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A layered, data-driven approach can strengthen nurse safety, engagement, and retention.

Workplace violence in healthcare affects nurse well-being, patient safety, staff retention, and organizational performance. It also has broad negative effects on morale, healthcare safety, and finances, with hospitals paying more than $18 billion in 2023 in costs related to workplace violence, according to the American Hospital Association. For nurses and healthcare leaders, the issue isn’t abstract. It shows up in verbal abuse that goes unreported, threats that escalate, injuries that lead to time away from work, and staff who leave a unit—or the profession—after a violent event.

Understanding the problem

For many years, healthcare workers heard that verbal abuse, threats, and even physical aggression were “part of the job.” That belief undermines reporting, weakens prevention, and isolates nurses who experience violence.

A mature workplace violence prevention program starts with acknowledging that verbal abuse is unacceptable and making it simple to report. Verbal abuse has become normalized in clinical environments across the country, and it remains woefully underreported; both because of the time and effort reporting requires and because staff rarely see any action taken as a result.

If you want data to drive your workplace violence mitigation strategy, you first must solve submission hurdles. One solution is a QR-code reporting option that staff can access directly from their phones. This can be paired with a communication campaign that makes clear that verbal abuse won’t be tolerated, and that keeps staff informed about aggression screening tools, de-escalation training, and other workplace violence prevention efforts already underway.

Reporting alone, however, doesn’t create safety. Staff must see leaders using the information they provide. When nurses report threats, abuse, or assaults but see no response, trust declines. When leaders use that data to identify hotspots, adjust staffing, refine workflows, and invest in visible safety measures, reporting becomes part of a safety culture.

Psychological safety requires action

Psychological safety develops when staff believe they’ll be supported when they speak up. In the context of workplace violence, that support must be visible, reliable, and sustained.

Staff want to see tangible safety measures, such as weapons detection at entrances and mobile duress devices that work consistently. These interventions show nurses that the organization has heard their concerns and acted.

Reliability is essential. A badge, button, alarm, or reporting system that fails can quickly lose staff confidence. Nurses are unlikely to use a device they can’t trust. Technology must work every time and be easy enough for staff to carry and use during a clinical shift.

Measuring progress

Advocate Health has implemented several violence prevention interventions and reported measurable improvement. From 2024 through 2025, the organization saw a 15% reduction in Occupational Safety and Health Administration recordable events and 28% decrease in DART (days away, restricted, or transferred) events. Interventions included mobile duress badges for nearly 40,000 employees, metal detectors at emergency department entrances, advanced weapons screening in selected high-risk locations, expanded de-escalation training, and increased public safety staffing. These data points matter because they move the conversation from anecdote to action.

Metrics leaders should monitor

C-suite leaders need information that shows whether prevention efforts are working. Useful metrics include the following:

• OSHA recordable events
• DART rates
• Staff responses to questions such as “Do you feel safe at work?”
• Mobile duress badge activations
• Fixed duress badge activations
• Weapons detected at screening sites
• Public Safety Response time tracking
• Trends over time, not just quarterly snapshots
• Reporting patterns that identify hotspots or gaps

OSHA data are especially important because they offer standardized definitions that allow comparisons across facilities and organizations. However, leaders need trend data to understand what the numbers mean. For example, adding weapons detection may initially increase the number of weapons found, which could appear alarming unless leaders understand that the increase reflects improved detection rather than increased danger.

Ownership at the executive level

Workplace violence prevention touches departments throughout an organization, including public safety, risk management, nursing, human resources, legal, patient safety, employee safety, IT, and operations. As a result, ownership can vary by organization.

The exact department responsible matters less than ensuring that information reaches the highest levels of leadership and that leaders have the authority to act. At Advocate Health, workplace violence prevention flows through public safety, supported by an enterprise council with six focus areas: prevention and prediction, prioritization and measurement, system design, leadership and policy, community and strategic partners, and wraparound support. The council includes leaders from across the organization and is supported by sub-councils that extend from senior executives to frontline workers.

This structure helps prevent fragmented efforts. In large organizations, many groups may try to solve workplace violence from different angles. Without coordination, interventions can overlap, conflict, or fail to scale. A council structure can align those efforts and help ensure that local solutions are shared across the enterprise.

Why one intervention isn’t enough

Traditional security models frequently focus on a single point of risk, such as the emergency department entrance or the presence of security officers. However, violence can occur in parking lots, lobbies, inpatient units, behavioral health areas, maternity units, ICUs, and home health settings.

Safety outside the walls of the hospital presents additional challenges. Inside a facility, leaders can rely on defined staffing models and existing infrastructure. Outside, parking structures, open lots, weather, limited power, and long distances can slow response and increase cost. In some outdoor areas, moving even a single data cable to expand infrastructure coverage can cost up to $100,000.

A layered model helps address this complexity while spreading capital costs out over time. By identifying gaps in technology and data relative to their workplace violence mitigation vision, organizations can build a multiyear strategy with a defined path forward. This phased approach also creates room to evaluate each technology on its own—what works, what needs improvement, and what didn’t succeed—rather than budgeting, implementing, and deploying numerous technologies all at once.

Rather than responding only to a single incident or location, leaders can examine the full pathway of risk: the parking lot, entrance, reception area, clinical unit, staff-only spaces, and the behind-the-scenes technology that supports response.

Building a layered model

A layered workplace violence prevention strategy includes people, technology, policy, training, reporting, and recovery. Each layer should support the others.

For example, weapons detection at an entrance may reduce risk, but it requires trained staff, clear visitor policies, reliable escalation pathways, and leadership support. Mobile duress devices may help staff call for help discreetly, but they require accurate location information, dependable communication infrastructure, response protocols, and staff education. De-escalation training may reduce the chance that verbal abuse becomes physical violence, but it must be reinforced by staff training, behavioral response resources, and a culture that supports reporting.

Layers create redundancy and resilience. If one system fails, another should continue to protect staff. This is especially important during power failures, network outages, mass casualty events, and other disruptions.

Preparedness investments

Three investment priorities can yield measurable results within 12 months:

• Weapons detection. Metal detectors and advanced weapons screening can reduce the risk of weapons entering high-risk areas. With advanced systems, organizations can move larger volumes of people through busy entrances.
• Mobile duress. Personal alarms connected to a communication center allow staff to request help silently and quickly, without needing to make a phone call.
• De-escalation training. Because many violent events begin with verbal escalation, training can help staff intervene earlier and reduce the risk of physical violence.

Technology that fits the clinical environment

Healthcare technology must match the realities of nursing work. Devices should be reliable, easy to wear, discreet, and integrated into workflow. They also should function in the spaces where staff work, including stairwells, parking areas, and locations beyond the hospital walls.

Staff confidence in a duress device, for example, depends on whether it works consistently. A silent, discreet device allows a nurse to call for help when a situation feels unsafe, rather than waiting until violence occurs.

Naming and framing also has an impact. At Advocate Health, we refer to the devices as mobile duress and de-escalation alarms, not panic buttons. This reinforces that staff should activate them proactively when they feel threatened, not only after an emergency has occurred.

From an IT perspective, organizations shouldn’t over-rely on Wi-Fi for safety-critical systems. Wi-Fi can go down, location accuracy can fail, and frequency changes can interrupt communication. Advocate Health uses public safety technology that doesn’t rely on Wi-Fi infrastructure, helping maintain function during outages and improving location accuracy when officers respond.

Supporting culture change

Moving from normalization of violence to intolerance of violence requires more than policies. Everyone must see safety as a priority in daily operations.

Visible investments—such as metal detectors, reliable duress badges, and public safety engagement—can demonstrate that leaders are listening. Staff engagement also improves when they see that their reports inform risk assessments and investment decisions.

Public safety should be integrated into daily huddles and unit-level communication, not called only after an event. This connection helps local public safety teams understand unit-specific concerns and gives clinical staff a direct relationship with those responsible for responding. Advocate Health created a nurse liaison role to bridge the gap between nursing and public safety, helping each group better understand the other’s work.

Home health environment

Home health and other lone-worker environments require different approaches. Unlike a hospital unit, a home care setting may involve variable cell coverage, unfamiliar neighborhoods, different law enforcement jurisdictions, and fewer immediate responders.

Organizations should ask practical questions before choosing a solution. Do staff carry phones? Should a duress alarm connect to a phone or function as a standalone cellular device? Would camera capability raise privacy or personal health information concerns? Is a check-in/check-out app sufficient, or is real-time duress response needed? Public safety teams also can help home health leaders build relationships with local law enforcement agencies.

After an event

Post-event response should support both learning and healing. Debriefs serve as valuable opportunities to identify lessons learned, and emergency management teams increasingly use post-event gap analyses, tabletop exercises, and cross-department collaboration to improve future response. However, leaders should avoid retraumatizing affected staff during these sessions.

For repeated threats or assaults, organizations must balance staff safety with legal and regulatory obligations. Temporary cooling-off periods, visitor management systems, and flagging individuals with a history of violent behavior can promote safety, but organizations must implement these measures without restricting a person’s right to emergency medical evaluation and treatment under laws such as the Emergency Medical Treatment and Labor Act.

Safer practice

Workplace violence prevention isn’t a single department’s project or a one-time technology purchase. It’s an organizational safety strategy. Effective programs make it easy to report concerns, treat verbal abuse as a warning sign, use data to guide decisions, and create visible layers of protection that staff can trust.

For nurses, safety starts with two principles: help can be called, and assistance will come. For leaders, the work begins with listening to staff, investing in reliable systems, and measuring outcomes over time. A layered, data-driven approach can help healthcare organizations move from reacting to violence to preventing it—and from accepting violence as part of the job to making it clear that it has no place in care.

Matt Lethbridge is the Enterprise Director of Security Technology at Advocate Health. Dan Snyder is the Enterprise AVP of Public Safety: Risk Mitigation at Advocate Health.

Reference

American Hospital Association. Violence costs hospitals a staggering $18 billion in 2023: AHA report. aha.org/aha-center-health-innovation-market-scan/2025-06-10-violence-costs-hospitals-staggering-18-billion-2023-aha-report