Workplace violence prevention requires a multifaceted approach.

hen you think of safety in the workplace, what comes to mind? Protection? Security? Well-being? All nurses and healthcare professionals deserve to feel safe in their work environment. Yet, many nurses face violence at work — in one study, on average, more than two nurses were assaulted every hour — and the majority of incidents are not reported. Despite this discouraging picture, solutions to address workplace violence (WPV) are at hand. Advancing a priority initiative, the American Nurses Association (ANA) Board of Directors approved a revised WPV position statement in March, which outlines constructive steps that nurses and healthcare organizations can implement together to make workplaces safer (bit.ly/4mY8R3J).

“Violence against healthcare professionals—the very people who are entrusted to care for the sick and encourage healing—is absolutely unacceptable and reprehensible,” said ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. “Employers have an obligation to ensure the safety of their employees. This includes healthcare institutions, which are becoming increasingly violent, dangerous places to work for nurses and other healthcare professionals.” She added that ANA is aggressively pushing both Congress and the Department of Labor for stronger standards and accountability for actions on workplace violence.

Building upon earlier actions

Seeking to foster change, ANA published its original 2015 incivility, bullying, and workplace violence position statement at a time when organizations took a strong stance against WPV, incorporating the idea of zero tolerance. To increase awareness, ANA launched the #EndNurseAbuse campaign in 2019, which shifted the focus toward violence prevention and provided nurses and organizations with educational resources, tools, and publications. However, multiple studies indicate the persistent need for culture change within organizations. International Association of Healthcare Safety and Security 2020 data indicated that assault rates in U.S. hospitals increased 23% from 10.9 to 14.2 per 100 beds. Survey data on acute care facilities by Press Ganey in 2022 showed that on average two nurses per hour experienced abuse. The American Nurses Foundation Pulse on the Nation’s Nurses Survey Series in 2022 found that nurses saw an increase in violent incidents after the pandemic.

Defining the problem and position

The 2025 WPV position, developed with insights from ANA’s National WPV Prevention Committee, redefines WPV, incorporating the categories of violence defined by the National Institute of Occupational Safety and Health and broadening recognition of where violence occurs to include the academic setting (See What is workplace violence, p. 36). When people think about WPV, they frequently imagine dramatic physical assaults. Violence directed at workers, however, can take many other forms, including verbal threats, intimidation, sexual aggression, and bullying, which nurses frequently deal with. While these microaggressions in isolation may appear trivial, over time they can wear a nurse down. ANA anticipates releasing a position statement specifically aimed at addressing incivility and bullying in 2026.

The revised position draws from the 2025 Code of Ethics for Nurses (Code), which states that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employers, students, and others with dignity and respect.” Provision 5 states that it’s not wrong for nurses to have a “moral duty” to themselves, including having the “expectation of working in a safe place.” This is called out in five specific areas:

• 5.1 Personal Health and Safety—Don’t trade your own safety for the benefit of others.
• 5.2 Wholeness of Character—Be authentic and acknowledge your uniqueness.
• 5.3 Integrity—Act according to personal values and have moral discernment.
• 5.4 Professional Competence—Keep abreast of technology and advances to improve quality of care.
• 5.5 Human Flourishing—Embody values such as inclusivity, compassion, and ethics.

In the 2025 WPV position statement, ANA upholds the values of the Code by emphasizing the importance of each facility having a comprehensive WPV program and policy in which nurses, leadership, and employers work together to develop the best evidence-based program for their facility. When all staff commit to a program that they’ve helped to develop, they own that program and want to ensure that its philosophies are maintained.
ANA recommends the following for a holistic prevention program:

• Adopt a structural framework for the organization.
• Develop a clear, easy-to-read WPV policy.
• Encourage ownership by employers and nurses to enhance overall program success.
• Establish a reporting mechanism with collectable data and an accountable WPV committee.
• Provide cultural support for the WPV program.
• Integrate processes and resources to achieve objectives.
• Provide training for all, in all shifts.
• Frequently practice prevention interventions.
• Evaluate data and implement changes as needed.

Preventing WPV—What can nurses do?

Whether you’re a direct care nurse, manager, or executive, we all play a role in ensuring that nurses are safe. When every nurse has ownership in WPV prevention, they can use the recommendations as a guide to assess and make changes in their organization. Nurses, staff members, and leaders can evaluate the workplace, notice gaps, and develop an action plan for change.

Consider the following categories when assessing and implementing WPV changes in your organization and creating an action plan:

Prevention programs. Establishing prevention programs can support organizations by providing a structured framework to achieve specific goals. By integrating resources and processes, they enhance the chances of success.

WPV prevention committee. Creating a diverse WPV prevention committee comprised of health professionals and representatives from security, data management, leadership, risk management, and ancillary services departments, and others will set an organization on the path to success. This committee should report to an executive champion who reports to the organization’s board of directors.

People. At the heart of every organization are its people, driving its success through collaboration and innovation. By nurturing a positive culture, organizations can improve employee engagement and harness the full potential of their workforce. Nurses should help determine their organization’s culture and set the tone.

Reporting and analysis. By providing clear insights and fostering transparency, regular reporting enables informed decision-making and holds teams accountable for their actions. An organization needs accurate data to understand the extent of its WPV problem. Clarity and accuracy in the presentation of data ensure that advocates understand the information being communicated. By identifying trends, organizations can adapt and strategize effectively. For full transparency, near-misses and incidents averted also should be included.

Training. Everyone who encounters a patient should receive training. Setting expectations upon entry to the facility helps to eliminate misunderstanding. Consider statements such as, “Welcome, this is a violence-free facility. Do you have anything on your person that can harm yourself or others? If you do, check in with security…” Signage throughout a facility reinforces this standard. Investing in training is crucial for enhancing employee skills and productivity. ANA offers webinars, videos, mini videos, flyers, podcasts, and other educational materials to help train staff members (nursingworld.org/endnurseabuse).

Operations. Include the operations staff in WPV prevention; they’re more than extra help during a crisis. Invite security personnel to attend unit huddles to provide their perspective about patient behavior and flow. Operations can assist with tracking aggressive patients, enforcing contraband, reacting quickly and promptly to codes, and providing real-time input.

Physical barriers. Many physical barriers can impede a successful WPV prevention program. This makes it paramount to assess a facility’s physical environment and for nurses to remain vigilant about and aware of ordinary items that can be used as a weapon. Areas such as registration, patients’ rooms, nurses’ stations, behavioral health, and other high-risk areas also should be assessed for opportunities to provide separation and safety. Satellite facilities should be considered extensions of the main facility and have equal protection.

Technologies and tools. Many technologies and tools can support WPV prevention programs. Using data and evaluation information, the WPV committee can research and determine which technology will fulfill a facility’s needs.

Advocating for change

At the federal level, ANA has spent more than a decade advocating for the U.S. Department of Labor (DOL) to establish enforceable standards aimed at preventing WPV in healthcare settings.

The DOL, through the Occupational Safety and Health Administration (OSHA), holds critical responsibility and authority for addressing WPV and reducing its devastating impact on healthcare professionals. One essential step forward is to create a mandatory OSHA standard that would require national reporting of WPV incidents. Such a standard would enhance transparency, improve data collection, and lay the foundation for more effective prevention strategies.
Despite the urgency of this issue, it’s been 2 years since OSHA began the rulemaking process, and progress remains slow. In response, ANA recently sent a letter to DOL officials requesting an update on the status of this rulemaking and urging timely action.

To further advance this effort and build broader support, ANA recognizes the need to engage other key stakeholders across the healthcare sector. Addressing WPV requires a united, system-wide response. As part of this strategy, ANA is working on hosting a national roundtable to convene healthcare stakeholders and other partners to discuss challenges, share best practices, and advocate for meaningful federal action.

Despite the administration’s delay in issuing a WPV standard, ANA continues to pursue legislative avenues to make it a reality. ANA supports the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2531/S. 1232). This legislation would require OSHA to issue a standard requiring healthcare and social service employers to write and implement a WPV prevention plan to protect their employees from violent incidents. The bill also would ensure that nurses and other direct-care employees have a role in the development and execution of WPV prevention plans, with the flexibility to tailor plans to specific units and patient populations, as well as specific environmental and population hazards. It also includes antiretaliation protections that would enable nurses to report WPV without fear of reprisal. This legislation passed in the U.S. House of Representatives during the 117th and 116th sessions of Congress with significant bipartisan support.

Achieving a violence-free workplace requires an organizational commitment. Nurses in all practice settings and positions can contribute to this effort. No matter your role, commit to being a leader and colleague who helps prevent violence and promotes safety, and work to foster a culture of respect within your sphere of influence. Serve on your facility’s WPV prevention committee, know your WPV policy, and ensure that those you work with also are aware. Keep abreast of WPV legislation at RNAction.org and advocate continually for WPV prevention. These actions, undertaken collectively by nurses, can turn the tide against WPV.

— Ruth Francis is a senior policy advisor at ANA. April Brooks is a former FBI agent and security expert. Simit Pandya is the director of congressional and grassroots advocacy at ANA. Alison Hernandez is a senior policy advisor at ANA.

American Nurse Journal. 2025; 20(10). Doi: 10.51256/ANJ102534

References

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American Nurses Association. Webinar: Workplace Violence Against Nurses: What You Can Do. 2023. event.on24.com/wcc/r/3942937/356608F01C261C0CBC6B371D91404E8E.

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Press Ganey. On average, two nurses are assaulted every hour, new Press Ganey analysis finds. September 8, 2022. pressganey.com/news/on-average-two-nurses-are-assaulted-every-hour-new-press-ganey-analysis-finds