Strategies and Tips for Violence Prevention for Nurses, Nurse Practitioners, and All Patient-Facing Healthcare Roles

In many healthcare facilities, the most direct contact with patients comes from nurses/nurse practitioners and physician assistants. This also means that when patient violence occurs they are often the targets, and in recent years the healthcare industry has seen a troubling escalation in violence against this dedicated workforce. Being on the frontlines of patient care, which ironically is the reason that so many get into the profession, has them increasingly facing mistreatment ranging from intimidation and verbal abuse to physical assaults. According to a survey by Premier, 40% of healthcare workers experienced an incident of workplace violence in the last two years. This growing and disturbing trend necessitates a heightened emphasis on violence prevention strategies to ensure the safety and well-being of healthcare professionals. As we reflect on the challenges of the past year, it becomes evident that cultivating a culture of vigilance is crucial for the protection of those who provide essential care.

40% of healthcare workers experienced an incident of
workplace violence in the last two years

The Escalation of Violence

The statistics highlight a rising tide of violence in healthcare settings. Contributing to this surge are amplified stress levels, longer wait times, the shortage of healthcare providers, substance abuse issues, and the emotional nature of healthcare interactions. Further aggravating these challenges was the pandemic. In fact, hostilities and violent occurrences increased significantly during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 per 1000 visits) and to the previous year (1.24 incidents per 1000 patient visits). A higher incidence of assault during the pandemic compared to before was also reported by healthcare personnel. The unfortunate truth we are facing is that healthcare providers must prepare themselves for the possibility of workplace violence through awareness, preparation, and training.

Strategies You Can Use for Violence Prevention

1. Awareness of Your Surroundings

One of the basic essentials for violence prevention is purposefully increasing environmental awareness. Assess your surroundings regularly and pay attention to your situation at all times; make this a routine part of your workflow. This includes identifying potential areas of vulnerability and ensuring escape routes are easily accessible. In the event of a dangerous situation, it is vital to know how to get out and where to go to find safety. Make sure you know the location of exits and areas that can provide safety and protection. Avoid being in poorly lit and/or isolated areas when alone.

2. Observing Patient Behaviors

Be attuned to patient behaviors and not only be able to recognize warning cues, but also regard them as such. Early intervention can help de-escalate situations before they turn violent. Remember, the risk of violence grows with the number of cues present. Warning signals can include:

Verbal:

• Yelling, speaking loudly
• Swearing
• Aggressive tone

Non-verbal:

• Breathing heavy
• Fist clenching
• Crossing arms over chest
• Pacing, agitation
• A frightened look; fear, high anxiety
• Fixed staring
• Aggressive posture
• Throwing objects
• Sudden behavior changes in behavior
• Signs of drunkenness or substance abuse

3. Self-Awareness and De-escalation Techniques

Be mindful of your own behaviors and communication style. When aiming to de-escalate a potentially violent situation, use an even, composed, and soothing tone of voice. Focus on maintaining a calm and empathetic manner. Keeping eye contact can help establish a connection with the patient. And avoid any confrontational or aggressive language or actions, focusing on being non-threatening and respectful. All these techniques can help to reduce tension and prevent the situation from escalating further.

4. Establishing Boundaries

Clearly communicating boundaries is important in preventing violence. You should assertively and clearly communicate your expectation of respectful behavior from patients and their families. Signage, written notices, and verbal communication can help to reinforce this. In a tense situation, giving a reasonable and specific limit and letting them know that if crossed, you will escalate the situation, can help. For example, a patient who is angry and is shouting at you can be told that if they continue you will have to leave the room, or if they are walking angrily toward you, let them know if they cross an area, say past a point in the room, that you will call the police. Note that you want the limit to be reasonable and measurable, as opposed to something nebulous, for instance telling the patient if they become any more irate you will take action. It’s not always easy to know if someone is getting more upset or not.

5.  Preparedness Training

Formal emergency prevention programs designed to train front-facing healthcare workers on techniques and procedures in de-escalating potentially harmful or violent situations is something every provider should undertake. This can include practicing emergency response procedures, i.e., using panic buttons, calling for assistance, and knowing when to involve security or law enforcement. Whether provided by your employer or something you seek out on your own, it’s an important measure to take for your safety. Readiness helps to provide confidence and can increase your ability to respond quickly and effectively.

6. Recognize When Further Measures and Assistance is Needed

If patients cross the boundaries you’ve set, it’s important to escalate the situation to the next level. This may mean calling security or this may mean calling law enforcement in, locking yourself in another room, or even evacuating the premises. Have your escalation strategies confirmed and clear so you know when to put a plan in motion.

Your Safety is the Bottom Line

A proactive and comprehensive plan for prevention is imperative as violence against healthcare workers continues to grow. Nurses and physician assistants who are among those at the front of patient care, need to be equipped with the knowledge and the tools to manage potentially dangerous situations. By having environmental awareness, being able to recognize patient behavior, cultivating self-awareness, and having escalation plans in place and clearly understanding them, you can help create a safer environment for yourself and others. As we acknowledge the challenges faced in the past year, let us collectively commit to a culture of vigilance and prevention, ensuring that we can carry out our vital roles with the security and respect they deserve.