Workplace violence in healthcare settings, especially in acute care environments, is a pressing issue. Nurses, physicians, and other healthcare staff frequently experience physical and verbal aggression from patients, their families, and even colleagues. In the high-stress world of acute care, where emotions can run high, issues can quickly escalate. While healthcare organizations typically have formal policies and procedures to combat violence, one often-overlooked strategy is empowering healthcare workers with bystander intervention skills.
Active bystanders can play a vital role in diffusing tense situations before they escalate into violence. This article will explore the importance of bystander intervention in acute care settings, offer strategies for empowering staff to act, and outline how fostering a culture of accountability and support can help prevent workplace violence.
What is bystander intervention?
Bystander intervention refers to actions taken by individuals who witness violence or aggression but are not directly involved in the conflict. In healthcare, this could mean intervening when a colleague is being verbally harassed by a patient, stepping in when a tense family interaction shows signs of escalating, or supporting a team member who is being bullied or intimidated by another staff member.
Effective bystander intervention requires that staff feel confident in recognizing warning signs of violence and understand the appropriate steps to take. These steps can range from nonverbal cues, like standing nearby to show support, to verbal interventions or alerting security, if necessary.
Empowering healthcare workers to act
The key to successful bystander intervention in acute care settings is empowering healthcare professionals with the tools, confidence, and organizational support to act. The following are strategies for promoting effective bystander intervention.
Training to recognize early warning signs
Healthcare workers often witness the early stages of escalating violence, such as increasing agitation, raised voices, or aggressive body language. However, without training, it can be difficult to recognize when these behaviors are likely to lead to a violent incident. Regular training sessions that teach staff how to spot the warning signs are crucial. This training should include:
- Verbal and nonverbal cues — Recognizing signs of escalating emotions such as clenched fists, pacing, raised voices, or hostile language.
- Risk factors — Understanding which situations are most likely to escalate (such as high-stress moments in the ED, discussions of sensitive information, or delivering bad news).
Establishing clear intervention protocols
Many healthcare workers hesitate to intervene because they aren’t sure of the appropriate response. Healthcare organizations can help remove this uncertainty by establishing clear intervention protocols that guide staff on how to act in different scenarios. These protocols should be easy to understand and adaptable to various situations, including:
- Nonconfrontational interventions — If a staff member notices a tense conversation between a colleague and a patient’s family, simply stepping in and asking how they can assist may defuse the situation.
- Direct verbal intervention — In situations of verbal abuse, a calm but firm statement such as, “We understand this is a stressful time, but we ask that you please speak respectfully to our staff,” can help deescalate without escalating further.
- Calling for help — Staff should be trained on when to call for additional support from security or supervisors, especially if they sense a situation could turn physical.
Encouraging peer support and accountability
Acute care environments can be isolating, with staff intensely focused on their tasks. Encouraging peer support through regular team-building exercises can help foster an environment where bystander intervention is a natural response. When staff feel connected to their colleagues, they are more likely to step in when they notice something is wrong.
Additionally, creating a culture of accountability where everyone is responsible for the safety of the team — not just leaders — reinforces the importance of intervention. Support this type of culture through:
- Open dialogues — Encourage open conversations about workplace violence and the role bystanders can play in prevention.
- Team-based approaches — Implement debriefings after violent incidents where team members can discuss what happened, how it was handled, and how bystander intervention could have improved the outcome.
How to create a culture of bystander intervention
For bystander intervention to work, healthcare organizations need to cultivate a culture that values and supports being proactive. A clear organizational commitment helps ensure all staff members feel safe and supported in stepping in to prevent or deescalate violence.
Ensure leadership support
Leadership plays a crucial role in creating an environment that encourages bystander intervention. Leaders should openly discuss the importance of bystander intervention and model the behavior themselves by:
- Including bystander intervention as part of workplace violence prevention programs
- Publicly recognizing and rewarding staff members who demonstrate bystander intervention
Establish nonretaliation policies
One of the biggest fears for healthcare workers who might otherwise intervene is retaliation —whether from the person they intervene against or from leaders. To combat this, healthcare organizations should establish nonretaliation policies that protect individuals who step in to prevent violence. Staff should know they won’t face negative consequences for reporting incidents or attempting to help.
Debrief after incidents
When violent incidents occur, it’s important to involve all team members in debriefings to discuss what happened, how bystanders reacted, and what could have been done differently. These conversations help reinforce the importance of intervention and provide learning opportunities for future situations.
The unique challenges of acute care settings
Acute care settings, such as emergency departments, intensive care units, and operating rooms, are highly dynamic environments. Healthcare professionals working in these areas often encounter patients in critical condition, accompanied by their anxious families. The intensity of these situations can contribute to workplace violence in various forms, from verbal threats to physical altercations.
Healthcare professionals in these settings may feel unequipped or hesitant to intervene when they witness a colleague being verbally abused or physically threatened, particularly if the aggressor is a patient or family member. This hesitation is natural but can lead to missed opportunities to de-escalate situations and prevent harm. Bystander intervention offers a way to empower staff to act when they see violence unfolding.
Benefits of bystander intervention in acute care
Bystander intervention not only helps prevent workplace violence but also strengthens team dynamics and enhances patient care. When healthcare workers feel empowered to intervene, they contribute to a safer and more supportive work environment, providing direct benefits for patient outcomes by:
- Reducing stress levels — A safer work environment reduces stress and burnout, allowing staff to provide better care.
- Improving communication — Bystander intervention fosters a culture of open communication, where staff are more likely to speak up about issues affecting patient care or safety.
- Increasing job satisfaction — Staff who feel supported and empowered are more satisfied in their roles, leading to better retention rates and a more stable workforce.
Being proactive now will pay off later
Workplace violence is a serious issue in acute care settings, but bystander intervention offers a powerful tool for prevention. By training healthcare workers to recognize the signs of violence, empowering them to act, and creating a supportive culture, healthcare institutions can foster safer, more respectful environments for both staff and patients. In the fast-paced world of acute care, where tensions often run high, having a team ready to intervene can make all the difference in keeping everyone safe.
Nurse Salary and Job Satisfaction Report
Download our 2024 Nurse Salary and Job Satisfaction Report to learn nurses’ reported experiences of violence at their jobs. Based on a survey we conducted of more than 3,600 nurses, the report provides actionable insights and current data for healthcare leaders to better understand the frequency and types of workplace violence and what leaders can do about it.
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