Focus on health to reduce risk.
- Firearm violence is a widespread reality in the United States, yet nurses feel underprepared to discuss firearm safety with patients.
- Despite frequent exposure to risk disclosures, limited training and political sensitivity create hesitation.
- By routinely offering safer storage resources, teaching difficult conversations, and assessing high-risk situations, nurses can meaningfully protect patients and families.
NURSES FREQUENTLY NEED to ask personal and sensitive questions, even in the absence of an established therapeutic relationship. Through typical healthcare interactions, disclosures about violence, risk, and firearm ownership may arise. However, nurses receive little or no education, training, or support regarding firearm violence discussions and risk assessment. Realities and legalities regarding firearms vary significantly from state to state and can frequently change, resulting in confusion on the part of nurses and patients alike.
Firearm violence realities
In 2024, Schaeffer, of the Pew Research Center, reported that 4 in 10 adults live in a house with firearms. Even with lawful use, firearms can result in significant injuries, death, and liability. The Centers for Disease Control and Prevention (CDC) confirms that 132 firearm deaths occur in the United States every day. The Pew Research Center notes that mass shootings or active shooter incidents account for only a small number of firearm deaths. The private and personal grief of the families of those who die by suicide, in which half of incidents involve a firearm, or by homicide, in which eight in ten incidents involve a firearm, goes overlooked in comparison.
As noted by Hills-Evans and colleagues, access to firearms remains a highly contested and politically charged issue, reflecting deep divisions in public opinion and policy. Debate persists among nurses and the public on what, if any, regulatory steps should be taken to reduce death and injury attributable to firearms.
Assessing and addressing
Nurses develop strong relationships with patients, spend significant time with them, and have key assessment skills to help identify risky scenarios. Nurses regularly evaluate and provide education on many important public health issues, including seatbelt use, smoking, and sexual health. Professional organizations, such as the Society of Trauma Nurses and the Emergency Nurses Association have developed recommendations on how to discuss firearm safety. However, nurses report some reservations about broaching the subject with patients and families due to the public discourse surrounding firearm ownership, safety, access, and use.
Hesitation and self-doubt
Nurses’ reluctance to ask about firearms can stem from a desire to maintain therapeutic and supportive relationships. In a 2024 study by Sheppard and colleagues, nurses voiced concerns about managing angry or dissatisfied patient reactions or responses to firearm safety discussions. Nurses also indicated uncertainty about how to escalate issues if a patient becomes upset after an interaction, or how to proceed if they identify any enhanced health risks related to firearm access or exposure. Nurses stated that they welcome clear organizational policies and plans for collected information.
In this same study, nurses reported low motivation to assess firearm safety without clear next steps; however, their willingness to have these conversations with patients rose dramatically with access to patient educational material they could distribute.
Hesitation around the topic of firearm safety occurs beyond the bedside. In a 2025 survey by Holmes and colleagues, nurse faculty reported high barriers to teaching about firearm injury prevention and low confidence in their expertise to teach it. Respondents cited political sensitivity and lack of available materials as barriers to teaching this content.
Resources to call on
Thankfully, nurses never need to worry alone. Asking for help and using our education and resources to find existing models and frameworks to guide productive conversations around firearm safety benefit our patients. Identifying a knowledge gap provides an excellent opportunity to ask colleagues how they offer resources and assess for risk. Damari and colleagues suggest that specialists in psychiatry are comfortable with these discussions and would likely welcome collegial interest in their experiences and methods.
Many professional organizations, including the Society of Trauma Nurses and the American Nurses Association, advocate for legislative solutions as well as enhanced training and support in firearm violence screening within care settings. Membership-based nursing organizations may have or be willing to develop resources around such an important issue.
Nurses can effectively address firearm violence and accident prevention with three practices: offer resources to everyone, teach patients and others how to have difficult conversations, and assess high-risk situations.
Offer resources to everyone
Offering resources to all patients and families equally may make a conversation about firearm violence and accident prevention more achievable. Asking about firearms in the home is an assessment question that can become as routine as asking about pets and smoke detectors, not an opportunity for judgment. Frame safer firearm storage information as a resource for patients, not a demand for behavior change.
Starkweather and colleagues found that more intensive and structured interventions—such as offering coupons or actual firearm locks or storage devices and documenting that in the patient’s electronic health record—have a greater impact on patient behavior. They noted that removal of firearms from a home is a rare outcome, but locking firearms presents a more achievable health goal.
Reassure patients and colleagues that any information gathered during a healthcare visit about firearm ownership, storage, and accessibility remains confidential. Models to follow include the American Academy of Pediatrics safety video series about safe firearm storage, or HealthyChildren.org, Be SMART, and Hospitals United’s conversational prompts for coaching parents and families. (See Patient resources.)
Patient resources
Share these safe firearm storage resources with patients.
Guns in the home: How to keep kids safe
How to start asking
Teach patients how to talk about firearms
When teaching a patient who expresses a desire to know more about firearm safety in their social circle, offer resources and strategies for starting conversations. For example, Hospitals United recommends that patients say to friends and family, “My doctor told me to ask,” or “I saw something about safer firearm storage on TV. What do you think?” Methods such as these offer socially adept ways to tie safer storage conversations to mutually acceptable institutions and frame the conversation as important, but nonthreatening and undemanding.
Also consider offering a three-step method in which an individual volunteers home safety information, asks about firearms along with other possible household safety risks, and thanks the person. (See How to have a safety conversation.)
How to have a safety conversation
Recommend that patients follow these three steps when having conversations about safety with friends and family members:
- Volunteer safety information. “We have a small inflatable pool, and our kitchen isn’t nut-free. We don’t have any firearms.”
- Ask about safety. “Do you have any pools, trampolines, allergens, or firearms in your home?” (Alter as relevant to your household rules, preferences, and needs).
- Thank. “Thank you for helping me by answering all my questions!”
Assess high-risk situations
When you identify a heightened risk, assess patient safety more urgently. You may not always predict who will disclose a risky situation or who perceives risk in their proximity to firearms, as risk crosses boundaries of patient characteristics and identities. So, you must be prepared to listen and follow-up on the information patients share.
Danger may be present in various patient contexts. Suicidal or homicidal ideation, interpersonal violence, confusion or lack of capacity due to neurologic impairment, developmental delay or stage, or acute or chronic psychosis can alter a patient’s ability to safely maneuver in the world. This diminished capacity may result in injury or death from all manner of causes, including a potentially increased risk for both purposeful and accidental use of firearms to harm self or another. In Holmes’ study, nurse faculty preparing the next generation of nurse leaders agreed on the importance of teaching about the connection between firearms and suicide, homicide, interpersonal violence, and other risks.
After a firearm violence incident, careful care coordination and referral can help prevent future incidents. Temple University Hospital and Eskenazi Health’s evidence-based programs are open to anyone experiencing violent incidents, including firearm injury.
Higher risk confers a higher level of duty upon the nurse. Firearm risk conversations can prove difficult, especially if we’re new to them, but available resources can guide productive conversations that support health. (See Resources for nurses)
Resources for nurses
Access these resources to learn more about firearm safety and how to have conversations with patients about this potentially sensitive topic.
Educating Kids about Gun Violence (EKG)
Project LIFE
Prescription for Hope
Project LIFE provides education to justice-involved youth and their families about the consequences of violence, including firearm offenses, in part by hearing stories of victims of firearm violence.
Prescription for Hope enrolls anyone with a gunshot wound who’s willing to engage with their wraparound services and referrals to community care.
Means Matter
Medicine
Reducing harm—Having conversations about firearm storage
Hospital Safety Net Programs
Cradle to Grave
Safe Bet
Turning Point
Safe Bet distributes free firearm locks.
Turning Point is a wrap-around education and violence prevention program for people who’ve sustained firearm wounds.
Suicide prevention is everyone’s business: A toolkit for safe firearm storage in your community
Counseling on access to
lethal means
Also consider the Lock to Live algorithm (lock2live.org), which can help identify risks and develop a plan for limiting access to firearms and other potentially dangerous items. You can share Lock to Live with patients at risk for self-harm and with those who live with someone with escalated risk factors.
Focus on health
Nurses can serve as effective public safety advocates and protect the most vulnerable patients from firearm violence without offering legal advice, firearm safety training, opinions, or political input. Harm reduction and individualized assessment sit well within nurses’ scope of practice.
No definitive evidence exists as to whether providing formal firearm safety training has an impact on firearm violence prevention, but nurses can provide information on where to seek more information and provide resources on safer firearm storage. The workplace security team, local public safety and public health officials, and the CDC all serve as resources for information on firearm violence prevention. Temple University Hospital and Eskenazi Health welcome outreach from those wanting to learn more about their effective models.
Just as Good Samaritan laws support a concerned and knowledgeable bystander who performs cardiopulmonary resuscitation at a cardiac emergency without worry of civil liability, local legislation can supply an intervention for the bystander encountering a potential firearm tragedy with enhanced risks like confusion or criminal intent. Many states have Extreme Risk Protection Orders (ERPO), also called “red flag” laws, which can be used to temporarily remove firearms and ammunition from a home to prevent suicide or homicide in situations where someone may act to harm themselves or others.
Nurses can counsel families, roommates, significant partners, and others close to a potentially lethal situation to investigate their options under ERPO laws. In a few states, nurses can serve as ERPO petitioners; however, as with all firearm safety initiatives, Lindley and colleagues found no comprehensive training or support process for nurses in this role. The American Academy of Pediatrics found significant reductions in suicide deaths in children and adults in states with ERPO laws.
Promote safer practices
Although firearm storage safety conversations may seem daunting, nurses frequently lead the way on patient safety with a willingness to ask uncomfortable questions about relationship dynamics, behavioral practices, and other risks, including sexual health, seatbelts, alcohol, tobacco, and other substance use. Firearms fall under this category: a public health concern that can result in death or threats to health if not properly handled.
Seeking training and information at work can help nurses feel more comfortable screening for firearm storage and safety. As nurses, private citizens, family members, friends, and community leaders, we have a responsibility to promote safer practices. (See Taking action.)
Taking action
Providing firearm safety information and assessing patients for risk can prove challenging. The following examples offer suggested questions, statements, and recommendations for additional support.
Offering safer firearm storage information
- “Here’s some information on safe storage of firearms. You never know when you might need it.”
- “There are programs that provide firearm locks. Would you be interested in that?”
Assessing a patient with increased risk
- “Do you have guns/firearms in the home?”
- “How are your guns/firearms and ammunition stored?”
Learning that a patient with enhanced risk may have unlocked firearms and/or ammunition
- “Would you be open to locking your firearm for a while?”
- “I’m concerned for your safety,” or “I want you to stay safe.”
- Seek guidance from colleagues in psychiatry or social work.
- Share information about local resources, such as crisis lines, suicide call centers, and rapid response as available and appropriate.
- Educate the patient about the National Suicide and Crisis Lifeline number 988.
Learning that a patient is at high risk of harm to self or others, due to lack of capacity or another reason
- Call identified family, friends, or healthcare proxy to discuss a plan for the firearm.
- Educate the patient’s support system about Extreme Risk Protection Orders in your area, if available, and encourage them to reach out to community resources.
Feeling uncomfortable about discussions around firearm ownership and risk
- Use the resources in this article to learn more about how to have these difficult conversations.
- Seek out your employer policies, professional organizations’ position statements, information, and training.
- Work with nursing leadership at your healthcare setting to bring in experts for staff training.
The authors work at MGH Institute of Health Professions in Boston, Massachusetts. Kathryn Kieran is an instructor, Meaghan Rudolph is an assistant professor, and Brenna Morse is an associate professor.
American Nurse Journal. 2026; 21(4). Doi: 10.51256/ANJ042621
References
American Academy of Pediatrics. Extreme Risk Protection Orders (ERPO) or “Red Flag” laws. aap.org/en/advocacy/state-advocacy/extreme-risk-protection-orders-erpo-or-red-flag-laws/
American Nurses Association. ANA 2023 membership assembly passes urgent recommendations to address gun violence as a public health issue. June 17, 2023. nursingworld.org/news/news-releases/2023/ana-2023-ma-gun-violence-recommendations
American Nurses Association. ANA applauds passage of the bipartisan gun safety legislation. June 24, 2022. nursingworld.org/news/news-releases/2022-news-releases/ana-applauds-passage-of-the-bipartisan-gun-safety-legislation/
Centers for Disease Control and Prevention. Fast facts: Firearm injury and death. July 5, 2024. cdc.gov/firearm-violence/data-research/facts-stats/index.html
Damari ND, Ahluwalia KS, Viera AJ, Goldstein AO. Continuing medical education and firearm violence counseling. AMA J Ethics. 2018;20(1):56-68. doi:10.1001/journalofethics.2018.20.1.stas1-1801
Gramlich J. What the data says about gun deaths in the U.S. Pew Research Center. March 5, 2025. pewresearch.org/short-reads/2025/03/05/what-the-data-says-about-gun-deaths-in-the-us/
Hills-Evans K, Mitton J, Sacks CA. Stop posturing and start problem solving: A call for research to prevent gun violence. AMA J Ethics 2018;20(1):77-83. doi:10.1001/journalofethics.2018.20.1.pfor1-1801
Holmes SM, Moorman MM, Draucker C, Perkins SM. Faculty behaviors and beliefs about teaching gun violence prevention in undergraduate nursing programs. Nurse Educator. 2025;50(1):1-6. doi:10.1097/NNE.0000000000001720
Lee CJ, Herrera J, Miller J, Moffit C, Wiczynski H. The role of nurses in firearm safety. Am Nurse J. 2023;18(11):12-5. doi:10.51256/ANJ112312 https://www.myamericannurse.com/the-role-of-nurses-in-firearm-safety/
Lindley LC, Policastro CN, Svynarenko R, Davis HA, Beebe LH. Nurses as petitioners: a legal mapping of state extreme risk protection order laws. Policy Polit Nurs Pract. 2024;25(3):182-8. doi:10.1177/15271544241262744
Schaeffer K. Key facts about Americans and firearms. Pew Research Center. July 24, 2024. pewresearch.org/short-reads/2024/07/24/key-facts-about-americans-and-guns
Society of Trauma Nurses (2022, July 18). STN position statement on gun violence. https://traumanurses.org/resources/latest-news/stn-position-statement-on-gun-violence
Smith Sheppard K, Hall K, Mancuso JM, et al. Firearm safety: Nurses’ knowledge and comfort. Am Nurse J. 2024;19(10):14-20. doi:10.51256/ANJ102414 https://www.myamericannurse.com/firearm-safety-nurses-knowledge-and-comfort/
Starkweather A, Goldsmith AC, Parker L, Brabham D, Gutman CK, Webb FJ. Firearm injury prevention and survivor interventions: a scoping review. J Psychosoc Nurs Ment Health Serv. 2025;63(4):12-9. doi:10.3928/02793695-20241101-01
Key words: firearms, firearm safety, firearm assessment
