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Update from the CDC

Workplace Violence Prevention for Nurses

Hartley, Daniel EdD, MS; Ridenour, Marilyn MPH, MBA, BSN; Wassell, James T. PhD, MS

Author Information
AJN, American Journal of Nursing: September 2019 - Volume 119 - Issue 9 - p 19-20
doi: 10.1097/01.NAJ.0000580228.01504.0b
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A psychiatric nurse is confronted by an agitated patient in one of the video case studies featured in the NIOSH Workplace Violence Prevention for Nurses course. Image courtesy of the Centers for Disease Control and Prevention.

In 2016, a total of 11,830 nonfatal workplace violence–related injuries requiring time off from work were reported in the Health Care and Social Assistance sector, accounting for 70% of this type of injury across all industries.1 Further, incidents of workplace violence directed toward health care workers continue to be underreported.2-4

In response to this unacceptable level of violence against health care workers, the National Institute for Occupational Safety and Health (NIOSH) has developed an online course to raise awareness of workplace violence among nurses and to help in the development of prevention strategies.

The NIOSH Workplace Violence Prevention for Nurses online training course contains units on what constitutes workplace violence, consequences of workplace violence for nurses and employers, and risk factors for both patient-on-worker violence and employee-on-employee violence. It also provides strategies nurses and organizations can use to prevent violence in their facilities. Each unit begins with a segment called “Nurses’ Voices” in which nurses who have experienced workplace violence give a brief testimonial and ends with an interactive self-check to make sure the nurse participant has understood the key concepts of the unit. The last five units are video case studies based on real-life examples of workplace violence.

On average, 600 health care professionals complete the training each month. It takes participants between two and three hours to complete. Those who do and successfully pass the posttest and evaluation may elect to receive 2.4 CNE credits.

A survey of course participants. In 2016, to determine the value of the course, NIOSH performed a descriptive analysis of participant responses to a survey conducted between August 12, 2013, and November 30, 2015. During this period, 14,518 participants, or 86% of registrants, completed the course and earned CNE credits. Among these, most (12,340 or 85%) were nurses, more than half working in the hospital setting. Two-thirds reported working directly with patients.

A total of 96% of participants felt the course was a good introduction to the topic and met the stated learning objectives. Ninety-five percent or more agreed or strongly agreed that after taking the course they could meet performance-based learning objectives related to

  • identifying institutional, environmental, and policy risk factors for workplace violence.
  • recognizing behavioral warning signs of violence.
  • employing communication and teamwork skills to prevent and manage violence.
  • identifying appropriate resources to support injured nurses.

Overall, most participants (at least 90%) agreed or strongly agreed that the course filled a knowledge gap and met their educational needs. The teaching strategies employed, including the real-life–based video case studies and testimonials from nurses, were well received and considered effective.

The remainder of the survey asked participants about their experience with workplace violence prior to taking the course. Ninety-four percent indicated they had experienced verbal workplace violence in the past 12 months—two-thirds perpetrated by patients (34%) and family members (33%), the remaining third perpetrated by supervisors (16%) and coworkers (14%). Nearly 18% of participants said they had experienced physical workplace violence in the past 12 months—three-fourths (74%) perpetrated by patients, 12% by patients’ family members, and 14% by coworkers (8%) and supervisors (6%).

The strong, positive participant responses to performance-based questions indicate that those who complete the course increase their awareness of workplace violence and gain a basic understanding of prevention strategies. The course also encourages nurses to become proactive in working with employers to prevent violence in the health care setting. After taking the course, 90% of participants felt they could take steps to implement a comprehensive violence prevention program in their workplace. The course is available on the NIOSH website at An AJN podcast with editor-in-chief Shawn Kennedy and lead author Daniel Hartley provides more detailed information on the course content (go to


1. Bureau of Labor Statistics. Injuries, illnesses, and fatalities. Case and demographic characteristics for work-related injuries and illnesses involving days away from work: calendar year 2016 survey results. U.S. Department of Labor. 2018.
2. Friedman RA Violence and mental illness—how strong is the link? N Engl J Med 2006 355 20 2064 6
3. Gillespie GL, et al. Workplace violence in healthcare settings: risk factors and protective strategies Rehabil Nurs 2010 35 5 177 84
4. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers. Washington, DC; 2016. OSHA 3148-06R 2016.
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