Safety Toolbox Resources

Workplace Violence and Staffing


Developing Safe Environments


Strategies and Standards of Practice


Nurses & Safety: Key Messages

  1. Safety is everyone’s responsibility. There is no hierarchy. Safety requires empowering every voice.
    • Nurses foster open conversations about safety issues, such as fatigue, stress, safe patient handling, workplace violence, incivility and bullying.
      • Workplace violence includes the following: physical, sexual, verbal, horizontal (verbal and nonverbal). Every health care organization should have a comprehensive plan for workplace violence, including horizontal violence
  2. Nursing leaders ensure resources are available to achieve safe results, providing resources for adequate staffing, equipment and education.
    • Nurses prioritize safe staffing and help connect individual, team and organizational safety goals.
      • the likelihood of adverse outcomes increases with an increase in the number of patients assigned to each nurse.
  3. The key components of a safe environment of care include culture and ideology, engagement, space and equipment, staff resources, education & training, patient assessment & monitoring, rules, emergency management, error prevention.
    • Staff behaviors create a safe milieu and promote a positive unit culture.
      • Psychiatric-mental health nurses provide leadership to create a culture that minimizes the use of seclusion or restraint, while promoting a safe environment for persons served as well as staff.
    • Nurses’ awareness, attending, caring, and connecting are critical skills for maintaining a safe environment.
      • Nursing abilities that contribute to a safe environment are learning to respect the client as an individual, the use of inter-subjective communication, and the ability to be fully present in the situation.
      • The de-escalation skills of inpatient psychiatric nurses are considered key to violence prevention.
      • At the patient level, the role of the nurse in suicide prevention includes assessing risk for suicide, providing suicide-specific psychotherapeutic interventions, monitoring and managing at-risk patients, and evaluating outcomes of all interventions.
      • At the systems level, the role of the nurse in suicide prevention includes assessing and maintaining environmental safety, developing protocols, policies, and practices consistent with zero suicide, and participating in training for all milieu staff.
      • The nursing response to persons during evolving behavioral emergencies is non-physical and based on a comprehensive initial and ongoing assessment of the person. The assessment includes behavioral and affective presentation as well as understanding of situations that trigger escalation.
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