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The prevalence of workplace violence compelled the American Nurses Association (ANA) to issue a position statement in July of 2015 titled, 'Incivility, Bullying, and Workplace Violence'. The statement addressed all forms of violence from all sources with a zero tolerance. According to the Code of Ethics for Nurses, nurses are obligated to "...create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students and others with dignity and respect." and "...bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors." (Hegge et al., 2015, p. 20)". While citing the Code of Ethics in the position statement, the ANA also clarified that this ethical and moral treatment must be reciprocated and anything less is not to be tolerated. The ANA furthered their position to include that nurses, schools, and employers have an 'ethical, moral and legal responsibility' to ensure a safe work environment (ANA, 2015)
According to the Occupational Safety and Health Administration (OSHA), "Healthcare workers are at an increased risk for workplace violence." (2015).  In an analysis between 2002-2013, Healthcare workers had the highest number of cases for serious workplace violence than any of the other private workforce sectors (OSHA, 2015). In a 2014, American Nurses Association's Health Risk Appraisal Survey, registered nurses and nursing students reported in a twelve month period that 21 percent were physically assaulted and more than 50 percent were verbally abused (OSHA, 2015). OSHA also believes that these numbers are under reported either because of a culture that believes 'it is part of the job' or because nurses do not feel that management would support them (OSHA, 2015).
Workplace Violence is a global issue, so mush so, that in 2002 the World Health Organization (WHO) released a publication 'Framework Guidelines for Addressing Workplace Violence in the Health Sector" (WHO, 2002). This framework addresses criteria that healthcare organizations must have or do to provide a 'safe' workplace for employees. Workplace violence comes at a high cost to employers, nurses and patients. There are costs associated with the medical treatment for the injured, work days lost, workers compensation claims, the loss of employees from caregiver burnout and errors/injuries associated with  patient care due to caregiver fatigue/stress (Papa & Venella, 2013). Workplace violence is a dynamic and evolving problem facing the world.

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(ANA.ORG, n.d.)

Current Situation:
Unfortunately, workplace violence in healthcare is on the rise. Daily we are bombarded with headlines in the news associated with drugs, gang violence, alcohol abuse, shootings, mental illness, nursing shortages, full hospitals, closing of specialty facilities, and the list goes on and on. As nurses, we care for all patients when they are admitted in the hospital regardless or not of their propensity for violence. The factors just mentioned are just some of the reasons why nurses are exposed to verbal and physical abuse while caring for their patients. As healthcare providers, we also belong to a culture that believes in the principle of ‘First, do no harm’, and sadly, we tend to accept workplace violence as ‘part of the job’. This mindset is misguided and detrimental to stopping workplace violence.

Several organizations have been lobbying lawmakers to create tougher penalties for those who commit workplace violence. The Emergency Nurses Association has been campaigning with law makers to make it a felony to attack or commit battery against healthcare workers in all states (Docksai, n.d.). Likewise, the American Nurses Association, recognized the threat that nurses face regarding workplace violence and in return they are pressuring Congress to pass legislation that would make the health care industry required to train employees to recognize and manage violent situations (Docksai, n.d.).

Involvement:
Nurses are a critical component in addressing workplace violence. Changing a cultures way of thinking is not an easy feat. Workplace violence is ‘not part of the job’ and nurses need to identify this behavior as not acceptable. Nurses can not refuse to treat a patient but they can ensure a safe environment to care for the patient (Docksai, n.d.. Nurse involvement is needed to influence all aspects of healthcare from management, administration, patient care, lobbying, etc.. The American Nurses Association represents approximately 4 million nurses nationwide and this number increases yearly with new graduate nurses entering the workforce (ANA, 2018).

Challenges:
Challenges nurses face in consideration to workplace violence in healthcare are tremendous and on a global level. Some factors include:

Closure of specialized mental health or detox facilities

Acute care hospitals treating mentally ill and detox patients

Increased number of patients

Higher accuity patient

Non-compliant patients

Longer wait periods for treatments or medications

Nursing shortage

Stressed/burn-out nurses

This list goes on and on and as soon as we find solutions to identified areas of concern more challenges surface. This is a dynamic situation and one that is extremely challenging.

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1. Mandatory education for all nurses.
Workplace violence education should be part of the required curriculum in nursing schools and part of the NCLEX. New graduates should know how to respond to escalating situations and how to deescalate a potential situation.  For established nurses, mandatory continuing education courses should be required, otherwise a whole population of nurses will not be educated on how to respond to workplace violence.

2. Mandatory prevention programs for all healthcare facilities with local, state and federal backing. All healthcare facilities should be mandated to have comprehensive workplace violence prevention programs. Annual training for employees and orientation training for new employees. There should be local, state, and federal requirements for these programs as this is a global issue.

3. Facility reform. Acute care facilities were not meant to be used as mental health or detox facilities. Aggressive or potentially violent patients should be cared for in special units where specially trained staff can manage their care and where they will not pose a threat to other patients or staff.