Workplace Violence: APNA 2008 Position Statement

Please note that these papers are for archival purposes only and do not necessarily represent APNA's current positions.

Introduction Inpatient Violence in Psychiatric Settings Outpatient Psychiatric Settings Interventions
Recommendations for Inpatient and Outpatient Settings Appendix Acknowledgments References
Download the full PDF

Executive Summary

The American Psychiatric Nurses Association (APNA), the largest professional organization for psychiatric nurses, recognizes that violence in the workplace is a pressing occupational concern for all registered nurses and for psychiatric nurses in particular. To examine the scope of the problem and to identify solutions, the APNA chartered a Task Force on Workplace Violence in May 2007. Content experts conducted a comprehensive review of the literature focusing on the following practice areas: inpatient psychiatric settings, outpatient settings, emergency departments, nonpsychiatric areas such as home care, and academic environments. Workplace violence was broadly defined, including physical, sexual, and verbal threats and abuse from peers (i.e., horizontal violence) as well as consumers. Based on the findings, the task force developed recommendations for environmental safety, education, and research, both globally and specific to each setting.

The task force examined a wide range of issues including the high rates of nonfatal assaults on nurses, the underreporting of violent incidents, the physical and emotional health consequences of violence, the associated costs relative to recruitment and retention of qualified staff, and the state of the science in management and prevention.

It is abundantly clear that violence at work from consumers, colleagues, and workplace intruders is a significant occupational health hazard for nurses in all settings. The evidence base is rapidly improving and reports relative to the efficacy of various risk management, regulatory, and legal interventions are identifying important protective measures. Nevertheless, barriers to effectively addressing the problem of workplace violence persist and include inconsistent legal and regulatory protections, widely varying prevention programs lacking an evidence base, the belief that violence is “part of the work,” and the absence of standardized operational definitions precluding benchmarking and monitoring.

The task force respectfully submits the following recommendations relative to workplace violence in all settings. Specific recommendations linked to discreet practice areas are addressed in each of the position papers developed by the task force.


  • Professional nursing organizations must advocate for (a) safe work environments, (b) education about risk management and prevention, (c) research support, as well as (d) stricter laws and mandatory regulations enforcing safe work practices.
  • Health organizations must establish and maintain a comprehensive program for the prevention, reporting, and management of all types of workplace violence.
  • Nurse managers need to create and maintain supportive work environments where respectful communication is the norm, organizational policies are followed, and incident reporting is efficient and blame-free.
  • Individual nurses should intervene when they witness aggression among their colleagues, recognize factors that may predispose patients to becoming violent, and report all incidents of violence.
  • Nursing educators must include workplace violence prevention and conflict management in the curriculum and prepare professional nurses in the prevention, assessment, and management of aggression in patients, visitors, and colleagues.
  • Investigators should study proactive prevention and intervention strategies, efficacy of training modalities, and efficacy of specific policies and leadership styles to identify best practices for prevention of workplace violence.
  • Researchers and clinicians must develop consistent and operationally defined definitions of what constitutes acts of violence in health care settings.

APNA supports a sustained commitment to fostering a safe and healthy workplace. APNA recognizes that the ultimate responsibility for maintaining the safety of staff and other individuals in treatment and learning environments rests with the nursing and administrative leadership of each setting. The association and its members must advocate for continued work on the prevention and reduction of workplace violence as well as for ongoing research to support 2 evidence-based practice in this area. APNA is committed to working with nursing colleagues, clients and families, physicians and other health care providers, and advocacy groups to minimize workplace violence.


Introduction Inpatient Violence in Psychiatric Settings Outpatient Psychiatric Settings Interventions
Recommendations for Inpatient and Outpatient Settings Appendix Acknowledgments References
Download the full PDF
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