Workplace Violence Training and Prevention in Hospital-Based Healthcare: Implications for Nursing and the Interdisciplinary Team in the Hospital


The aim of this integrative review is to inform best practice by evaluating and synthesizing findings from studies about the impact of workplace violence de-escalation programs in the hospital setting. This integrative review will evaluate themes identified from the various research articles, as well as limitations from the research. Workplace violence has been proven to impact healthcare. There is great potential for nursing and security to partner to work towards reducing the risk of WPV. Security personnel often have knowledge and expertise in the training and intervention in prevention and intervention of violent situations. These personnel can be strong partners for nursing and other healthcare workers through training, support, and education. The articles addressed one or both of the review questions surrounding workplace violence in healthcare. The review questions include discussing effectiveness in de-escalation training in reducing workplace violence, as well as staff perceptions to management of violent events after de-escalation training.


A leading theme was the utilization of the standard coping scale tool to help improve confidence in managing aggressive patients. A common tool utilized in several studies was developed by Michael Thackrey (Thackrey, 1987). The Confidence in Coping with Patient Aggression Instrument (CCPAI) is a widely known tool to help standardize subjective responses relating to specific questions. This tool is used to measure the confidence staff have in managing aggressive and violent patients. The research articles that utilized the CCPAI showed significant increase in confidence managing aggressive and violent patients post de-escalation training (Thackrey, 1987). The surveys utilize an 11-point Likert Scale over ten standardized questions. Shaw (2015) did not utilize an intervention nor the CCPAI to evaluate staff’s perception to workplace violence in emergency departments. However, Shaw (2015) findings did show concerning results of staff’s perception of a lack of safety protocols and procedures within the department and healthcare.

Simulation training and education to strengthen staff’s confidence and competence in managing aggressive patients is another key theme from the research articles. In the majority of the research articles, simulation training and education was utilized in the de-escalation training programs. The simulation training and education allowed for staff to analyze, learn, and understand key points in managing escalating patients, preventative measures, and de-escalation techniques in a controlled environment. Simulation training allowed for staff to learn in a controlled environment without endangering themselves or patients.

One of the final key themes identified in the research articles is the magnitude and prevalence of workplace violence throughout healthcare on a global scale. Each research article’s data spoke to workplace violence in their organization. This key theme can associate workplace violence in healthcare as a pandemic problem. If healthcare does not remedy the safety issues and concerns raised by frontline staff, healthcare will continue to suffer staffing shortages, increased workman’s compensation claims, and decreased quality care delivery to patients.


The integrative review has numerous limitations. This integrative review only reviewed articles from the previous five years to better understand recent advances made in the research surrounding workplace violence in healthcare. The integrative review did utilize a global search, however, there remained a limited number of articles applicable to the integrative review topics. Further limitations in this integrative review are related to the lack of published articles and research in the field of workplace violence in healthcare. The integrative review also incorporated a variety of quality rated articles that might not have been included if more articles were available for review.


The implications from this integrative review result in a need for increased research and interest surrounding workplace violence in healthcare. Future studies should evaluate the effectiveness of de-escalation strategies in reducing the rates of workplace violence, establish a best practice in de-escalation training, and staff’s perceptions to workplace violence in healthcare. Studies should also focus on their countries or local governments stance on preventing workplace violence in healthcare. Healthcare systems must lean on their governments the importance of preventing workplace violence in healthcare and the potential outcomes associated if workplace violence continues to be overlooked as a serious pandemic in healthcare.


Workplace violence in healthcare is a global pandemic that will affect the future of healthcare and care delivery. Research is needed to determine the magnitude and prevalence workplace violence has in healthcare. Anonymous surveys, that ensure staff are safe from repercussions, are highly encouraged to determine accurate data surrounding workplace violence in healthcare. As healthcare continues to grow, the need for a safe work environment becomes a higher priority. An estimated 1 in every 4 nurses have been assaulted during their career. The workplace violence epidemic that is affecting healthcare can be correlated as one of the leading factors to increased turnover rates. The 2019 National Health Care Retention & RN Staffing Report stated that hospitals have had an average turnover rate of 87.8% of its workforce since 2014 (NSI Nursing Solutions, Inc., 2019). Healthcare leaders must address the incidences of workplace violence and create a standard for a safe work environment. Due to the current limited data, leaders must focus on ways to increase data. A preliminary focus for building a zero-tolerance environment is through understanding ways to create an environment of reporting. Through reporting, leaders will better understand the prevalence of workplace violence and the impact on healthcare (American Nurses Association, 2019). Healthcare workers deserve the right to work in a safe environment and as leaders it should be our primary focus to help achieve that goal.


Lacey Byrd is a Healthcare Risk Manager who began her career as a Registered Nurse. She has dedicated her professional career to improving outcomes for patients and increasing safety for frontline staff. Lacey graduated with her Bachelor of Science in Nursing from the University of South Carolina and obtained her Master of Science in Nursing from Kennesaw State University.

Margot Lisa Hedenstrom, PhD, RN, MSN, MBA, NEA-BC is an Assistant Professor at Kennesaw State University where she teaches in the MSN Nursing Administration track. She is certified as a Nurse Executive Advanced from the American Nurses Credentialing Center. She serves with the ANCC as a peer reviewer for the ANCC Magnet© recognition program and as an appraiser for the Pathway to Excellence© program. Prior to joining Kennesaw State, she worked for many years in system and organizational nursing executive leadership roles including hospital and healthcare Chief Nurse Executive roles as well as serving as a Patient Safety Officer. She has a BSN from Georgia Southern University, an MSN from Medical College of Georgia, an MBA from Brenau University, and a Ph.D. in Nursing from Georgia State University. She is certified as a Nurse Executive NEA-BC through the ANCC credentialing center.