Forum Focus – AONE Toolkit and Guiding Principles on Mitigating Violence in the Workplace

Workplace violence is an increasingly recognized safety issue in the health care community. In 2010, the Bureau of Labor Statistics data reported health care and social assistance workers were the victims of approximately 11,370 assaults by persons. While workplace violence against health care professionals can and does happen everywhere, the hospital emergency department is among the most vulnerable settings. According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported.

Concerned about the issue, members of the American Organization of Nurse Executives (AONE) and ENA met to discuss how incidents of violence are currently addressed in hospitals and the need to create an environment where health care professionals, patients and families feel safe. A culture change is also needed so violence against health care professionals is no longer viewed as “part of the job.”

The outcome of the meeting was the development of guiding principles and a tool kit to assist nurse leaders in systematically addressing measures to manage and reduce violence against health care professionals in hospitals.

Guiding Principles and Priorities

The guiding principles are steps to systematically reduce lateral, as well as patient and family violence in the work place. These include recognizing that violence can and does happen everywhere, requiring an interdisciplinary team, which includes patients and families, to address workplace violence, and that addressing workplace violence may increase the effectiveness of nursing practice and patient care.

The priority areas delve deeper into the guiding principles, focusing on five areas critical to a successful workplace violence prevention program. They challenge organizations to take a closer look at their social environments, figure out how hazards can be addressed and what training may be required to mitigate them, and devise a way to measure success.


The toolkit provides step-by-step procedures for customizing a violence prevention plan for organizations, as well as templates to document progress. It begins with defining what constitutes workplace violence and providing resources for organizations to develop a zero-tolerance policy. It next shows organizations how to assess the risk factors in their facilities and develop a workplace violence prevention plan. It also offers a number of resources organizations can utilize to train and deploy staff to recognize what isn’t acceptable and what to do if they witness workplace violence. Lastly, it provides resources organizations can use to evaluate the changes and identify next steps in the process.

To download the toolkit and guiding principles, visit