Workplace Violence: Staying Aware and Prepared

By: Melanie Perry, BSN, RN, CNOR, CSSM

Published: 3/13/2025

Nurses can be found in a variety of settings, but we all have something in common: patient care. But our proximity to patients puts us at an increased risk for assault and workplace violence. In fact, statistics show that one in four nurses are abused in the workplace and two nurses per hour are assaulted in the acute care setting.¹

Recent Events

Recently, we’ve been horrified as details have unfolded about the vicious attack on 67-year-old Leela Lal, a nurse at Palms West Hospital in Florida. She was attacked, unable to defend herself, beaten until she was unconscious, and suffered severe injuries that left her in critical condition with every bone in her face broken.

We’ve also heard about the shooting at UPMC Memorial Hospital in Pennsylvania where the gunman was upset that nothing more could be done for his terminally ill wife, and after being given the news, he “returned carrying a backpack with a firearm, zip ties and duct tape, and held staff members hostage before being killed in a shootout with police.”² An ICU doctor, a nurse, and a custodian suffered gunshot wounds and a police officer tragically lost his life in this incident.

These tragic events not only shake the entire health care community but also serve as a stark reminder of the vulnerability of nurses, including those of us in perioperative settings. While violence in emergency departments and psychiatric units is well-documented, as perioperative nurses, we also have to acknowledge the risks we face and learn how to mitigate them.

What It Means for Nurses

Workplace violence in health care settings includes physical assault, verbal threats, and even fatal attacks. The increasing number of incidents points to an urgent need for stronger safety protocols and better training for health care workers. This issue can be particularly concerning for novice nurses because they’re still adapting to the fast-paced surgical environment and focusing on everything they need to learn to be successful. But understanding potential threats, recognizing warning signs, and knowing how to respond effectively are crucial for personal safety and overall team security.

Key Strategies to Enhance Safety

All of us in the perioperative setting, whether we’re brand new or more “seasoned,” must be aware of workplace violence and take proactive measures that can help to enhance our safety. Here are some key strategies:

1. Situational Awareness is Key

a. Pay attention to patients, family members, or visitors exhibiting agitated or aggressive behavior (Table 1).

b. Trust your instincts—if something feels off, alert security or your supervisor.

2. Know Your Facility’s Safety Protocols

a. Familiarize yourself with hospital policies regarding workplace violence prevention and response.

b. Identify the locations of emergency exits and security call buttons within the OR and adjacent areas.

3. Communicate and De-Escalate³

a. If a situation is escalating, use a calm, non-threatening tone; additional de-escalation tips can be found in Table 2.

b. Avoid confrontation when possible and seek help whenever you feel the situation warrants it.

4. Participate in Workplace Safety Training⁴

a. Engage in crisis prevention training or self-defense workshops offered by your hospital.

b. Regularly attend drills for active shooter scenarios or emergency lockdown procedures.

5. Report All Incidents

a. Many violent incidents go unreported due to fear of retaliation or dismissal (according to the American Nurses Association, only 20-60% of events ever get reported¹). Don’t let fear keep you from reporting an incident. It is essential to document and report any threats or assaults to improve safety measures.

6. Advocate for Safer Work Environments

a. Join workplace safety committees or support initiatives that call for enhanced security measures, such as increased security presence or access controls in high-risk areas.

b. Download, read, and share the ANA’s #EndNurseAbuse Resource Guide.

Table 1. Examples of Agitated or Aggressive Behaviors

Behavior type	Example
Verbal	Raised voice or sudden changes in tone (e.g., from calm to yelling) Excessive complaints, arguing, or making unreasonable demands Threatening language, such as "You’ll regret this" or "I’ll make you pay" Blaming staff or making accusations of negligence Incoherent or pressured speech, indicating emotional distress or confusion
Nonverbal	Clenched fists, tense posture, or pacing Invading personal space, such as leaning too close to staff Sudden movements, such as jerking, pointing aggressively, or standing up abruptly Refusing to follow instructions or ignoring staff directives

Table 2. De-Escalation Tips

Tip	Example
Maintain a calm demeanor	Speak in a slow, steady, and reassuring tone.
Respect personal space	Stay one to three feet away to avoid escalating tension.
Use nonthreatening body language	Keep hands visible, avoid sudden movements, and maintain an open posture.
Practice active listening	Nod, make eye contact, and paraphrase concerns to show understanding.
Use clear and simple language	Avoid medical jargon; speak in short, direct sentences.
Validate feelings	Acknowledge the person's emotions with statements like, “I can see this is frustrating for you.”
Offer choices and control	Provide options to empower the individual (e.g., "Would you like to speak in a private room?").

Conclusion

Reports of violence against nurses and other health care providers are alarming. They shake us to our core and can erode our sense of safety and security. And unfortunately, it’s a harsh reality that we all must be prepared for. By staying vigilant, knowing facility protocols, and participating in safety training, we can protect ourselves and contribute to a safer surgical environment. Yes, hospitals must take responsibility for reinforcing security measures, but our individual roles are critical as well. Every nurse should feel safe and should be able to provide quality patient care without fear of danger or abuse. Through increased awareness, preparedness, and advocacy, we can work together to end nurse abuse.

	Periop Times Key Points
Event or Trend:	Rising workplace violence incidents in health care.
What This Means for You:	Increased need for situational awareness and preparedness in the perioperative setting.
Key Actions to Take:	Learn security protocols, recognize warning signs, participate in safety training, and report incidents.
Things to Watch:	Hospital policy updates, legislative efforts to enhance health care worker protection, and emerging security technologies.

References:

Amercian Nurses Association. End Nurse Abuse. Accessed March 8, 2025. https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/
Miller J, Boyette C. Gunman who held Pennsylvania hospital staff hostage felt more could have been done to save his terminally ill wife. CNN. February 26, 2025. Accessed March 8, 2025. https://www.cnn.com/2025/02/24/us/pennsylvania-hospital-shooting-motive/index.html
Yosep I, Mardihyah A, Hendrawati H, Hendrawati S. Interventions for reducing negative impacts of workplace violence on health workers: a scoping review. J Multidiscip Healthc. 2023;16:1409-1421.
Havaei F, MacPhee M, Lee SE. The effect of violence prevention strategies on perceptions of workplace safety: a study of medical-surgical and mental health nurses. J Adv Nurs. 2019;75(8):1657-1666.