAbuse pledge, the nursing profession has taken a firm stance: violence of any kind, from any source, is unacceptable.
Nurses and employers across all settings – clinical, academic, and research – must work together to foster a culture of respect, free from incivility, bullying, and violence. Yet, recent data reveals just how urgent this issue remains. According to National Nurses United (NNU), over 80% of nurses experienced at least one form of workplace violence in 2023, and more than 45% reported an increase in violence on their specific units (NNU, 2024).
Whether treating patients who have experienced trauma or recovering from it themselves, nurses need support. One such intervention is Psychological First Aid (PFA), an early psychosocial approach that helps reduce acute stress and promotes adaptive coping mechanisms in individuals following trauma (Vernberg et al., 2008).
PFA is endorsed by the World Health Organization (WHO) and focuses on listening without forcing disclosure, identifying and addressing immediate needs, and encouraging connection to personal support systems (Figueroa et al., 2024). The Hobfoll model of PFA highlights five essential elements: safety, calm, self-efficacy, connectedness, and hope. This model utilizes techniques such as active listening, relaxation strategies, problem-solving, and fostering social connections. Remarkably, even a single session has shown reductions in anxiety, depression, and PTSD symptoms (Figueroa et al., 2024).
Still, the best way to reduce workplace violence is through prevention.
The Occupational Safety and Health Administration (OSHA) mandates that all healthcare organizations implement a workplace violence prevention plan. These plans must consider unit-specific risk factors, including patient population, staffing levels, and the surrounding environment (NNU, 2024). An effective assessment should include walkthroughs of care areas, frontline staff input, and a thorough review of prior incident reports.
Following this assessment, hospitals should adopt behavioral, administrative, and environmental strategies, such as identifying high-risk patients, installing security cameras and metal detectors, and limiting visiting hours. In one study, implementing such strategies led to a 50% decrease in violent incidents (NNU, 2024).
Despite these promising interventions, employer responses to violence remain inconsistent. According to a 2023 NNU survey:
• 42% investigated reported incidents
• 28% offered counseling
• 43% implemented training or retraining
• 21% made procedural changes
• 17% discouraged reporting
• 29% blamed the employee
• 45% ignored the report altogether (NNU, 2024)
Worse still, only 10% of respondents said their employers had implemented any preventive measures at all. Many facilities still view violence as an unfortunate but a normal part of the job.
A complicating factor is that approximately 90% of violent incidents are perpetrated by patients. When a patient’s medical condition contributes to violence, it can be difficult for law enforcement to intervene, as establishing intent is challenging (NNU, 2024).
Despite these obstacles, it is essential that healthcare institutions not only have a workplace violence prevention plan but also ensure it is transparent, actionable, and developed with input from those on the frontlines.
PFA, though originally developed for humanitarian crises, is proving to be a critical tool in addressing the trauma of workplace violence in healthcare. As nurses continue to face this growing threat, they must be equipped not only with clinical skills but also with the psychological support systems to care for themselves and each other.
– Dawn Whiteside, DNP, MSN-Ed, RN, CNOR, NPD-BC, RNFA is the Director of Education and Professional Development of the Competency & Credentialing Institute. Dr. Whiteside has over 35 years of experience as a perioperative nurse in many roles including circulator, scrub, first assistant, team leader, charge nurse, manager, and educator. She serves on the ABSNC Board of Directors as well as the editorial board for OR Today. As an educator, Dr. Whiteside is passionate about developing educational materials for all members of the perioperative team.
References
American Nurses Association (ANA). (2017). Take the pledge to #EndNurseAbuse. https://www.myamericannurse.com/take-pledge-end-nurse-abuse/
Figueroa, R. A., Cortés, P. F., Miller, C., Marín, H., Gillibrand, R., Hoeboer, C. M., & Olff, M. (2024). The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: Results of a randomised controlled trial. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2364443
National Nurses United (NNU). (2024). High and rising rates of workplace violence and employer failure to implement effective prevention strategies is contributing to the staffing crisis. nationalnursesunited.org/sites/default/files/nnu/documents/0224_Workplace_Violence_Report.pdf
Vernberg, E. M., Steinberg, A. M., Jacobs, A. K., Brymer, M. J., Watson, P. J., Osofsky, J. D., Layne, C. M., Pynoos, R. S., & Ruzek, J. I. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39(4), 381–388. doi:10.1037/a0012663
