Workplace Safety in Advanced Nursing Practice: Workplace Violence Against Nurses – Evidence, Ethical Analysis and DNP Translation

Assignment: Contemporary issue in advanced nursing practice

Select one contemporary issue relevant to your current or anticipated advanced nursing role. Topic: Workplace safety. Use the following four headings.

1. Practice Issue (approximately 100–150 words): Briefly identify the issue and explain why it matters to advanced nursing practice.
2. Nursing and Interdisciplinary Evidence (approximately 250 words): Identify what current nursing knowledge/evidence contributes to understanding the issue. Then identify what one other discipline contributes. Synthesize the two perspectives rather than discussing them as unrelated bodies of knowledge.
3. Ethical Analysis (approximately 250 words): Identify one current policy or practice associated with the issue. Analyze it using an ethical framework or relevant ethical principles. Explain the ethical concern or dilemma from the perspective of advanced nursing practice.
4. Translation to Practice (approximately 150 words): Based on your evidence and ethical analysis, recommend one action that a DNP-prepared nurse could reasonably take. Explain how the recommendation reflects evidence from nursing and other sciences.

Original example for study purposes. Use it as a model, not as your submission.

Practice Issue

Workplace violence (WPV), including verbal threats, physical assault and intimidation by patients and visitors, is one of the most serious safety threats facing nurses. Healthcare workers account for 73% of nonfatal workplace injuries caused by violence in the United States and are about five times more likely than workers overall to be injured by violence at work (U.S. Bureau of Labor Statistics [BLS], 2020). In a 2025–2026 national survey, 84.8% of registered nurses reported experiencing violence in the past year, and 25.5% had considered leaving the profession (National Nurses United [NNU], 2026). WPV matters to advanced nursing practice because it harms nurses’ physical and psychological health, worsens staffing shortages and threatens patient safety. DNP-prepared nurses, as clinical leaders, are positioned to translate evidence into organizational systems that protect both staff and patients.

Nursing and Interdisciplinary Evidence

Nursing evidence explains the human and organizational dimensions of WPV. Nurses experience violence most often during direct care, especially in emergency, psychiatric and geriatric settings, and many incidents go unreported because nurses perceive violence as “part of the job” or fear blame. In the NNU (2026) survey, 22.8% of nurses said employers ignored their reports, 17.4% were blamed or reprimanded for reporting, and only 18.2% said nurses were included in risk assessments. Psychological harm is substantial: 63.1% reported anxiety, fear or heightened vigilance after violence. Nursing research therefore highlights culture, underreporting, psychological harm and the need for nurse voice in prevention.

Occupational health and safety science contributes a systems framework, the hierarchy of controls, which prioritizes eliminating hazards and using engineering and administrative controls over relying on individual behavior (Occupational Safety and Health Administration [OSHA], 2016). Consistent with this framework, a systematic review found that staff training alone mainly improved knowledge and confidence, whereas multicomponent programs combining environmental changes, organizational measures and training produced the clearest reductions in violent incidents (Wirth et al., 2021).

Synthesized, the two perspectives show that WPV is not simply an individual nurse’s problem to manage with de-escalation skills. Nursing evidence identifies where and why violence occurs and why it remains hidden, while occupational safety science shows which interventions work: layered systems that include risk identification, environmental design, adequate staffing and responsive reporting. Effective prevention requires both: system-level controls informed by front-line nurses’ knowledge of risk and a reporting culture that makes the data trustworthy.

Ethical Analysis

One common practice is placing behavioral flags in the electronic health record (EHR) to warn staff that a patient has previously been violent or threatening. The practice is intended to protect staff and is consistent with The Joint Commission’s (2021) requirement that hospitals identify and address WPV risks.

Using principlism (Beauchamp & Childress, 2019), flags support nonmaleficence toward staff by alerting them to prevent harm. The American Nurses Association (2025) Code of Ethics also affirms that nurses owe duties to themselves, including safety. However, flags raise concerns about justice and beneficence toward patients. In one large emergency department study, Black patients were flagged at nearly twice the rate of White patients, and flagged patients waited longer and received fewer tests (Agarwal et al., 2023). Flags are often subjective and permanent, so implicit bias can follow a patient into every future visit, and the flag can delay care and erode trust. This also challenges respect for persons, because patients are rarely told they are flagged and cannot contest it.

The dilemma for the advanced practice nurse is that both obligations are legitimate: protecting colleagues from foreseeable harm and providing equitable, unbiased care to every patient. Eliminating flags could expose staff to preventable injury, while unregulated flags can produce discriminatory harm. From an advanced nursing practice perspective, the ethical response is not to choose one value over the other but to redesign the practice so that it protects staff while meeting standards of fairness, accuracy and transparency.

Translation to Practice

A DNP-prepared nurse could lead an interprofessional team to implement a standardized, criteria-based behavioral risk alert protocol with routine equity auditing. The protocol would replace subjective flags with alerts based on documented, specific behaviors and a validated violence-risk screening tool; require review and expiration dates for each alert; include a care plan describing how to provide safe care rather than labeling the patient; and track alert rates and care times by race and ethnicity each quarter.

This recommendation reflects nursing evidence by drawing on front-line nurses’ knowledge of risk and building a trusted reporting process. It reflects occupational safety science by using an administrative control as one layer of a multicomponent program (OSHA, 2016; Wirth et al., 2021). Equity auditing responds to evidence of disparities in flagging (Agarwal et al., 2023), honoring both nurse safety and justice for patients.