AACN Position Statement: Preventing Violence Against Healthcare Workers

Feb 27, 2025

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This AACN Position Statement was first published May 1, 2019. It was reviewed and updated on February 26, 2025.

Background:

Nurses are on the frontlines of healthcare and are uniquely vulnerable to verbal and physical abuse in the workplace. The American Association of Critical-Care Nurses (AACN) is dedicated to creating a safe and healthy work environment, where acute and critical care nurses make their optimal contribution. The AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence calls for zero tolerance regarding bullying, verbal abuse, and other forms of institutional violence.1 Sadly, the incidence of verbal abuse and physical assaults, including shootings and other physical violence, is at a level that requires focused attention.

The U.S. Bureau of Labor Statistics reports that during the two-year period of 2021-2022, 72.8 percent of all nonfatal cases of workplace violence that required days away from work, job restriction, or transfer were in the healthcare and social assistance industry.2 A Press Ganey report found that 16,975 assaults against nurses occurred in 2023, an increase of 5 percent since 2022.3 And according to AACN’s 2021 Critical Care Nurse Work Environment Survey, 72 percent of respondents who worked in hospitals that had not implemented the Healthy Work Environments Standards reported at least one incident of sexual harassment, discrimination, verbal abuse, or physical abuse in the previous year.4

Unfortunately, research indicates that many violent incidents go unreported, even when policies and procedures for reporting are in place. Nurses not only face the danger of violence during interpersonal interactions, but the hospital environment is also subject to violent incursions such as hostage situations, terrorism, and active shooters.

AACN’s Position:

Healthcare facilities are responsible for applying evidence-based practices to ensure the safety and security of staff, patients, and visitors. AACN calls upon healthcare institutions to have clear and widely circulated policies and procedures regarding both the violence that occurs within the daily functioning of the hospital and the threat from outside incursions. Institutions nationwide should require violence prevention plans to be in effect at all times in all patient care units, including inpatient or outpatient settings and clinics. Additionally, we urge all nurses, physicians, and allied health professionals to report every incident of workplace violence and to maintain their knowledge of safety policies, procedures, and crisis plans.

Recommended Actions for Healthcare Institutions:

  • Educate staff on how to recognize the potential for violence, how to employ de-escalation techniques, and how to seek assistance to prevent or respond to violence.
  • Enable staff to adapt visitation for visitors who do not treat staff with the level of respect they deserve.
  • Establish a clear and consistent reporting structure for workplace violence, with specific policies and procedures on how to report violent incidents to law enforcement.
  • Encourage employees to press charges against persons who assault healthcare workers, and support staff who do. Many states have established laws with enhanced penalties for these offenses.
  • Provide resources and support programs for employees to help them cope with violent incidents.
  • Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.
  • Establish or adopt tools for staff to screen patients for aggression risk.
  • Ensure the presence of sufficient security systems, including alarms, emergency response, and available security personnel.

Recommended Actions for Nurses

AACN maintains that healthcare facilities are responsible for applying evidence-based practices to protect team members from workplace violence, however there are some individual actions that can be taken.

  • Use AACN’s essential healthy work environment standards to improve workplace culture.
  • Seek solutions as a team, including security officers and support staff.
  • Participate in educational training on violence awareness and prevention.
  • Learn and maintain your knowledge of your hospital’s safety policies, procedures, and crisis plans.
  • File a report if you experience an incident or witness violence against someone else.
  • Press charges if you are assaulted.
  • Support co-workers who experience violence.

References:

  1. Barden C, Cassidy L, Cardin S, eds. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016. Accessed February 24, 2025. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments
  2. U.S. Bureau of Labor Statistics. Workplace Violence 2021-2022. October 08, 2024. Accessed February 24, 2025. https://www.bls.gov/iif/factsheets/workplace-violence-2021-2022.htm
  3. Press Ganey. Safety in healthcare 2024. Accessed February 24, 2025. https://info.pressganey.com/e-books-research/safety-2024
  4. Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National Nurse Work Environments - October 2021: A Status Report. Crit Care Nurse. 2022;42(5):58-70. https://doi.org/10.4037/ccn2022798

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