Where professional nursing organizations stand
- Nurses and other healthcare professionals must care for patients who’ve experienced the results of gun violence, including mass-casualty events, intentional self-harm, accidental injury, interpersonal violence, and law enforcement response.
- The perspective and experience of nurses and the nursing organizations that serve them can contribute to the national conversation about gun violence and firearm safety
Theoretical debates about gun violence disappear within the realities of practice: the emergency department (ED) nurse supporting a family who’s lost a loved one to suicide, the surgical team nurse collaborating to mend the violent impact of bullet wounds on the body, the school nurse grieving after a mass school shooting. Rising incidents of gun violence, including mass-casualty events across the country—some in healthcare settings—create cause for alarm and intensify the need to address firearm safety.
Along with our healthcare team colleagues, nurses encounter the results of intentional self-harm, accidental injury, interpersonal violence, and law enforcement response. Nurses bear witness to the effects of firearm violence across clinical specialties, roles, and practice settings. We face the death of individuals, the long-term impact of physical and psychological injury, and the far-reaching effects on families and communities. (See Firearm violence statistics.)
Responding during an active shooter situation
Firearm violence statistics
Reporting on firearm violence is complicated by variations in reporting mechanisms and methodology. However, the following statistics merit concern and consideration:
- The Centers for Disease Control and Prevention reports the following:
- 45,222 firearm-related deaths occurred in the United States in 2022 with nearly 20% due to unintentional injury.
- More than 70% of medically treated firearm injuries were the result of assaults.
- Men account for 86% of all firearm deaths.
- Firearm deaths by suicide are highest among adults over age 75.
- The Center for American Progress reports the following:
- Firearm violence has an unbalanced impact on populations of color. Young Black Americans face the highest rates of homicide across all demographic groups, young Hispanic Americans are disproportionately victims of firearm homicides, and women of color are more likely to be killed or threatened by a firearm.
- The concentration of homicide rates in large U.S. cities is concerning for urban communities, which face persistent economic disparities, marginalization, and racism.
- According to the American Academy of Pediatrics, firearms are the leading cause of death among children and youth ages 0 to 24 years in the United States.
- Education Week reports that since 2018, 111 people have been killed and 288 have been injured in school gun violence incidents.
The perspective and experience of nurses and the nursing organizations that serve them can contribute to the national conversation and inform actions to address this complex issue. The following summaries of various professional organizations’ positions on firearm safety and violence prevention can help guide you in your role as advocate. (See The role of professional organizations)
American Academy of Nursing
The American Academy of Nursing (AAN) serves the public by advancing health policy with a focus on the development and dissemination of nursing knowledge. It published a position statement outlining a plea for action that includes support for universal background checks, policies regulating firearm conversion to automatic weapons, risk protection for firearm purchases by those at risk of harming themselves or others, age restrictions on purchases, and re-enactment of specific parts of the federal Public Safety and Recreational Firearms Use Protection Act.
AAN also recommends funding for evidence-based prevention and intervention programs. The organization supports health professionals’ engagement with family and community health screenings, counseling work, and prevention training. AAN specifically noted the need to address related critical issues of stress, bullying, partner violence, and mental health. As a response to multiple firearm incidents in May 2022, AAN reiterated its position on firearm violence as a national policy priority with a focus on racially motivated events and hate crimes.
American Nurses Association
The American Nurses Association (ANA) represents the interests of nurses in promoting quality in a safe practice environment and advocates on issues affecting nurses and the public. ANA published a declaration in response to the 2018 Parkland, Florida, school shooting that resulted in the deaths of 17 students and staff members. Consistent with the nursing role of advocacy, the organization presented three calls for action: meaningful firearm control legislation, repeals to research limits on firearm violence, and an appeal for collective action on underlying causal issues. The declaration recognized the stark realities facing healthcare professionals in light of rising rates of national mass shootings, suicide rates, homicides, and accidental events secondary to firearm use.
In June 2023, ANA built upon its longstanding advocacy with a resolution recommending heightened support and legislation, improved mental health services, and research specific to the healthcare arena. ANA calls for the 2015 ANA statement, Incivility, Bullying, and Workplace Violence, to be updated to include firearm violence and prevention in healthcare settings. ANA urges nurses to acquire more knowledge about the connections between violence and public health in the United States, to develop evidence-based strategies, and to work to promote safety and decrease violence, with a special emphasis directed at children, adolescents, and young adults.
American Psychiatric Nurses Association
The American Psychiatric Nurses Association (APNA) presents an important perspective in a position paper on violence prevention. Although not specific to firearm violence, the statement points to the far-reaching impact of violence in the lives of survivors and to the social fabric of communities. Psychiatric and mental health nurse expertise supports risk factor assessment and education. In addition, these nurses serve as role models in thoughtful approaches to address and respond to violence in the work setting and society.
The APNA position states that patient-centered, trauma-informed, recovery-oriented practices are integral elements of violence prevention. Notably, the association shares various resources, including strategies to establish a practice framework of trauma-informed care. APNA directs nurses to fully recognize the human experience of trauma and its lasting effect on health and behavior.
Emergency Nurses Association
The mission of the Emergency Nurses Association (ENA) is to advance excellence in emergency nursing. ED nurses encounter and care for victims of firearm violence across the lifespan. The reality of this work substantiates the organization’s call to action.
Invested in safe work environments, ENA has partnered with the American Academy of Pediatrics to develop a podcast series, an online seminar, and a free continuing education package for its members on firearm injury prevention and patient safety. Within its practice resource library, available to members and non-members, the organization provides topic briefs on firearm safety and harm prevention as well as active shooter incident preparedness in the ED. The organization’s detailed position statement supports screening patients for firearm access, including those with records of partner violence or misdemeanor crimes, and endorses open dialogue between nurses and their patients about firearm use and safe storage. The ENA has designed an educational graphic referencing safe storage, including secure vault storage and lock use, which is available to its members.
National Association of Pediatric Nurse Practitioners
The National Association of Pediatric Nurse Practitioners (NAPNAP) empowers nurses to improve the health of children and families and emphasizes the concerning reality that firearm injuries are the leading cause of death for children and adolescents in the United States. The organization has articulated a clear position urging solutions to the impact of firearm violence on this population. NAPNAP endorses education about firearm storage, distribution of firearm locks, and the development of new innovations to secure firearms. The association proposes a federal law precluding firearm purchases (with exceptions for military and law enforcement professionals) by those under age 21.
NAPNAP calls for healthcare professionals to develop skills in screening for adverse childhood events and to adopt trauma-informed care practices as they encounter families experiencing violence. At the policy level, the organization supports background checks, bans on firearm modifications, and restrictions on access by individuals with mental health conditions and those who have the potential for violence. NAPNAP also supports a mandate for all schools to conduct regular active shooter training drills.
National Association of School Nurses
The National Association of School Nurses (NASN) represents nurses who work in the K–12 educational setting. NASN affirms the importance of schools as safe and trauma-sensitive environments and calls for attending to the root causes of violence as a priority. The reality of firearms as the leading cause of death for American children, teens, and young adults corresponds with the high concern about school shootings by students and parents, especially those of color.
NASN offers online school emergency triage training aimed at preparing nurses as leaders in disaster response teams and providing them with the skills required to respond to mass casualty events. The organization highlights the need to address the psychological impact of these events, with distinct attention on responding to the unique requirements of students with special needs.
Society of Trauma Nurses
The Society of Trauma Nurses (STN) advocates for the highest level of quality trauma care with a focus on collaborative care. The STN position on firearm violence highlights attention to nurses’ ethical role in advocating for change to reduce violence, including the impact of firearm violence. The organization supports evidence-based approaches and makes a specific statement to focus on setting-based interventions and addressing underlying factors that contribute to firearm violence. Eleven other organizations have signed on to STN’s statement, including the American College of Surgeons and the American Trauma Society.
Workplace violence
National statistics related to workplace violence against healthcare professionals continue to increase. In 2022, The National Institute for Occupational Safety and Health reported that 76% of those experiencing trauma secondary to workplace violence were those in healthcare and social service fields. Leaders in healthcare settings must implement proactive education and strategies to protect employees from violent threats or events, including those that involve firearm violence. Practice settings also must recognize the consequences of trauma on staff well-being and provide appropriate education and effective staffing. Thoughtful and timely resources, such as de-briefing and counseling, play a critical role in supporting nurses and other healthcare staff who’ve been impacted by firearm violence, injury, and death.
Action steps
Nurses, nursing leaders, practice settings, and nurse educators have roles to play in promoting firearm safety and preventing firearm violence.
Drawing on the expertise of professional nursing organizations, nurses can develop practice guidelines, influence policy development, educate others, and generate new knowledge. They must expect and participate in developing zero-tolerance workplace violence policies. Practice settings can invest in education about firearm violence and conduct threat assessments and response training for all employees. Nursing leadership must be represented on threat assessment teams and collaborate to develop protocols appropriate to acute care, primary care, and community settings. Nurses also require dedicated support resources after acute events and ongoing attention for those who regularly care for victims of firearm violence.
The ANA Code of Ethics for Nurses with Interpretive Statements identifies advocacy as a critical nursing role responsibility. With increasing national rates of injury and death related to firearm violence at all stages of life, professional nursing organizations are calling for strengthened policies and regulations to improve the public’s overall health and well-being. Rising incidents of workplace violence also warrant nursing advocacy. Professional organizations provide a starting point as sources of information, guidance, and direction. Individuals and nursing groups can advocate for action by sharing expertise with elected representatives, conveying positions via social media platforms, and participating in voter registration and political campaigns. Practicing nurses have unique and powerful real-world experiences to educate communities and influence others.
Future nurses also require effective preparation. Participation in simulations focused on threat assessment and response, involvement in public health education, and engagement in advocacy events provide meaningful education on this topic. Faculty and nurse scholars must advocate for research funding on firearm violence and safety and disseminate new knowledge to influence change.
Influence change
As nurses, we have a deep understanding of the human experience and clinical expertise that enrich our perspective on the issue of firearm violence. As citizens, we also share a human reaction to the incessant news of firearm violence in our nation. Rooted in our professional standard to care for others, nurses have a powerful opportunity as individuals and through our professional organizations to influence action and policy on firearm safety and violence.
The role of professional organizations
The American Nurses Association’s Nursing Scope and Standards of Practice and Code of Ethics for Nurses with Interpretive Statements guide quality nursing practice and endorse calls for professional organizations to advocate for others and to integrate principles of social justice into nursing and health policy. Professional nursing organizations serve as a resource to help nurses stay current with evolving standards and evidence-based practice, further education, and connect with colleagues. Nurses have a powerful opportunity to advocate for our profession, patients, families, and communities. Through their organizations, they can influence national health policy relevant to the nursing profession and the health of others.
- American Academy of Nursing (www.aannet.org) works to improve health and health equity by influencing policy.
- American Nurses Association (nursingworld.org) ensures nurses’ voices and vision are recognized by policy leaders, industry influencers, and employers. You can find your state organization at nursingworld.org/membership/find-my-state.
- American Psychiatric Nurses Association (apna.org) provides leadership to nurses, improves mental healthcare, and shapes health policy.
- Emergency Nurses Association (ena.org) advances excellence in emergency nursing practice.
- National Association of Pediatric Nurse Practitioners (napnap.org) promotes the health of children and families.
- National Association of School Nurses (nasn.org) optimizes student health and learning by advancing the practice of school nursing.
- Society of Trauma Nurses (traumanurses.org) elevates trauma care via a focus on trauma nurses.
The following organizations, although not specific to nursing, also work to strengthen firearm violence prevention.
- American Academy of Pediatrics (aap.org) dedicates itself to improving the health of children.
- Brady Center to Prevent Gun Violence (bradyunited.org) advocates for firearm control and against firearm violence.
- Center for American Progress (americanprogress.org) offers information on gun violence prevention.
- Sandy Hook Promise (sandyhookpromise.org) aims to protect America’s children from firearm violence
Also, consider reaching out to your congressional and state representatives to help influence firearm safety policy. You can find your representatives at govtrack.us/congress/members.
Carolyn J. Lee is a retired professor at the University of Toledo in Toledo, Ohio. Jackeline Herrera and Heidi Wiczynski are staff nurses at University of Michigan Health in Ann Arbor Michigan. Julianne Miller is a staff nurse at Promedica Toledo Hospital in Toledo, Ohio. Christopher Moffitt is a staff nurse at Renown Medical Center in Reno, Nevada.
American Nurse Journal. 2023; 18(11). Doi: 10.51256/ANJ112312
References
American Academy of Nursing. American Academy of Nursing’s statement firearm safety and violence prevention. bit.ly/45frgiR
American Academy of Pediatrics. Gun safety and injury prevention. June 20, 2023. aap.org/en/patient-care/gun-safety-and-injury-prevention
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. Code of Ethics for Nurses with Interpretive Statements. 2015. nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only
American Nurses Association. Incivility, bullying, and workplace violence. July 22, 2015. nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence
American Nurses Association. Stop the madness: End the violence. June 15, 2018. https://www.nursingworld.org/news/news-releases/2018/stop-the-madness-end-the-violence/
American Psychiatric Nurses Association. APNA Position: Violence prevention. April 2022. apna.org/news/violence-prevention
Center for American Progress. Gun violence disproportionately and overwhelmingly hurts communities of color. June 30, 2022. americanprogress.org/article/gun-violence-disproportionately-and-overwhelmingly-hurts-communities-of-color
Centers for Disease Control and Prevention. Fast Facts: Firearm violence prevention. May 4, 2022. cdc.gov/violenceprevention/firearms/fastfact.html
Education Week. School shootings in 2022: How many and where. January 5, 2022. edweek.org/leadership/school-shootings-this-year-how-many-and-where/2022/01
Emergency Nurses Association. Firearm injury prevention and patient safety: Online course. enau.ena.org/Listing/Firearm-Injury-Prevention-and-Patient-Safety-Online-Course-2053
Morin KH. Editorial: Contributions of professional nursing organizations. J Adv Nurs. 2021;77(6):e1-3. doi:10.1111/jan.14808
National Association of Pediatric Nurse Practitioners. NAPNAP official statement on firearm injury prevention. May 9, 2018. napnap.org/napnap-official-statement-on-firearm-injury-prevention
National Association of School Nurses. School Emergency Triage Training (SETT). nasn.org/education-events/sett
National Institute for Occupational Safety and Health. Occupational violence. August 31, 2022. cdc.gov/niosh/topics/violence/fastfacts.html
Society of Trauma Nurses. STN position statement on gun violence. July 18, 2022. traumanurses.org/stn-position-statement-on-gun-violence
Key words: firearms, guns, firearm safety, gun safety, nursing organization firearm safety positions
