Top Healthcare Violence News - April 2025 Month-In-Review

May has been a month of celebrating and recognizing our amazing nurses and other healthcare professionals with National Nurse's Week and National Hospital Week.

But the best way to honor healthcare professionals is to keep them safe from violence so they can focus on caring for patients. Yes- it's even better than a pizza party cue audible groans.

And yes, I realize that this newsletter is a bit delayed. I was working on the big release of the Healthcare Violence Risk Mitigation Framework (HVRM-F) and got sidetracked - sorry!

30% of ED Staff Meet Criteria for PTSD from Violence

Staff repeatedly exposed to verbal, physical, sexual violence

It's no secret that violence is pervasive in emergency departments (EDs). But a new study from the Orlando College of Osteopathic Medicine reveals the psychological toll that violence takes on ED staff.

The study of a cross-section of 125 clinical ED staff found that that nearly 30% of met criteria for PTSD, primarily stemming from repeated exposure to verbal, physical, and sexual violence.

📊 Key Findings:

• Verbal aggression was the most commonly experienced form of violence.

• 29.6% of participants reported PTSD-level symptoms; recurrent distressing thoughts were reported by over 55%.

• Sexual trauma showed the strongest correlation with PTSD.

• Affected workers typically experienced multiple forms of trauma.

The study authors suggest that there is an urgent need for interventions by healthcare organizations. Their recommendations include creating comprehensive violence prevention policies, enhancing security measures, offering de-escalation training, and offering accessible mental health support programs.

Analysis: 

The never ending drumbeat of violence in the ED should never be accepted as inevitable. However, in many healthcare organizations, this is exactly what happens. Repeated exposure to violence numbs staff to it and the ED culture normalizes it. This leads to high thresholds for reporting violence and acceptance of violence as part of the job.

However, the psychological burden of ED violence threatens clinician well-being, retention, and care quality—especially in high-risk environments like emergency departments. Tailored solutions are needed for the unique challenges of ED violence and clinicians and support personnel in the ED must be offered wraparound support by every organization- from training to robust security measures and psychological support.

A Systems Thinking Approach to Healthcare Violence

Study examines the research-practice gap in addressing WPV

A study in Safety Science Journal explores the practical application of systems thinking to address healthcare violence, aiming to bridge the "research-practice gap". The researchers developed and tested a suite of systems thinking resources, that study participants found practical and appropriate for implementation.

📊 Key Findings:

• Holistic Perspective: Recognize that violence emerges from interactions across the entire healthcare system, not just from individuals directly involved. Violent behaviors and incidents involve multiple factors with contributions from various levels of the system, including budgetary constraints, staffing, management competence, and societal issues.

• Systemic Response to Violence: Instead of focusing solely on individual behavior (e.g., de-escalation training for workers after an incident), consider broader systemic changes. For example, if a patient uses a chair on a behavioral health unit as a weapon, a systemic response would involve:

• Changing the environment design to secure furniture and provide clear escape routes.

• Improving communication and coordination to ensure staff are informed of a patient's history of violence.

• Updating hospital design standards or implementing new communication protocols and software systems at higher levels for more sustainable change.

• Utilize Systems Thinking Resources: The study developed three key resources based on systems thinking principles to support WRV prevention and management:

• Multi-level Risk Assessment Toolkit: Provides guidance for managing WPV risks from a systems thinking perspective, with tailored resources.

• Systems Thinking in Incident Investigation Guidance: Focuses on principles for WPV incident investigations, emphasizing a culture of learning and trust and shared responsibility for safety.

• Reporting Culture Improvement Roadmap: Proposes short, medium, and long-term initiatives to improve reporting culture across healthcare system levels.

The study authors acknowledged that barriers/limitations to implementation exist, such as training, practice and time. They also highlighted the importance of leadership buy-in for successful implementation of systems thinking.

Analysis

Systems thinking offers a useful approach to the issue of WPV, offering a different lens on the causes of violence. It also provides a means to achieve a deeper understanding of the factors leading to violence in each unique organization. Using systems thinking can help validate existing strategies and tactics while uncovering opportunities to improve upon violence prevention and mitigation plans.

News and Research You Can Use

Hatchet Attack Sparks Security Changes

An incident involving man wielding a hatchet who ran at a doctor in Carilion Roanoke Memorial Hospital last Christmas has prompted enhanced security.

The hospital has installed metal detectors at all entrances after a pilot in the emergency department proved successful. The hospital will also be searching bags and adult visitors will be required to wear ID badges.

Sadly, incidents like this are often the lever that gets workplace violence prevention and mitigation the attention (and funding) it needs. However, after a violent incident like this, the psychological damage is already done- staff are scared and their confidence and a sense of safety has been shattered.

I hope that this hospital will continue beyond technology to build a robust WPV program to mitigate future incidents and support staff healing.

The Harm of Incivility in the Operating Room

An editorial article in the Journal of Cardiothoracic and Vascular Anesthesia tackles (sorry) the issue of incivility in the OR. Incivility (a euphemism I find that some high-level healthcare professionals use to describe violence) includes behaviors ranging from rudeness to physical aggression and dismissiveness, according to the authors.

Despite awareness of incivility as a threat to patient safety and clinical well-being, it remains a problem, especially in high-stakes environments like cardiothoracic surgery. At the least, incivility can disrupt communication, and erode team trust. At the worst, incivility impairs decision-making, and increases the risk of medical errors, burnout, and clinician attrition.

Some interesting stats from this article:

• 78% of perioperative staff report experiencing workplace violence and 69% report verbal abuse.

• 79% of UK cardiothoracic surgeons experienced bullying within 3 years.

• Surgeons with repeated unprofessional behavior reports have up to 31.7% higher patient complication rates.

The authors go on to recommend actionable strategies for healthcare leaders that include, but are not limited to:

1. Publicly recognize the problem. Create and enforce policies with transparent consequences.

2. Enable anonymous and direct reporting of incivility.

3. Hold all team members, regardless of rank, accountable for professionalism.

That's all for now!

Stay safe out there and keep fighting the good fight.

-Dave