Security Won’t Stop The Violence


Workplace violence in hospitals is unfortunately increasing in frequency. What can be done to stop this? Security is vital to the day-to-day operations of hospitals. There is no doubt they do keep us safer.  However, assaults often happen before security arrives. What will work? Read on...

What will stop the violence against healthcare workers?

Security Won’t Stop The Violence

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“What if we hire more security at night?”

This suggestion is a natural conclusion that many people suggest when discussing violence in hospitals. This particular person was Congressman Dutch Ruppersberger (D-MD), and we were speaking in the weeks following a (false alarm) active shooter incident at Walter Reed National Military Medical Center. Around 2:00 pm on November 28, 2018, an active shooter alert was called at the hospital. This alert and the panic that went with it lasted an hour and a half while occupants of the building sheltered in place.

The disruption from this event was caused by an error in the usage of a mass notification system. During the lockdown, though, no one knew it was a false alarm, not even law enforcement. Given the recent history of mass shootings and active shooters in hospitals, the possibility of something like this being real likely was questioned by no one. In retrospect, it seems reasonable to assume a larger number of security officers with tighter, more thorough security methods, might prevent mass shootings in hospitals.

There is, however, a pressing issue when it comes to workplace violence in healthcare: even if security is called, assaults often happen before security arrives. When they arrive, the damage is already done. One recent story shared with us by a Silent No More members illustrates this well. A nurse in the ED was hoping to get labs from a sleeping patient. The nurse decided to pull blood from the patient’s IV instead of waking the patient for a needle stick. A patient care tech (PCT) was there to assist. As the automatic cuff inflated, the patient awakened and kicked the PCT in the face using both feet. As the nurse attempted to block the next kick, the patient bit her. The patient held onto the nurse with her biting teeth, then grabbed the PCT by her hair.

In the aftermath of that assault, it became known that this patient had a history of violence toward staff and law enforcement. This patient was alert and oriented, and not psychologically impaired by a medical condition. This event could not be predicted when it happened. Adding security would not have changed this. This situation required something altogether different.

So, then, what is necessary? What does work?

The unfortunate truth is that little research data specific to violence in healthcare workplaces exists on this topic. What is clear is that change will require collaborative, multimodality approaches. This is not only about reducing some risk factors. This is not only about hiring more security. This will not only be about legislation. Change requires multiple things.

Post-Assault Assessment

I am a large believer in looking at each assault and determining from its details what can be done differently next time. I had my own similar experience, much like the above story. A sleeping frequent flyer patient with dementia had a systolic blood pressure over 200. He had been refusing all medications the entire admission, so I took the opportunity while he was sleeping to try an IV anti-hypertensive. I did not realize his IV was clotted off, which woke him up. I was punched in my head before I even knew he was awake.

The similarities between this and the other nurse’s story is clear: a patient was awakened by surprise, and we failed to recognize that in our focus on what we were doing. This is not something that has been overlooked since. Our eyes remain on the patient at all times. The root causes were clear, and we now are safer in our practice.

Determining post-assault what can be done differently, is one of the best tools that a nurse has. However, this cannot be used as an opportunity to blame the victim. Too often, stories submitted to Silent No More Foundation are filled with retaliatory actions taken toward nurses who have been assaulted. This is not okay. Nurses need support when a traumatic event happens.

Self-Defense Training

Employers can provide self-defense training. This can be very helpful, especially if the self-defense program has experience with self-defense in healthcare. Nurses are in the unique position of being responsible for the safety of the violent patient, in addition to our own. A self-defense training program that recognizes the unique challenges we face can be very empowering. A nurse should know up front the level of force they can use and how to use it if a violent episode becomes inevitable.

Potential Weapons

Another key factor in deterring assaults is to ensure we do not give our patients or their family members weapons that can be used against us. One brief Google search of nurses being strangled by stethoscopes that hung on their necks will return pages of relevant results. We place syringes on ourselves and on our computers, even when they are not needed. What’s worse, we walk away from those syringes or leave them in rooms where patients have access. We also do not consider our position in the room. Do you have a clear path for escape? If a patient makes you uncomfortable, do you bring someone into the room with you? Another personal safety measure: do you communicate risks to the next shift so they can protect themselves, too?

Advocate for Change

Increasingly, resources are being presented through organizations and OSHA with limited data to support their recommendations. It is important that nurses advocate for the changes necessary for the prevention of workplace violence. If there is one thing to urge no matter your employer’s response to these guidelines, it is that each nurse pay attention vigilantly to the patient’s behaviors and movements at all times. Ensure weapons are not attached to you or left in the room. Bring someone with you if a patient is at risk for violence.

Always prioritize your own safety. If you would like to learn more, find Silent No More Foundation. Protecting workers from assault is our mission.

Silent No More Foundation began in June 2017 as collectively healthcare workers all over the country united to say we will be silent no more about violence in healthcare workplaces. Since then, we have collaborated on and impacted legislation, connected victims to resources, developed education, spoken at US and international events, empowered thousands of healthcare workers to inspire change for safer workplaces, and more! Silent No More is on a mission to protect healthcare workers before, during, and after and assault in the workplace through education, awareness, advocacy, and legislation. Want to be part of the movement? Find us on Facebook and join the conversation!

Angela Simpson, BSN, RN is the Founder & National Director of Silent No More Foundation, Salisbury, MD. Contact information:

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8 Comment(s)


Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,957 Posts

When I worked in a hospital---We had a Barney Fife character of a security guard. Did not have a weapon and could not wrestle a guinea pig in a fight. Nice guy, but that showed us how much they valued our safety.



37 Posts

Your examples are inappropriate. If I startle a sleeping patient, I am rolling the dice. That was my choice not to wake the patient and therefore not allow them the opportunity to refuse care they possibly did not want.

Active shooter events are something different. Want to stop that, then medical facilities need metal detectors at every entrance, just like courts and airports.

In addition, we cannot "stop the violence" because ultimately we are unable to exercise control over the behavior of our patients and their family members. People control their own behaviors. A better example would have been, a nurse told a patient in the ED that the provider is not going to order Dilaudid. The patient then takes the call light and hits the nurse with it and says "I'll kill you".

However, it is important to call out the fact that there is a small subset of patients whom we care for who choose to abuse and assault staff on a repeated basis. It is this specific portion of the patient population who need to be flagged, tagged, followed and ultimately charged.

We can, via legislation, force employers and the general public to take notice that assaults against medical staff are not going to be tolerated by medical staff without repercussions for the institutions who employ us and the public we serve. I believe this would cause a shift nationally in the culture of violence against medical staff.

Legislation doesnt work? OK so there are "Magnet" hospitals. How about hospitals that attract staff with the additional benefit of "Staff Safety" certification. This could be an independent certification organization (just like Magnet) requiring an institution to implement certain policies, teams, and protocols to earn a Staff Safety rating and designation. Throw the metal detectors in with this as a certification requirement. I know where I would choose to work!

Independent nonprofit certification aside, nothing really has the permanence of legislation. The only way our employers are going to take this seriously is to have laws in place where the employer can be sued or fined when they dont follow the law. This is why employers are so afraid of OSHA.

1. FEDERAL LAW for specific criminal charges against individuals who assault on duty medical staff members of any kind. The state level is a mess, its different everywhere.

2. Outside and separate from criminal charges: enact federal laws that identify, track, flag and report individuals who perform or threaten assault against medical staff (just like the narcotics tracking systems). Once this individual is flagged, if they present for care in a medical facility, their flag displays and that medical facility is then under federal law required to provide a trained security officer escort for that patient as long as they are in the 4 walls of the facility. This could even roll up under OSHA.

3. Law for any facility giving short or long term admission to a patient including, dialysis centers, hospitals, SNF, LTACH, etc etc, where the patient is assigned a nurse who takes an admission of that patient, to have a Behavioral Safety Team (like Rapid Response meets Case Management, for behavioral safety issues). Patients who display behaviors that per the nurse's assessment make the patient a danger to the nurse or others, the nurse or physician can make a documented referral for that patient to Behavioral Safety Team. Example, patient who is yelling for ice water every 5 minutes but who is cooperative when redirected, no. Patient who throws ice water on a nurse, bites a CNA, or threatens to kill a physician can be submitted for admission to the Behavioral Safety Team. Then it is the responsibility of the facility to create a care plan for staff safety at the confluence of the patient's psychiatric, medical, purely behavioral, and criminal presentation. Nursing is removed from the inappropriate responsibility of having to diagnose behavioral disorders on the fly when the individual displays a history of dangerous behavior directed at staff. If the patient is discharged and later readmitted, and were admitted to Behavioral Safety service prior, Behavioral Safety automatically receives a consult and performs a new assessment each time the patient is readmitted. Behavioral Safety Team needs to contain a psych eval and is responsible for diagnosing whether the patient is competent to be accountable for their behaviors, or not, and Behavioral Safety must care plan accordingly.

What mentally competent, abusive patient is going to show up to a Staff Safety-rated emergency room with metal detector, a federal law in place against assault, and a Behavioral Safety Team who at the first threat or assault, ready to slap a security escort on them and assess them to be forever flagged? Either they will behave appropriately, they will leave voluntarily when they realize they will not be allowed to abuse staff, Behavioral Safety will discharge them for safety reasons, or they will assault someone and suffer federal charges. And society will get the message.

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,558 Posts

20 hours ago, SmilingBluEyes said:

When I worked in a hospital---We had a Barney Fife character of a security guard. Did not have a weapon and could not wrestle a guinea pig in a fight. Nice guy, but that showed us how much they valued our safety.

We must have worked together! I had a patient beat me so bad once, they thought he broke my jaw, while "Barney" stood there and kept saying " sir, please stop that..."


6,319 Posts

On 9/3/2019 at 3:56 PM, Silent No More Foundation said:

A sleeping frequent flyer patient with dementia had a systolic blood pressure over 200. He had been refusing all medications the entire admission, so I took the opportunity while he was sleeping to try an IV anti-hypertensive.

The examples are not helping your cause, particularly this one which essentially amounts to medical battery.

Silent No More Foundation

2 Articles; 5 Posts

Greetings! I wanted to clarify something that was poorly worded: the examples given were intended on being bad ways of approaching situations. With word limits, clearly I didn’t word that well. Continuing in the article, it says that the mistakes we made highlight behaviors no longer engaged in. The decisions made were poor.

The important message to take away is that looking at what we are doing as a whole matters in determining root causes for each situation. Doing that in a manner that does not victim blame, but instead highlights prevention in the future through corrective actions, or even environmental changes, is vital in reducing future assaults. We do have some ability to reduce assaults and learning from past mistakes is one of multiple ways to prevent each assault’s circumstances from duplicating themselves in the future.

I hope this clarification helps explain a little better the point that was meant to be conveyed. Mistakes were made, and they have been learned from.

Thank you so much for your feedback!


futurepsychrn, ADN

Specializes in Pschiatry. Has 3 years experience. 188 Posts

And meanwhile where I work they took our security because of the expense. We get 1 guard from 7p-7a, and he can't leave the security office. The hospital is in a really BAD neighborhood and there is minimal staff in the hospital at all times. We have no daytime security. The main campus has 1 guard from 7p-3a. In other words, they could care less if we are safe.


buttercup9, ASN, BSN, MSN

Has 14 years experience. 62 Posts

On 9/9/2019 at 6:56 AM, futurepsychrn said:

And meanwhile where I work they took our security because of the expense. We get 1 guard from 7p-7a, and he can't leave the security office. The hospital is in a really BAD neighborhood and there is minimal staff in the hospital at all times. We have no daytime security. The main campus has 1 guard from 7p-3a. In other words, they could care less if we are safe.

Seriously, you need to find a new job.


You have clearly put a lot of thought into this issue. Very well said!!



37 Posts

Thank you! I do think about the issue a lot. Because I used to work in Med Surg in a non-union state, and I now work in Corrections. It has caused a large amount of personal growth and discovery. No amount of non-incarcerated patient shenanigans will ever look the same to me.