Nursing executives keep a close eye on quality metrics, patient satisfaction scores and retention rates. But ask them how many of their nurses were threatened by a patient last month, and many won’t have a clear answer.
That’s according to Christian Burchill, PhD, MSN, associate chief nursing officer for research, evidence-based practice and innovation at Penn Medicine in Philadelphia, and director of nursing research and evidence-based practice at Penn Medicine Lancaster (Pa.) General Hospital. Dr. Burchill has spent more than a decade researching workplace violence in emergency care and is slated to be inducted this fall as a fellow into the Emergency Nurses Association’s Academy of Emergency Nursing, one of just 220 nurses recognized this way out of the association’s 45,000 members nationwide.
For Dr. Burchill, the focus on workplace violence is personal. Early in his nursing career, his research centered on how teamwork influenced patient and provider outcomes. Then, during an overnight emergency department shift, he was physically assaulted by a patient — an experience that permanently redirected his research focus.
“Probably from that point forward, my interest changed from investigating teamwork to really thinking: If we’re not physically safe within our environment, we’re never going to have teamwork,” he said during a July 24 episode of the “Becker’s Clinical Leadership Podcast.” “So I totally shifted my research focus to start looking at workplace violence, especially in emergency departments.”
That shift set the course for the research he’s built since. First and foremost, Dr. Burchill points to an ongoing problem with underreporting, driven in part by a lingering culture in healthcare that treats a certain level of incivility, disrespect and even violence from patients as part of the job.
“We excuse way too much of it,” he said. “We just tend to let it go, and then that means that clinicians aren’t reporting it, and that really hamstrings people in leadership positions. If they’re not getting the data that says people at the front lines are suffering, then they don’t have anything to work with.”
That’s where his own research comes in. Dr. Burchill developed and tested a survey instrument that measures emergency nurses’ perceptions of safety, breaking the results into six factors that shape whether staff feel safe from patient violence:
- Institutional support
- Belonging
- Teamwork
- Training
- Security partnership
- Trust that reporting actually leads to action
Rather than relying on incident counts alone, the tool gives leaders a cumulative safety score and subscale scores for each factor, turning a vague sense that something feels off into a specific, actionable diagnosis. It’s also designed to be used repeatedly, so leaders can test whether a specific fix — more training, a new security partnership or another measure — actually moves the numbers.
A better score won’t fix the underlying reporting problem on its own, though. Nursing leaders also need to set, and repeat, explicit expectations that every incident, whether it’s name-calling, disrespect or violence, gets logged in the hospital’s formal reporting system. That kind of routine reporting, up the chain and on a set cadence, is what turns an assumption into evidence leaders can use to justify more security staffing, more training or more support for a unit.
Even with better data and a clearer mandate, none of it matters if nurses don’t trust leadership to act on what they’re told, Dr. Burchill added. Trust starts with something as simple as a C-suite leader reaching out personally to a nurse who’s experienced workplace violence: acknowledging what happened, apologizing and committing to fix the problem together.
“Oftentimes, I hear from nurses, ‘I didn’t fill out an incident report because it just goes into a black hole and nobody does anything with it anyway,'” he said. “Getting that message out that we are doing something about this, and that we do actually really care about you, is the most important thing someone in an executive position can do.”
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