How to Improve Nurse Safety: Step-by-Step Guide for Leaders

According to Press Ganey, more than two nurses were assaulted every hour in the second quarter of 2022.

This data poses a significant problem for facilities. Nurse safety is one of the most important objectives to achieve, as it leads to better patient outcomes and reduced absenteeism, burnout, and turnover. Therefore, healthcare leaders must find ways to ensure the safety of their nursing staff.

Nurses make a pledge to protect patient safety, and often, they put their own lives at risk to maintain patient safety and provide quality care.

They deserve safe work conditions and the support of healthcare leaders. This article aims to provide a guide and resources for facilities dealing with this challenge.

Why prioritizing nurse safety is so important

Nurse workplace safety is essential not only for staff but also for the wellbeing and security of patients. Establishing clear nursing protocols helps everyone know which steps to take when a threat is noticed or a violent episode occurs.

Workplace violence has a direct impact on high turnover rates, burnout, and nurse fatigue. It also diminishes team morale.

Here is an overview of nurse safety statistics in different situations:

Emergency, psychiatric, and pediatric units have the highest number of assaults against nursing professionals.
Patients are the largest source of violence. However, family members, visitors, and coworkers are also known to be perpetrators.
The majority of assailants are male.
Neonatal intensive care and obstetrics units have the lowest numbers of assaults.
Verbal abuse represents the most common form of non-physical violence, reaching 57.6%.
A third of nurses (33.2%) suffer threats, and 12.4% experience sexual harassment.

Safety culture surveys show that healthcare workers who suffer some kind of harassment are more likely to have feelings of anxiety, depression, and burnout.

The top safety threats to healthcare workers

Healthcare workers are exposed to various safety hazards. To create a culture of safety in nursing, it is important to identify the pain points and assess them thoroughly.

Workplace violence

Workplace violence (WPV) has a significant impact on the healthcare system in the U.S. According to the American Hospital Association, the financial cost of violence in hospitals in 2023 was around $18.27 billion.

WPV is not just a monetary problem, as it affects all healthcare providers, from physicians to nurse aides, psychologically and physically. Therefore, it is essential to seek mechanisms that ensure safety in healthcare.

According to the American College of Surgeons, 73% of all nonfatal workplace injuries and illnesses due to WPV occur in healthcare. Hence, healthcare workers are 5 times more likely to experience a violent event than those in other industries.

Quick facts: Due to workplace violence, 6 of 10 registered nurses have considered leaving their jobs or changing their profession.

Burnout

Understaffing leads to heavy workloads, which decrease job satisfaction, create an economic burden due to premium overtime rates, and affect the quality of care.

Burnout and understaffing create a self-reinforcing cycle where understaffing leads to higher levels of burnout among in-house staff, which, in turn, results in high turnover rates and further understaffing.

Burnout not only affects nursing safety but also significantly impacts patient outcomes. Clinicians who are experiencing burnout struggle to perform at their total capacity, since they often feel anxiety, physical and emotional fatigue, and depression.

Healthcare is experiencing a nurse staffing shortage that affects facilities and clinicians around the country. This situation is forcing facilities to rely on overtime to cover open shifts in their schedules, resulting in overworked nursing staff. There is a need for efficient ways to recruit and retain clinicians in order to maintain adequate staffing levels.

Work-related musculoskeletal disorders

Nursing involves repetitive physical efforts, such as helping residents take a shower, moving them from one bed to another, or assisting them into a comfortable position.

Safe patient handling often requires being in awkward positions, and this can lead to injuries to muscles, tendons, and nerves.

When facilities are short-staffed, the risk of personnel experiencing these types of injuries increases. Workplace injuries impact the care process and make it difficult to maintain a proper nurse-to-patient ratio, which in turn impacts hours per patient day (HPPD) metrics.

Infectious agents

Clinicians are exposed daily to infectious organisms like viruses, fungi, bacteria, and parasites.

In nursing, managing needles is like using pencils in other professions. Therefore, it is important to have strict policies to reduce risks not only for clinicians but also for patients.

In medical centers struggling to fill gaps in their schedules, there are increased chances for nurses to contract infections and for patients to acquire hospital infections.

How to build a culture of safety in nursing: Step-by-step roadmap

Nurse wellbeing is one of the top priorities for medical centers. Therefore, it is necessary to implement policies that promote a culture of safety in nursing.

The following examples illustrate how to ensure nurse safety.

1. Secure buy-in from stakeholders

To find a proper solution and implement the right policies, a multidisciplinary team must be created to gather different perspectives and share responsibility, ensuring that all stakeholders are involved.

On one side, there are nurse leaders who need to be attentive to any type of risk in their units, assess it properly, and encourage team members to report risk factors that may affect staff, patients, or others.

On the other side, there is the nursing workforce, who are on the frontline and can identify potential risks fast, report them, and take action before anything happens or mitigate negative outcomes.

2. Audit the state of safety throughout the healthcare facility

Managing the proper nurse safety metrics will provide the necessary information to reduce risks and achieve better outcomes.

Knowing your numbers helps you understand where you are and where you want to be.

For example, incident reports can indicate the injuries that occur in a given period of time and in specific situations, such as those that occur when handling patients, using sharp objects, or administering medication.

3. Clearly define safety policies

To maintain health and safety in healthcare, clear protocols, from guidelines for administering medication to an emergency operation plan, are necessary.

Communication protocols: Clear communication paths across teams are necessary. When roles and responsibilities are clearly defined, everyone knows their part. These communication paths include per diem nurses who need to understand the facility's protocols.
Fall prevention: Establish strategies to safely handle patients and monitor high-risk individuals to prevent them from encountering hazards in their environment.
WPV prevention: Empower and provide clear paths for nurses to report violent incidents.
Patient identification: Incorporate a three-step verification process for identification before providing medications or care.
Procedures and equipment: Relying on technology enables more control over different procedures, but everyone involved must be trained meticulously to ensure optimal results.

4. Incentivize improvement

To establish a culture of safety, it is necessary to involve everyone in the process. Therefore, creating a rewards plan can incentivize nursing staff not only to file reports but also to be the first to identify potential risks.

Best practices for fostering nurse safety

Creating a facility culture where nurse injury prevention is a top priority requires specific practices to achieve the expected results.

1. Lead by example

Nurse leaders not only need to be aware of potential risks, but also need to create a safe environment so their personnel feel comfortable when applying safety protocols.

Regulatory compliance is non-negotiable for healthcare leaders; they must demonstrate precise adherence to protocols.

For leaders to understand their roles and assess their performance, facilities must do the following:

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. Tie success to specific metrics

Using metrics can help foster a culture of safety in nursing. Identify areas already succeeding and those that need improvement by tracking:

Injury rates
Near-misses
Violence incidents
Staffing levels
Patient experience
Fatigue-related absenteeism

Additionally, it is essential to seek accreditations that enable facilities to enhance risk management, mitigate risks, and deliver quality care, such as that offered by The Joint Commission.

3. Don’t assume that a “one-size fits all” approach is enough

Medical centers offer a range of services and have varying staff requirements.

A small rural facility, for example, will not face the same patient volumes, acuity patterns, or security risks as a large metropolitan hospital. The same is true at the unit level: an emergency department’s exposure to high-risk situations differs drastically from that of a long-term care unit or outpatient clinic.

Therefore, every facility needs to have a tailored approach to implementing safety protocols that is specific to its unique needs.

4. Hard-code safety communication in team rituals

Creating clear communication protocols and making them a routine through the implementation of nursing communication tools helps to build trust between nurses and reduce communication errors.

Here are some nursing communication tools that might help:

Situation, Background, Assessment, and Recommendation (SBAR)
Nursing huddles
Safety briefings

5. Don’t neglect psychological safety

Forsaking psychological safety is like building a house without solid foundations.

Creating an environment where nurses are supported to speak up without fear, feeling that they can report incidents, ask questions, and share concerns, reflects better patient outcomes and a stronger facility's safety culture.

6. Take measures to reduce strain on nursing staff

Even the strongest safety protocols break down when nurses are overloaded. Chronic understaffing increases the likelihood of errors, accelerates burnout, and heightens the risk of workplace violence and injuries—especially when clinicians are forced to rush, skip steps, or perform tasks without adequate support. To prevent strain, facilities need flexible staffing solutions that stabilize schedules even when census spikes or last-minute call-outs occur.

Leveraging on-demand staffing platforms like Nursa allows facilities to quickly bring in qualified clinicians and avoid stretching their core staff beyond capacity. With the right support in place, nurses can work at a safe pace, follow protocols consistently, and deliver the level of care patients deserve.

Nurse safety translates to safe patient outcomes

Workplace violence in the healthcare industry directly impacts patient outcomes, diminishes the morale of the nursing workforce, and increases burnout and error rates among nursing professionals.

It is essential to foster a safety culture in nursing by implementing clear communication protocols, creating a supportive environment for clinicians, and establishing multidisciplinary safety teams.

When building a safety culture, it is also essential that everyone feels involved to create cohesion among healthcare workers, effectively reducing risks and achieving better outcomes.

Nurse safety is also not possible without proper staffing ratios.

Discover resources from Nursa on filling last-minute schedule gaps and maintaining safe staffing ratios.

Sources:

How to improve nurse safety in healthcare

Key takeaways:

Why prioritizing nurse safety is so important