How to improve nurse safety and build a culture of trust

Healthcare workers are far more likely to be injured by workplace violence than workers in most other industries, and nurses, who spend the most time at the bedside, are often the first to face it. Many incidents go unreported, so the true scale of the problem is likely larger than the data show.

Violence is only one part of the picture. Nurses also face lifting injuries, exposure to infections, sharps injuries, and the fatigue that comes with chronic understaffing. Nurses who feel unsafe at work often call out more, burn out faster, and eventually leave. That strain then reaches patients as delayed care and avoidable errors.

Nurses spend every shift protecting their patients, and they deserve the same protection from the facilities where they work. This guide covers the most common hazards nurses face, the metrics worth tracking, and a step-by-step roadmap for building a culture of nurse safety.

Why nurse safety matters for facilities and patients

Unsafe conditions for staff often become unsafe conditions for patients. Nurses who are injured or exhausted may have a harder time detecting subtle changes in a patient’s condition or double-checking a medication, which is why patient and healthcare worker safety tend to rise and fall together.

Workplace violence not only contributes to turnover and burnout—it can also erode an entire team’s morale. When nurse safety slips, the business costs follow: resignations drive recruiting costs, open shifts increase overtime, and recurring incidents raise survey risk. Investing in proper nurse workplace safety protects both your staff and your budget.

Nurse safety statistics that facilities should know

The following nurse safety statistics show where risk concentrates:

• Healthcare and social service workers are 5 times as likely to suffer a workplace violence injury as workers overall, according to the U.S. Bureau of Labor Statistics. In 2018, healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence.
• A global meta-analysis found that 61.9% of healthcare workers had experienced workplace violence in the past year, and 24.4% had experienced physical violence.
• Verbal abuse is the most common form of nonphysical violence, reported by 57.6% of healthcare workers in the same analysis, while 33.2% reported threats and 12.4% reported sexual harassment.

According to an analysis conducted by Press Ganey: 

• More than 2 nursing personnel are assaulted every hour across U.S. hospitals, which amounts to roughly 57 assaults per day.
• Psychiatric units, emergency departments, and pediatric units have reported the most assaults against nursing personnel.
• Obstetrics and neonatal intensive care units (NICUs) have reported the fewest assaults.
• Patients are the largest source of violence, but family members, visitors, and even coworkers can also commit assaults.

The most common occupational hazards for nurses

Every nurse safety program starts with knowing which occupational hazards are present on each unit.

Workplace violence

According to an American Hospital Association (AHA) report, workplace and community violence cost hospitals across the United States an estimated $18.27 billion in 2023, ranging from prevention and security spending to treating injuries. 

Beyond the cost, violence harms staff physically and psychologically. Since 2022, the Joint Commission’s workplace violence prevention standards have required accredited hospitals to maintain a prevention program with leadership oversight, incident reporting, data analysis, post-incident follow-up, and staff training.

Burnout and understaffing

Burnout and understaffing create a self-reinforcing cycle: understaffing leads to higher burnout among in-house staff, which results in turnover and further understaffing. The link between understaffing and nurse safety is clear: rushed nurses may skip steps or work alone when they actually need help. 

Musculoskeletal injuries

Patient handling often involves lifting, repositioning, and working in awkward positions, which can strain nurses’ muscles, tendons, and nerves and lead to injury. 

Facilities can prevent many of these nursing injuries. Keep lift equipment available and maintained on every unit, define when mechanical lifts are mandatory, and build staffing plans that allow for 2-person transfers. Short staffing can push nurses to attempt transfers alone, increasing the risk of injury. 

Infection exposure and sharps injuries

Clinicians may be exposed to infectious organisms such as viruses, fungi, bacteria, and parasites every day, and sharps injuries can transmit bloodborne pathogens. 

Sharps injury prevention in healthcare relies on safety-engineered devices, such as retractable or shielded needles, which employers must evaluate and implement in accordance with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. 

Every exposure should be reported immediately and logged. The same hand hygiene and personal protective equipment (PPE) practices that reduce hospital-acquired infections also protect your staff.

How to build a culture of safety in nursing

The steps below build on one another and show how to improve nurse safety in healthcare settings of any size. Adapt each step to your facility and units: a small rural facility faces different volumes, acuity levels, and security risks than a large metropolitan hospital, and an emergency department’s needs differ markedly from those of a long-term care unit. 

1. Secure buy-in and assign ownership

Form a multidisciplinary safety team with nurse leaders, frontline nurses, security, employee health, risk management, and quality improvement. 

Nurse leaders should watch for unit risks and consistently encourage reporting, while frontline nurses can spot hazards early and act before harm occurs. Leaders should also model the protocols they expect staff to follow. 

To make ownership stick: 

• Define explicit safety leadership competencies for managers and supervisors.
• Incorporate safety metrics into performance reviews and leadership evaluations.
• Designate unit safety champions who track progress and lead local initiatives.

2. Assess risks and track nurse safety metrics

Start with a baseline workplace hazard assessment for each unit: review a year of incident reports and the OSHA 300 Log, walk each unit, and ask staff where they may feel unsafe. Then track a consistent set of nurse safety metrics:

• Injury rates: Track musculoskeletal, sharps, and fall injuries by unit.
• Near-misses: Count reports, since a rising count often means reporting is working.
• Violence incidents: Log verbal and physical incidents by unit, shift, and source.
• Staffing levels: Compare actual staffing with planned ratios using healthcare staffing metrics.
• Patient experience: Watch scores for signs that staff strain is reaching patients.
• Fatigue-related absenteeism: Monitor sick calls after heavy overtime.

3. Define safety policies and protocols

Written safety protocols in nursing turn good intentions into consistent practice. At a minimum, be sure to cover:

• Communication protocols: Define how staff hand off patients, escalate concerns, and call for help so everyone knows their role.
• Fall prevention: Establish strategies for safely handling patients and for monitoring high-risk individuals.
• Workplace violence prevention: Your formal workplace violence prevention program should provide nurses with clear, simple ways to report incidents and to call for help.

Align each policy with the latest Joint Commission changes so your protocols also support hospital inspection readiness.

4. Train every clinician on the floor

Protocols only work if everyone on the unit knows them. Build nurse safety training into onboarding and schedule regular refreshers on de-escalation, safe patient handling, sharps safety, and incident reporting. Training should reach in-house staff, float nurses, and per diem clinicians alike, so everyone on a unit follows the same protocols. 

5. Build safety communication into daily routines

Strong safety communication in nursing depends on simple, repeatable tools:

• Situation, Background, Assessment, and Recommendation (SBAR): Use it during handoffs and when escalating a concern to a provider.
• Nursing huddles: Hold them at the start of each shift to flag high-risk patients and staffing gaps.
• Safety briefings: Run them after incidents or before procedure changes.

6. Make it safe to speak up and report

Psychological safety in nursing means that nurses can report incidents, ask questions, and share concerns without fear of blame. It strengthens safety culture and can lead to better patient outcomes. Facilities can support it by:

• Keeping reporting nonpunitive. This matters most for workplace violence reporting in nursing, since many incidents go unreported. 
• Closing the loop by showing staff what changed as a result of their reports.
• Recognizing nurses who report near-misses or flag risks early, whether with shout-outs or a formal recognition program. 

7. Staff to safe levels

Even the strongest safety protocols can break down when nurses are overloaded, raising the risk of errors, burnout, violence, and injuries.

Predictive staffing models help anticipate demand before gaps appear, and nurse workflow optimization can reduce delays that drain time from crucial patient care. 

Scheduling tools can show coverage gaps and projected overtime before a schedule goes live. When internal staff can’t cover a shift, Nursa’s Shift Marketplace provides facilities with access to per diem clinicians. With the right support in place, nurses can work at a safe pace, consistently follow protective protocols, and deliver the care patients deserve.

Improve nurse safety with safe, visible staffing

Nurse safety comes down to a few connected habits: knowing the hazards on each unit, tracking the right metrics, setting clear protocols, training everyone on the floor, and making it safe to speak up. None of these holds up for long when nurses are stretched thin, which is why safe staffing levels are the foundation of any nurse safety program.

When nurses see leadership act on their concerns, they’re more likely to report risks early, stay with their facility, and give patients their full attention.

See how Nursa’s Central Staffing helps you spot coverage gaps and projected overtime before your schedule goes live.

Sources:

• Press Ganey: On average, two nurses are assaulted every hour 
• U.S. Bureau of Labor Statistics: Workplace Violence in Healthcare 
• Occupational and Environmental Medicine: Prevalence of workplace violence against healthcare workers 
• American Hospital Association: A comprehensive assessment of financial costs and other impacts of workplace and community violence  
• The Joint Commission: Workplace violence prevention 
• Centers for Disease Control and Prevention: Bloodborne infectious diseases