Mitigating Workplace Violence Against Nurses: A Quality Improvement Project

Background – Workplace violence (WPV) impacts nurses at greater rates than any other profession, despite voluntary and mandatory mitigation efforts.

Local Problem – Workplace violence leads to patient and staff injuries, burnout, and high turnover rates in the acute care setting. The institution did not have a comprehensive, multimodal WPV mitigation training available on site for staff.

Methods – The quality improvement project included the design of a multimodal WPV mitigation training program that included didactic, role-play, and physical skills training with return demonstration and a weekly participant self-reflection on skills used during an 8-week period. Setting was a large urban hospital in southwestern Pennsylvania. Participants included eight champions who served as facilitators of the multimodal training and 60 additional nurses.

Interventions – Participants were surveyed on perception of safety using the Safety Attitudes Questionnaire pre- and post-program implementation. Participants completed self-reflection exercises. Incidents of workplace violence toward staff were measured pre- and post-implementation, using pre-existing collection measures through the WPV review committee.

Results – Overall participant perception of safety, in relation to WPV, improved by 5% in teamwork climate but decreased in stress recognition. Self-reflection exercises revealed application of trauma-informed care was the skill used most frequently by participants. There was no significant decrease in staff injures although improved nurse-patient communication was noted. The multimodal training was implemented and disseminated hospital-wide for program sustainment.

Conclusions – Perception of safety and communication improved after implementation of a multimodal WPV mitigation training, led by designated, trained nurse leaders. Program can be applied to other hospital-based nursing settings.