Title: Tackling the Surge of Violence in Health Care: Cultivating Safety as a Daily Habit

The health care field is swiftly transforming into one of the most perilous professions in the United States. Once viewed as places of healing, hospitals and clinics are increasingly facing a troubling escalation in violent threats and assaults. In his latest piece, “Violence in health care: Why doctors and nurses are leaving,” Dr. Harry Severance raises a critical warning: violence has transitioned from being an unexpected anomaly to a harsh reality for those on the front lines.

As someone who transitioned from surgeon to psychotherapist and physician coach, I’ve engaged in numerous discussions with clinicians who have endured intimidation, verbal mistreatment, and even physical violence in environments ranging from emergency departments to inpatient facilities and rural health centers. The narratives are profoundly distressing—and alarmingly prevalent.

However, action cannot solely rely on policy changes. While structural reforms addressing issues like staffing shortages, enhanced security, mental health resources, and systemic inequalities in health care are urgently needed, physicians and nurses still face the immediate responsibility of showing up for their shifts. They need to manage the unpredictable situations of handling pain, fear, confusion, and often intentional aggression.

This article presents five essential strategies that clinicians can implement immediately to boost safety, mitigate violent situations, and safeguard their mental well-being.

1. Recognize the Early Warning Signs

Violence seldom occurs without premonitory signs. By identifying early behavioral cues, health care professionals can act more proactively. Indicators may include:

– Raised voices or shouting
– Clenched fists or restless pacing
– Direct insults or refusal to comply with instructions
– An intuitive feeling that something is off

In every new health care environment, clinicians should familiarize themselves with their surroundings as if entering an unknown city. Understand the physical layout, locate all exits, and identify security personnel and emergency procedures. Becoming acquainted with the geography of your work environment can save critical time during a crisis.

This approach is not alarmism—it’s preparation that empowers clinicians to take early preventive measures and mitigate risk.

2. De-Escalate using Intentional Communication

As tensions escalate, the focus must shift from asserting control to calming the situation. Successful de-escalation tactics are founded on emotional intelligence and purposeful communication:

– Lower your tone and slow down your speech to ease the atmosphere.
– Use the name of the patient or family member; it personalizes the interaction.
– Offer small choices (“Would you like water or juice?”) to restore a feeling of control.
– Acknowledge feelings without acquiescing to unreasonable requests. Say, “I can see you’re very angry. Let’s find a way to resolve this safely.”

These responses help to slow emotional triggers and often avert situations from escalating further.

3. Center Yourself Before Responding

One of the essential tools during a crisis is your own nervous system. Our responses—whether conscious or subconscious—can either soothe or exacerbate tensions. If you tense up with fear, speak sharply, or react defensively, you may be intensifying the situation.

Instead, take a moment to:

– Breathe slowly and deeply from your abdomen.
– Relax your shoulders and ease your grip.
– Ground your stance to feel secure and balanced.
– Communicate from a grounded position, not from a place of panic.

In emotionally charged scenarios, aim to be the most composed person in the space—not due to being unaffected, but because you choose not to elevate the situation’s volatility.

4. Establish Boundaries and Seek Assistance Promptly

You are not a security personnel and should not have to endure danger in the name of professionalism. If a patient or visitor poses a threat, is unwilling to de-escalate, or invades your personal space, take action.

– Activate security systems or panic buttons where possible.
– Leave the area if your safety is compromised.
– Set boundaries using the “broken record” method: calmly and repeatedly articulate the behavioral limits.

For instance: “I need you to sit down so we can proceed.” Repeat calmly. Repetition signifies authority without aggression, particularly when emotions are running high.

Crucially, don’t wait until you’re in immediate danger. The sooner you call for help or extricate yourself, the more likely a situation can be managed safely.

5. Acknowledge and Process the Aftermath

Following a violent or aggressive episode, although adrenaline may wane, the psychological ramifications often persist. Dismissing trauma—or, worse, normalizing it—intensifies long-term stress, burnout, and emotional detachment.

After any encounter:

– Dedicate 10–15 minutes to debrief with a colleague or mental health expert.
– Identify your emotions: fear, frustration, helplessness, sorrow.
– Reflect on the events and what was helpful (or not) in the situation.

This is not indicative of weakness. It is what psychologists refer to as psychological first aid. Just as physical injuries require care, so too do the unseen mental pressures. The cumulative impact of overlooking these experiences is deterioration—of empathy, safety, and human connection.