Workplace Safety and Violence

Workplace violence and relational aggression are contributors to nurse burnout, turnover, and lack of engagement. By proactively addressing relational aggression and violence, organizations can have higher nurse engagement and reduce turnover intention (1). Healthcare organizations can work to improve the physical and emotional culture of safety within the workplace in the following ways:

  • Start violence in the workplace initiatives with a safety assessment.
    • One such assessment uncovered in this work was the OAHHS toolkit (2). 
  • Address security concerns promptly, including environmental, cultural, and perceived threats (1). 
  • Engage in honest dialogue addressing disruptive behaviors, including individual and institutional racism (2,3). 
  • Underscore professionalism is a part of being a competent nurse (4,5).
  • Emphasize a supportive climate to build trust (1). 
  • Let individuals know how their behavior impacts their colleagues, patients, and the work environment (6).
  • Set clear expectations about acceptable behavior (7).
  • Avoid ineffective leadership strategies such as rationalizing uncivil behavior (7, 3).
  • Be willing to separate employees who continue to create a culture of incivility despite coaching, regardless of clinical practice experience (7).
  • Implement multicomponent interventions that go beyond individual-level training to include organizational policies and work environment changes formed from collaborative discussions between direct care workers and management-level staff (8).


  1. Liu, W., Zhao, S., Shi, L., Zhang, Z., Liu, X., Li, L., Duan, X., Li, G., Lou, F., Jia, X., Fan, L., Sun, T., & Ni, X. (2018). Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study. BMJ Open, 8(6), e019525.
  2. Oregon Association of Hospitals and Health Systems with the Washington State Hospital Association, (2020). Stop Violence in Healthcare: A toolkit for prevention and management. Retrieved from
  3. Truitt, A. R., & Snyder, C. R. (2019). Racialized Experiences of Black Nursing Professionals and Certified Nursing Assistants in Long-Term Care Settings. Journal of Transcultural Nursing, 31(3), 312–318.
  4. Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies, 52(2), 649–661.
  5. Fowler, M., PhD. (2015). Guide to the Code of Ethics for Nurses: With Interpretive Statements: Development, Interpretation, and Application (Second). American Nurses Association.
  6. Thompson, R. (2022). Coping with Incivility: Steps to Move Toward a Supportive Culture. Voice of Nursing Leadership: American Organization for Nursing Leadership May 2022.
  7. Sutton, R. I. (2007). The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t. Business Plus.
  8. Somani, R., Muntaner, C., Hillan, E., Velonis, A. J., & Smith, P. (2021). A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings. Safety and Health at Work12(3), 289–295.