Abstract
Violence against nurses is a nationwide problem that has set the stage for unhealthy work environments and has driven nurses away from patient care. So, what can be done to retain our nurses and provide safer work environments? By creating an all-inclusive toolkit for managing violent and aggressive patients, this healthcare organization has made great strides to better protect their nurses.
Impact: To address this problem head on, evidence-based practices were used to develop an all-inclusive toolkit to implement a multifaceted approach to assessment, de-escalation, and allocation of resources. This approach took the guesswork out of what steps to take when assessing and managing aggressive and violent patients. An evidence-based assessment tool was implemented to guide the interventions of the nurse. A patient escalation algorithm was also created to aid the nurse in applying each of the available resources at the right time during the patient’s care. Visual alerts through discreet signage and safety banners within the electronic health record (EHR) added an additional layer of awareness for staff safety. Further, a three-tiered approach to manage patients at all spectrums of escalation was created. This tiered approach included a Bedside Escalation Huddle, Behavioral Emergency Response Team (BERT), and Code Charlie. Lastly, formal de-escalation training was incorporated into staff education to equip those providing patient care with the knowledge needed to enact these steps.
Outcomes: Looking at data from 6 months pre-implementation and 6 months post-implementation of the toolkit, there was a reduction of 3.74% in staff assaults across all inpatient units within the health system. Although slight, this reduction took place even amid increased awareness for staff to report all incidences of violence. For instance, it was estimated that there was a high rate of underreporting of assaults prior to this work. Through this implementation, there was a heavy push for staff to report all assaultive events. These contributing factors glean insight into the positive impact this implementation made on the overall reduction in staff assaults and that the overall percentage of reduction is likely much higher.
Implications: Nursing assaults are a nationwide, hot topic across healthcare systems, professional nursing organizations, and legislative leaders. This prevalent issue impacts multiple arenas in healthcare including the nurse’s ability to maintain their wellbeing, engagement, and quality of care. The downstream effect of these issues leads to increased costs for healthcare organizations.
Practical Takeaways: This toolkit can be spread across multiple clinical settings and adapted to meet the needs of each organization. Due to the push for zero tolerance for violence, the expectation of reporting all assaultive events was communicated among the care team. This likely increased reporting post-implementation which could have skewed the data to represent less of a reduction than truly took place. By creating an all-inclusive toolkit for managing violent and aggressive patients, nurses and other healthcare staff can be better protected through safer workplace environments.
Notes
Presenter notes available in attached slide deck.
Reference list included in attached slide deck.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Workplace Violence, Prevention of Violence in the Workplace, Workplace Violence -- Prevention and Control, Program Development, Rapid Response Team
Recommended Citation
Williamson, Brittney L. and Rouse, Melissa, "An All-Inclusive Toolkit for Managing Workplace Violence in Healthcare" (2026). Creating Healthy Work Environments (CHWE). 61.
https://www.sigmarepository.org/chwe/2024/presentations_2024/61
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-19
An All-Inclusive Toolkit for Managing Workplace Violence in Healthcare
Washington, DC, USA
Violence against nurses is a nationwide problem that has set the stage for unhealthy work environments and has driven nurses away from patient care. So, what can be done to retain our nurses and provide safer work environments? By creating an all-inclusive toolkit for managing violent and aggressive patients, this healthcare organization has made great strides to better protect their nurses.
Impact: To address this problem head on, evidence-based practices were used to develop an all-inclusive toolkit to implement a multifaceted approach to assessment, de-escalation, and allocation of resources. This approach took the guesswork out of what steps to take when assessing and managing aggressive and violent patients. An evidence-based assessment tool was implemented to guide the interventions of the nurse. A patient escalation algorithm was also created to aid the nurse in applying each of the available resources at the right time during the patient’s care. Visual alerts through discreet signage and safety banners within the electronic health record (EHR) added an additional layer of awareness for staff safety. Further, a three-tiered approach to manage patients at all spectrums of escalation was created. This tiered approach included a Bedside Escalation Huddle, Behavioral Emergency Response Team (BERT), and Code Charlie. Lastly, formal de-escalation training was incorporated into staff education to equip those providing patient care with the knowledge needed to enact these steps.
Outcomes: Looking at data from 6 months pre-implementation and 6 months post-implementation of the toolkit, there was a reduction of 3.74% in staff assaults across all inpatient units within the health system. Although slight, this reduction took place even amid increased awareness for staff to report all incidences of violence. For instance, it was estimated that there was a high rate of underreporting of assaults prior to this work. Through this implementation, there was a heavy push for staff to report all assaultive events. These contributing factors glean insight into the positive impact this implementation made on the overall reduction in staff assaults and that the overall percentage of reduction is likely much higher.
Implications: Nursing assaults are a nationwide, hot topic across healthcare systems, professional nursing organizations, and legislative leaders. This prevalent issue impacts multiple arenas in healthcare including the nurse’s ability to maintain their wellbeing, engagement, and quality of care. The downstream effect of these issues leads to increased costs for healthcare organizations.
Practical Takeaways: This toolkit can be spread across multiple clinical settings and adapted to meet the needs of each organization. Due to the push for zero tolerance for violence, the expectation of reporting all assaultive events was communicated among the care team. This likely increased reporting post-implementation which could have skewed the data to represent less of a reduction than truly took place. By creating an all-inclusive toolkit for managing violent and aggressive patients, nurses and other healthcare staff can be better protected through safer workplace environments.
Description
Violence against nurses is a prevalent issue that negatively impacts the well-being of nurses and their ability to deliver quality care. Workplace violence hinders teams from establishing healthy work environments. Learn more about how this healthcare organization successfully reduced their staff assaults by implementing practices to keep their nurses safe.