J.D. Buchert, DNP(c), MSN, M.Ed., MS, RN, CNOR: No financial relationships to disclose
Learning Outcome: After this education activity, participants will be able to explain the multidisciplinary strategies necessary to prevent workplace violence in perioperative and ambulatory surgical settings. Participants will be able to identify tools and processes for assessing behavioral risk, managing high‑risk patients, and implementing effective violence‑prevention interventions.
Overview/Abstract: Workplace violence (WPV) in healthcare has escalated to crisis levels, with perioperative professionals facing disproportionately high rates of verbal and physical aggression. In 2023, more than 80% of healthcare workers experienced WPV, and three nurses were assaulted every hour in the United States. These incidents not only threaten staff safety but also compromise patient care, organizational stability, and workforce retention. Ambulatory and perioperative settings present unique vulnerabilities, including high‑stress environments, rapid patient throughput, and limited behavioral health resources. This presentation provides an evidence‑informed overview of the growing WPV epidemic and offers practical strategies for creating safer perioperative and ambulatory surgical environments. Participants will explore multidisciplinary approaches to building a sustainable violence‑prevention infrastructure, including the development of comprehensive WPV plans, formation of interdisciplinary committees, and integration of behavioral expectations into patient care workflows. The session will highlight Texas SB 240 and related national legislation as models for establishing clear policies, reporting protections, and accountability measures across care settings. Attendees will examine tools for risk identification, de‑escalation, and data‑driven intervention, as well as methods for assessing and managing high‑risk or repeat‑offender patients. Emphasis will be placed on situational awareness, frontline engagement, and fostering a culture of civility, transparency, and shared responsibility. Through case examples and regulatory guidance, the presentation equips perioperative professionals with actionable strategies to enhance staff preparedness, strengthen organizational readiness, and ultimately reduce violence‑related harm. Ensuring safety in perioperative practice is not optional—it is an ethical and operational imperative.
Description of Current State: Workplace violence in healthcare has escalated into a nationwide crisis, with healthcare workers now experiencing violence at rates dramatically higher than any other profession. Healthcare staff account for 73% of all nonfatal workplace injuries due to violence and are up to five times more likely to be assaulted compared to workers in other industries. The problem continues to worsen, with rising rates of physical assaults, verbal aggression, and threats directed toward frontline clinicians, especially in high‑stress environments like perioperative and ambulatory surgical settings. This growing violence has significant human and operational impacts: hospitals face an estimated $18.27 billion in annual costs related to workplace and community violence, including prevention, injury care, staffing shortages, and infrastructure damage. Nurses remain the most frequently targeted group, with agitation and aggression identified as key precipitating factors in reported incidents. As a result, healthcare workers increasingly report diminished psychological safety, declining job satisfaction, and intentions to leave the profession—further straining an already burdened workforce.
Description of Desired/Achievable State: In the desired future state, perioperative and ambulatory surgical professionals are equipped with the knowledge, skills, and organizational support needed to effectively prevent, recognize, and respond to workplace violence. Participants will be able to apply evidence‑informed strategies to strengthen a culture of safety, promote early identification of escalating behaviors, and implement consistent de‑escalation and reporting practices across all care settings. They will engage proactively in multidisciplinary workplace violence prevention efforts, contribute to policy development, and use data‑driven tools to assess risk, track incidents, and support continuous improvement. By the end of the activity, participants will be able to:
Implement structured processes to identify, assess, and manage patients or visitors exhibiting behavioral risk indicators. Apply effective verbal and nonverbal de‑escalation techniques to reduce the likelihood of violent incidents. Participate in organizational WPV committees or initiatives to improve policy, training, and response protocols. Utilize incident reporting tools to ensure timely documentation, trend analysis, and follow‑up action. Foster a safer perioperative environment by supporting situational awareness, teamwork, and shared accountability for violence prevention.
Audience Engagement: The audience will have an opportunity for a Q&A and sharing experiences.
Additional Information: By achieving the desired future state, participants will be able to:
Integrate evidence‑based WPV prevention strategies into daily perioperative and ambulatory workflows, contributing to a measurable reduction in violent incidents. Apply structured risk‑assessment frameworks to identify behavioral red flags early and implement rapid, team‑based mitigation strategies. Demonstrate proficiency in de‑escalation, including verbal, nonverbal, and environmental techniques appropriate to high‑acuity care settings. Engage in multidisciplinary WPV committees, policy development, and data‑driven practice improvements to ensure alignment with state and federal regulatory expectations (e.g., TJC, OSHA, SB 240). Support a culture of civility and psychological safety, enhancing teamwork, communication, and reporting transparency across clinical units.
Content/Topics: 30‑Minute Presentation Outline “How to Tackle the ‘Epidemic Before the Pandemic’: Workplace Violence in Perioperative & Ambulatory Settings”
1) Welcome, CE Instructions, and Disclosures (1–2 min)
Purpose of the session CE documentation process Speaker disclosure (no conflicts)
2) Current State of WPV in Healthcare (5 min)
Rising rates of WPV; healthcare workers 5× more likely to experience violence than other industries [jamanetwork.com] 73% of nonfatal workplace injuries in healthcare are due to violence; escalating psychological and financial toll [AORN Ambul...esentation | PowerPoint] Special vulnerability of perioperative and ambulatory settings (high‑stress, immobile patients, constrained environments)
3) Definitions and Key Risk Factors (3 min)
WPV categories: verbal assault, physical assault, disruptive behavior, property destruction Precipitating factors such as agitation, aggression, and behavioral triggers identified in patient safety event data [shepscenter.unc.edu] Unit‑specific environmental and workflow stressors
4) Legislative & Regulatory Expectations (5 min)
Overview of Texas SB 240 and ASC‑specific WPV requirements TJC WPV Elements of Performance and alignment with national expectations Impact of federal proposals like the Save Healthcare Workers Act
5) Prevention & Response Strategies (10 min) A. Building Prevention Infrastructure
Core components of a WPV plan (committee, training, reporting, incident response) Importance of a multidisciplinary approach
B. Practical Tools for Perioperative/ASC Teams
Situational awareness (“Stop, Look, Listen”) Red‑flag identification and early verbal de‑escalation Buddy system and escalation protocols Documentation essentials and reporting pathways
6) Data, Trends & Continuous Improvement (3 min)
Why WPV incident reporting matters Trending by role, time, location; using data to drive action
7) Key Takeaways & CE Reminder (1–2 min)
Safety as a shared responsibility Encourage immediate application of one prevention strategy Attendance/QR code reminder for CE Contact information for follow‑up
References: Crisis Prevention Institute. (2025). Workplace violence prevention training annual report 2025. https://www.crisisprevention.com/globalassets/us-ca/resources/pdf/2025-annual-report-final.pdf [aha.org] American Hospital Association. (2025). The burden of violence to U.S. hospitals: A comprehensive assessment of financial costs and other impacts of workplace and community violence. https://www.aha.org/system/files/media/file/2025/05/The-Burden-of-Violence-to-US-Hospitals.pdf [facs.org] Jacobs, L. M. (2025, June 10). Alarming rise of workplace violence forces healthcare workers to rethink safety. American College of Surgeons Bulletin. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2025/june-2025-volume-110-issue-6/alarming-rise-of-workplace-violence-forces-healthcare-workers-to-rethink-safety/ [jamanetwork.com] Tabaie, A., Bennett, S. S., Tran, A. K., et al. (2025). Health care staff–reported workplace violence in patient safety event reports. JAMA Network Open, 8(11), e2544642. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841679 [shepscenter.unc.edu] Verkada & The Harris Poll. (2025). The state of healthcare worker safety. https://docs.verkada.com/docs/verkada-state-of-healthcare-safety.pdf [AORN Ambul...esentation | PowerPoint]
