Workplace violence prevention in healthcare, as highlighted by new research in AACN Advanced Critical Care, must move beyond de-escalation training to address systemic issues such as staffing, organizational culture, and ethical care delivery.
Efforts are falling short because they focus too heavily on individual incidents rather than the systems that shape them.
Five Topics Overlooked in Workplace Violence Discussions in Health Care Settings outlines five critical yet often underrecognized factors, particularly in non-psychiatric units, and argues that meaningful progress requires a shift in both practice and culture.
Co-author Kathleen Delaney, PhD, APRN, PMHNP, FAAN, professor emeritus at Rush University College of Nursing in Chicago, says current approaches do not go far enough.
“No one should believe violence or physical assault is part of the job, and we must look beyond preventing individual incidents to addressing the organizational structures, staffing models, and cultural expectations that shape systemic issues,” she said. “We need a paradigm shift beyond current approaches, if we truly want to create safer hospitals, support nurse retention and honor the ethical imperative to provide care in a manner that is safe, compassionate and just.”
A Shift Beyond De-Escalation Training
Workplace violence prevention strategies have largely focused on training clinicians in de-escalation techniques. However, a technique-driven model does not fully reflect the complexity of real-world care environments.
Instead, the authors argue for principle-based approaches, including patient-centered and trauma-informed care.
Reframing Workplace Violence as Core Nursing Practice
The research also explores how nurses perceive workplace violence prevention within their evolving scope of practice, and recommends reframing it as an integrated part of nursing care rather than an added responsibility.
Ethical Tensions at the Bedside
Nurses are often forced to balance their duty to care for patients with the need to maintain personal and workplace safety, creating difficult decision points in high-risk situations.
The Role of Patient Engagement
Gaps remain in current prevention strategies, including limited emphasis on patient engagement and relational skills, which can help reduce perceived threats before situations escalate.
Organizational Barriers and Unintended Consequences
Organizational barriers continue to pose challenges. Insufficient staffing and lack of teamwork can undermine prevention efforts, while overly risk-averse environments may lead to an overreliance on security measures and punitive policies rather than proactive, care-centered solutions.
