Speaking up for safety

BACKGROUND: Type 2 workplace violence (WPV), defined as violence perpetrated by patients or visitors against health care workers, remains a significant threat to nurse safety, well-being, and retention. Inadequate communication regarding patients' history of violent behavior may leave nurses unprepared to manage escalating situations and contribute to underreporting of WPV incidents. PURPOSE: To evaluate the impact of a structured Potentially Violent Patient Handoff (PVPH) tool on nurses' confidence in managing potentially violent patients and on Type 2 WPV reporting within an inpatient neurology/neurosurgery unit. METHODS: This quality improvement project used a pre-post design over 6 months in a high-risk inpatient unit. The PVPH tool was implemented through education, stakeholder engagement, and Plan-Do-Study-Act cycles. Outcomes included nurse confidence measured by the Clinical Confidence in Coping with Patient Aggression scale, perceptions of handoff effectiveness and safety, and Type 2 WPV event reports. RESULTS: Mean confidence scores increased from 58.1 to 66.3 following implementation. Nurses reported improvements in perceived safety, support, collaboration, and adequacy of handoff information. Agreement regarding the importance of reporting violent events increased from 69% to 88%. Although reported violent events increased from 19 to 37, reporting trends declined over the intervention period, suggesting improved awareness and reporting behaviors alongside enhanced preparedness. CONCLUSIONS: A structured violence-focused handoff tool improved nurses' confidence and perceptions of safety while promoting communication about behavioral risks during care transitions. Standardized violence-related handoff processes may support safer work environments and strengthen WPV prevention efforts in inpatient settings.