April 2, 2024 | 7 minute

Workforce Violence Prevention for CNOs

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Violence in healthcare is an epidemic.

  • 1 in 4 nurses has experienced assault.
  • 7 in 10 ER nurses have been hit or kicked.
  • 2 nurses get assaulted every hour.
  • 57 assaults happen each day across the nation.
  • OSHA reports workplace violence is 5 times more likely to happen in hospitals.
  • 5200 nursing personnel were assaulted in the second quarter of 2022.

These sobering statistics illustrate the seriousness of the problem and the need for immediate, effective solutions. Nurses have the right to feel safe at work. Many who quit the profession cited increased instances of violence as one of their main reasons for leaving the healthcare field.

This epidemic is something all healthcare systems must address. At, we work every day – alongside our industry experts like CNO Dr. Rhonda Collins – to provide modern solutions to help solve workplace violence, along with the vital role of AI analytics and wearable badges outfitted with duress buttons that employees can use to signal for immediate assistance.

What Is Workplace Violence?

The Joint Commission defines workplace violence as “an act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.”

Plus, the Joint Commission has produced guidelines for hospitals to follow to set safety protocols in motion. Your health system can use these as a starting point for creating your own that work for your facility.

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Types of Workplace Violence

Workplace violence comes in many forms, but all disrupt the work site and cause harm. Sometimes it is physical violence, threats, or even homicide. Other times it’s harassment, intimidation, or verbal assaults. Whatever form it takes, workplace violence hurts the employees, patients, clients, and visitors who experience it. The CDC has broken workplace violence down into four categories to make it easier to create safety protocols:

  • Type I: Criminal intent where the perpetrator has no legitimate relationship to the business or its employees. This includes violence with guns and other weapons.
  • Type II: Customer/Client which is the primary concern in healthcare.
  • Type III: Worker on Worker, or lateral violence. Examples include yelling, bullying, and degrading.
  • Type IV: A personal relationship where a domestic violence situation shows up at work.

Most healthcare entities work with Type II and Type III. These are the categories of priority when creating a program for workplace violence in a healthcare setting.

Reducing Risk Factors for Workplace Violence

The Joint Commission has outlined a set of actions for reducing workplace violence that include developing procedures and protocols, improving training and reporting, and making changes to the physical environment.


For a long time, there was the assumption that patients and families would get out of hand and nurses would just have to put up with their bad behavior. However, violence does not “come with the territory” of working in healthcare. Leadership must solve this problem and implement a zero-tolerance framework for violence with no exceptions.

Workplace violence in healthcare is severely under-reported, with as many as 80% of aggression events kept silent by employees fearing reprisal, blame, or loss of work. Many say they get ridiculed for complaining because the attitude is they need to learn to deal with this type of behavior from patients. Solving the problem must include destigmatizing the reporting process with policies that reinforce the zero-tolerance stance at every level.

The single most effective way to manage workplace violence is through effective leadership. By studying the issues and coming up with policies and protocols, leaders in healthcare systems can create a safe and productive work environment through ownership and accountability. Part of this is by standing up and refusing care to patients who repeatedly demonstrate aggressive behavior to enforce the zero-tolerance policy.


Changing the structure of the facility through a redesign of the physical space, educated responses, and protocols can have a profound impact on safety.

Patient Flow

Sometimes congestion can cause problems. Identifying bottlenecks and restructuring patient flow to avoid lengthy delays can help avoid high-tension situations.

Another important factor is the early identification of concerns with patient assessments. Patients who show a tendency for aggression get a note in their documentation to provide all employees with a heads-up. Everyone understands there is a potential issue and can respond and report accordingly. Communication is key here. Employees should never keep knowledge of aggressive behavior to themselves.

Response Plan

Having a plan in place that details who responds to duress calls is critical. Identify who among your security team and other departments must respond to a call, along with how many people respond.

You can seek out professional guidance from consultants and your local law enforcement to help you put an effective response team in place. Always communicate clearly to identify each person’s role and responsibility. Evaluate your metrics frequently to determine how many events took place, the response time, and the outcomes.

Policies and Protocols

Many employees don’t know how to respond in violent or aggressive situations. Education is critical to ensure they have the appropriate training and understand who to call, who responds, and other essential details. Create defined, specific protocols for different events. For example, the policy for responding to a shooter and responding to an aggressive and disoriented patient are very different.

When Protocols Alone Are Not Enough

Having a policy in place to handle workplace violence isn’t always enough. Many times, employees need immediate help. It only takes a fraction of a second to hit someone or to knock someone out. What can an employee do when they see a situation getting out of hand and need to alert multiple people that an urgent situation is occurring?

The most efficient and effective solution is enabling clinicians and staff to do what needs to be done at the moment by pressing a button that can reduce the response time from minutes to seconds, or faster. Technology solutions designed to prioritize safety elevate your facility’s protocols by getting critical information about a threat to the right people. At, that’s what we focus on. We provide a platform that uses AI and IoT technologies to enhance your policy.

The Role of Technology: Solutions from

Using’s real-time, cloud-based platform, any staff member can simply use the one-touch duress button located on their badge to summon help. The location data provides room-level accuracy, even if the employee is in motion, in real time.

This solution is much more effective than older methods of emergency communication like nurse calls, yelling for help, and even using smartphones. The duress signal summons security and other designated response team members with a vibration alert instead of an audible alarm, which can further escalate an already precarious situation.

Beyond enabling fast response to emergency alerts,’s AI-powered analytics reveal high-risk areas and times, helping you improve security protocols and prevent incidents before they happen.

Chaotic, unpredictable work environments can take a toll. Now more than ever, we must protect the physical, mental, and emotional well-being of our clinicians. Nurses just want to feel safe at work. This is their right and is a basic requirement for all of your employees to have the capability to function at their highest level and provide quality care. Technology such as’s staff safety solution summons help immediately, so employees don’t face dangerous situations alone while they wait for help to arrive.