Session: The importance of having a comprehensive plan to prevent workplace violence in ASCs

Editor's Note

In this session, Beverly Kirchner, BSN, RN, CNOR(E), CASC, vice president of compliance at TriasMD and ambulatory surgery center (ASC) track leader for the OR Manager Conference, spoke on behalf of Parkland Health’s JD Boucher and Karen Garvey on how violence against healthcare workers is rising and requires the same rigor leaders give to infection prevention and fire safety. “We’re not safe,” Kirchner said. “You have to be alert, you have to train, and you have to understand what to do.”

The session traced scope and drivers. Per the speaker, COVID-era isolation, strained mental health resources, long waits, unclear instructions, and unrealistic expectations fuel aggression. Verbal abuse is routine and physical assaults are no longer rare. Kirchner cited figures such as “three nurses are assaulted every hour” and reported that more than 80% of healthcare workers experienced workplace violence in 2023. “Healthcare workers are five times more likely to experience workplace violence than workers in any other industry,” she said.

Operational answers focused on assessment, environment, reporting, and recovery. Parkland built an intake tool to flag high-risk patients and families on arrival. It also installed metal detectors at every clinic, which prompts the removal of “a minimum of 80” weapons a week, including guns and knives. Inside facilities, however, Kirchner urged leaders to secure back-of-house doors with badges or biometrics, raise or shield front desks, and drill staff on active assailant response. “Be very careful about who you let behind those doors,” she said.

Policy infrastructure matters. Kirchner asked ASC leaders to spearhead workplace violence prevention committees, adopt a written plan, and document every incident with time, location, type of aggression, injury, and lost work days. Reports should feed risk management and workers’ comp, then roll up transparently to the governing board. “You’ve got to be able to report this stuff,” she said. Panic buttons and personal alarms were recommended, along with de-escalation and customer service training. Kirchner advised annual education at minimum, with more frequent drills in high-risk settings.

Support after harm is essential to retention. Parkland dispatches a clinician or psychologist to the injured nurse, places them on leave, and initiates treatment immediately. “They are retaining their nurses because the nurses know they are valued,” Kirchner said. Leaders should also reduce agitation upstream. Kirchner encouraged rewriting discharge and preoperative instructions to a third- to fifth-grade reading level, eliminating acronyms like DOS and PRN, and delivering materials in the patient’s first language. Clear expectations lower frustration.

Legal context is evolving. Kirchner noted emerging state laws, including Texas statutes that make assaulting healthcare staff a felony with potential prison time, as well as national standards from accrediting bodies that now call for maintaining workplace and patient safety. Templates and toolkits from state agencies can jump-start ASC programs. “Share and steal from each other shamelessly, so we all get to zero harm,” she concluded.