Workplace violence in healthcare is one of the most urgent safety concerns facing today’s nurses, clinicians, case managers, social workers, and healthcare leaders. During CareerSmart® Learning’s interactive webinar, “Workplace Violence in Healthcare: Creating a Safer Environment for All,” presented by Rachel Crowley, BSN, RN, WCC, attendees brought forward thoughtful, real-world questions about violent patients, bullying, hostile work environments, reporting concerns, trauma-informed care, virtual care safety, and how to better prepare healthcare teams before incidents occur. This follow-up Q&A brings together key questions from the session, including several that could not be addressed live, to help healthcare professionals and organizations continue the conversation, strengthen workplace safety practices, and support a culture where violence, intimidation, and abuse are never accepted as “part of the job.

Questions Not Addressed in Webinar

Have you heard of organizations that have a 1:1 sitter of a security officer for violent patients? This is regarding a patient with multiple assaults on healthcare workers. Appreciate your insight!

Answer: I can only speak for the facilities that I have worked at, but yes. When we have had a violent patient or one with a history of violence during the admission, security is assigned to the room.

Have hospitals installed metal detectors?

Answer: I am sure that some hospitals have metal detectors. When I approached leadership and security about this, one of the obstacles was the amount of entry points needed to provide the detectors/security at those locations. Some of the research that was also used at this time, stated that having metal detectors doesn’t correlate to a decrease in assaults; just pulls more metal. They stated that most of the attacks are done with physical violence (punching/kicking/biting). We are looking at an object identifying. It reminds me of what you would see at an airport, to help see who has a gun/weapon on their person.

Can you elaborate on steps to take when the hostile environment stems from your supervisor or manager.

Answer: The best advice I can give is to keep a record of everything. Document encounters, save emails, do not discuss things without someone else present if possible. If you have mentioned those things to your manager and still feel like it is a hostile work environment, take your concerns to HR. Some organizations have courses built to help with teamwork that may also be useful.

It’s very challenging when the bully is someone in a very high level of authority! How to best deal with that when HR is not always eager to get involved?

Answer: When discussing things with HR, it can be really hard to see what is going on behind the scenes because they cannot say anything about the “follow up” that they do. Again, the recommendation would always be to document every interaction that is viewed as hostile, statements made, scenarios, witnesses. In order to build a case, it cannot be hear say. This has always been a difficult one to deal with because when you do place a variance or report things of this nature, most feel they are retaliated against.

During a team meeting the team leader is swearing and cussing every other word.  Is this bullying or creating a hostile environment?  Or misuse of authority? Directed to?

Answer: In this case, there should be a policy in place that states the expectations of behaviors. One of which should include use of profanity. If you have a policy about that and documentation of someone abusing it, then I would take it to HR to review. This could also be something that if you have not mentioned to the individual, I might start there. I do no know the situation, but sometimes once something is addressed, you might find out that they didn’t know that it was offensive. When it comes to a hostile work environment or bullying, I would find it is less of bullying and more of a combination of misused authority and creating a hostile work environment. It needs to be addressed. If it has and nothing has changed, document what is said, when it is said and find out if you have a policy on this.

Questions Addressed in Webinar

What guidance can help when a healthcare team says workplace violence is part of the job?

Answer: I think one of the biggest shifts we need to make is recognizing that workplace violence is common in healthcare, but it should never be considered “acceptable” or “just part of the job.” When teams start normalizing it, reporting decreases and staff stop feeling supported. I try to reinforce that every verbal threat, intimidation, or assault matters and deserves follow-up, support, and reporting. Culture change starts with leadership consistently responding to concerns instead of minimizing them.

What is TIC education?

Answer: Trauma-Informed Care (TIC) education focuses on helping staff recognize how trauma impacts behavior, communication, emotional regulation, and reactions to care. It teaches staff to approach patients—and each other—with safety, empathy, and curiosity rather than judgment. In healthcare, TIC also helps reduce escalation by improving communication, awareness of triggers, and understanding the “why” behind behaviors we may see during stressful situations.

Do you have any additional tips for remote colleagues/virtual departments/Telephone calls/Video visits?

Answer: One thing I encourage is setting clear boundaries and expectations early in the interaction, especially on difficult calls. Tone matters tremendously over the phone or video because we lose body language cues. I also think scripting and de-escalation training are incredibly helpful for virtual staff. Teams should know when it is appropriate to pause, redirect, end a call, or escalate concerns. Debriefing after difficult interactions is just as important for virtual teams as it is for bedside staff.

What are best practices that you’ve seen in educating nursing students on workplace violence before they graduate?

Answer: The most effective education I’ve seen is realistic, scenario-based training rather than lecture alone. Students benefit from practicing de-escalation, boundary setting, situational awareness, and communication skills in simulation or role-play environments. I also think it is important to openly discuss reporting processes, emotional impact, and the idea that asking for help is not weakness. Preparing students for workplace violence should focus on both safety skills and building confidence to speak up early.