We have a significant issue in healthcare today that many nurses are ill prepared to manage: workplace violence. Violence isn't a new problem. It's one that emergency and behavioral health nurses in particular have long confronted as an occupational risk. The difference today is the increased frequency, prevalence, and pervasiveness of the problem across most healthcare settings. Despite this rising tide, there are considerable shortcomings in nurses' knowledge of violence mitigation strategies, their willingness to report episodes of violence to employers, and healthcare facilities' preparedness to prevent or deal with it.

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In February 2017, The Joint Commission rereleased a Sentinel Event Alert that had been previously published in 2010 entitled, "Preventing Violence in the Health Care Setting." A new addendum includes links to resources that facilities can use in developing or strengthening their own plans.1 Although patients and visitors are generally the perpetrators of violence, staff members can also be the offenders. Whatever the case, The Joint Commission calls for a "zero tolerance" approach to violence.

Two formidable obstacles can short-circuit zero-tolerance policies: the sense that staff are powerless to address threats, intimidation, or violent acts because "administration" will turn a blind eye to uphold patient satisfaction scores; and the reluctance to report concerning behaviors in coworkers before they escalate into violence for fear of being wrong or suffering retaliation.

Let's be clear-actions that promote excellent patient satisfaction don't include allowing staff to be victims of violence. Depending on the circumstances and state law, violent behaviors may be criminal acts. Similarly, employees who report coworkers who demonstrate warning signs for violence give leaders the opportunity to intervene before a potentially serious event occurs. (For more on the clinical implications of disrespectful staff behavior, see Clinical Rounds, "Rude Surgeons Linked to Poorer Outcomes," on page 25 of this issue.)

Healthcare leaders and staff must be completely aligned on violence prevention and management actions, including when to press criminal charges against perpetrators. I encourage you to read The Joint Commission's Sentinel Event Alert and discuss the strategies with your team. Which ones are in use at your facility? Which ones should be implemented that aren't in place? Now more than ever, adopting a zero-tolerance approach is an imperative to support a safe environment for staff and patients.

Until next time,

Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, FAWM, FAAN

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Editor-in-Chief, Nursing2017 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.

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