This article, written by Vistelar's Chief Clinical Officer, Dr. Julibeth Lauren, PhD, APRN, ACNS-BC, CENP, is organized into two sections that address the same evidence from two vantage points.
Section 1 is written for nurse leaders and clinical staff: it examines the research on safety culture, workplace violence, and skills-based prevention.
Section 2 is written for healthcare executives and administrative leaders: it translates that same evidence into organizational impact, financial risk, regulatory alignment, and strategic priorities.
Both sections draw from the same data and can be read independently or shared with the appropriate audience.
A strong and consistently practiced culture of safety is one of the most reliable foundations for high-quality nursing care, and workplace violence prevention has become an essential part of that foundation. Recent findings from Press Ganey (2026), reinforce what nurses and nurse leaders have expressed in recent years: when nearly half of healthcare workers report low perceptions of safety culture, it signals meaningful opportunities to strengthen the systems that support both staff and patient well-being.
Nurses continue to experience some of the highest rates of workplace violence in healthcare, and research demonstrates that exposure to violence affects far more than morale. Fricke et al. (2023) emphasize that effective workplace violence prevention is not the responsibility of leadership alone but requires a comprehensive, organization-wide approach. Their review found that prevention efforts are most successful when organizations integrate environmental safety measures, adequate staffing and human resources, reliable reporting systems, and a prevention-focused safety culture that supports staff in speaking up and responding early to risk.
The connection between safety culture and violence prevention is well established. Fricke et al. (2023) found that effective violence-prevention programs consistently include leadership accountability, structured reporting pathways, and learning systems, elements that align closely with the Joint Commission’s National Performance Goal 2A (2026), which elevates workplace violence prevention to a core safety requirement. NIOSH (2024), further emphasizes that psychological safety is essential for workforce stability, mental well-being, and reliable care delivery.
Leadership accountability for workplace violence prevention programs
Annual worksite analysis and risk assessment
Structured reporting and organizational learning systems
Consistent staff training on prevention and response
Shift-specific realities also shape the safety environment. The Press Ganey report highlights a “three-shift
While aggression occurs across all shifts, recent evidence shows that most documented aggressive events occur during the day. Iennaco et al. (2024) found the following distribution of aggression events:
These predictable variations underscore the need for tailored, shift-specific safety strategies rather than uniform approaches.
Staff education and skills-based training are essential components of a comprehensive workplace violence prevention program, equipping teams to recognize early warning signs, apply prevention or non-escalation and de-escalation strategies, and respond confidently when conflict arises. Fricke et al. (2023) found that effective prevention efforts require coordinated organizational structures that include staff training, environmental safety measures, and operational supports that reinforce a climate of prevention.
When staff are prepared with consistent, evidence-based skills, they are better able to intervene early, reduce risk, and contribute to a stronger culture of safety. Integrating these competencies across onboarding, annual training, and ongoing practice helps create a workforce that is both confident and capable in managing escalating situations.
Early warning sign recognition
Prevention or non-escalation and de-escalation techniques
Onboarding, annual training, and ongoing practice reinforcement
Evidence-based, consistent skill standards across all units and shifts
Strengthening safety culture requires more than visible leadership presence and reliable reporting systems. As Fricke et al. (2023) emphasize, effective workplace violence prevention depends on a comprehensive, organization-wide approach that integrates environmental safety measures, operational supports such as adequate staffing and workflow design, and a prevention-focused climate that promotes both psychological and physical safety. When these elements work together, organizations create conditions that allow staff to speak up early, respond confidently to risk, and sustain a culture of safety.
Nurses are central to the success of any safety culture. By reinforcing the structures that protect them, organizations strengthen the foundation of patient care itself. The evidence is strong, and the opportunity is real: a safer workforce creates better outcomes, and nurse leaders are uniquely positioned to guide that progress with confidence and clarity.
It means that despite improvement in national safety culture survey scores overall, a large portion of frontline staff do not feel consistently safe or supported in their work environment. Low safety culture perceptions are associated with reduced reporting, higher burnout, and greater risk of adverse events. This gap signals that system-level improvements are not yet reaching the frontline experience consistently.
The Joint Commission elevated workplace violence prevention to a National Performance Goal 2A in 2026, recognizing staff safety and patient safety are highly correlated, a relationship supported by research demonstrating that worker harm, psychological distress, and organizational instability directly increases risks to patients (NIOSH, 2024; The Joint Commission, 2024, Weigl et al., 2017). Accredited organizations need to demonstrate leadership oversight, conduct annual risk assessments, reporting systems, and staff training as core compliance requirements.
According to Iennaco et al. (2024), day shift accounts for 50.7% of documented aggression events, followed by night shift at 25% and evening shift at 24.3%. While day shift volume may reflect higher patient census and activity, nights and weekends carry compounding risks due to reduced staffing and slower response times.
Research supports skills-based training that integrates prevention or non-escalation and de-escalation techniques, early warning sign recognition, and consistent practice across onboarding and annual competency requirements. Effective training connects individual skills to organizational structures, including reporting systems and environmental safety supports.
A strong safety culture reduces burnout and turnover intention. Research from Çakır et al. (2025) and Yun et al. (2023) demonstrates that violence exposure significantly increases emotional exhaustion and predicts thoughts of leaving. When staff feel protected, supported, and heard, they are more likely to remain and contribute to high-reliability care.
Shift-specific staffing gaps, especially on nights and weekends, represent targeted investment opportunities with measurable returns in safety outcomes.
New national data from Press Ganey (2026) shows that nearly half of healthcare workers report low perceptions of safety culture. For executive leaders, this represents a clear opportunity to reinforce the systems that support workforce stability, patient safety, and organizational reliability. A strong safety culture is one of the most consistent predictors of high-performing healthcare environments, and workplace violence prevention is now a central component of that culture.
A culture of safety is a leading indicator of operational strength. When staff feel physically and psychologically safe, communication improves, reporting increases, and high-reliability behaviors become more consistent (Murray et al., 2024). Variation across day, night, and weekend shifts highlights the need for tailored support and shows where targeted investment can produce measurable gains.
Recent research confirms that workplace violence contributes to burnout and turnover intention among healthcare workers. Çakır et al. (2025) found that exposure to violent events significantly increases emotional exhaustion and depersonalization, while Yun et al. (2023) demonstrated that workplace violence is directly associated with burnout and strongly predicts thoughts of quitting. These findings reinforce that violence exposure is a critical driver of workforce instability and emotional strain. Reducing violence and improving safety culture directly support retention, reduce premium labor reliance, and stabilize staffing.
The Joint Commission’s National Performance Goal 2A (2026) positions workplace violence prevention as a core safety requirement. Compliance includes leadership accountability, annual worksite analysis, reporting and learning systems, and staff training. Strengthening these areas supports staff wellbeing and ensures readiness for accreditation and regulatory review.
Organizations with strong reporting cultures are eight times more likely to rank in the top quartile for teamwork, learning, and collaboration (Press Ganey, 2026). When staff feel safe, they communicate more effectively, escalate concerns sooner, and participate more actively in improvement efforts. Violence prevention is therefore a quality strategy as much as a workforce strategy.
Staff education and skills-based training are core elements of an effective workplace violence prevention strategy, ensuring teams can recognize early warning signs, apply non-escalation and de-escalation techniques, and respond confidently when conflict emerges. Fricke et al. (2023) emphasize that prevention requires coordinated organizational structures that integrate staff training with environmental safety measures and operational support to reinforce a climate of prevention. Preparing staff with consistent, evidence-based competencies strengthens early intervention, reduces risk, and contributes to a more reliable culture of safety.
A strong safety culture is a strategic asset. By reinforcing the systems that protect caregivers, organizations strengthen the foundation of patient care and position themselves for long-term stability and success. Key priorities for executive leaders include:
When nearly half of healthcare workers report low safety culture perceptions, it signals that aggregate improvement scores may mask significant variation at the unit and shift level. For executives, this is a call to invest in the systems, structures, and training that translate policy into daily frontline experience, particularly in areas of known risk such as nights, weekends, and high-acuity units.
Violence exposure is a measurable driver of burnout, emotional exhaustion, and turnover intention. Çakır et al. (2025) and Yun et al. (2023) both confirm this link. When organizations reduce violence and strengthen safety culture, they reduce the premium labor costs and recruitment burden associated with high turnover, creating direct financial return on safety investment.
The Joint Commission’s NPG 2A (2026) requires organizations to demonstrate leadership accountability for workplace violence prevention, conduct annual worksite analyses, maintain reliable incident reporting and learning systems, and ensure staff receive consistent skills-based training. These are not just policy requirements; they are the structural building blocks of a functioning safety culture.
The Press Ganey three-shift reality framework identifies systematic differences across shifts in staffing levels, leadership presence, and response capacity. Nights and weekends often operate with fewer resources and slower escalation pathways. Targeted investment in those environments, including adequate staffing, accessible leadership, and trained staff, produces disproportionate safety gains.
Press Ganey (2026) reports that organizations with strong reporting cultures are eight times more likely to rank in the top quartile for teamwork, learning, and collaboration. When staff feel safe to speak up, they identify risks earlier, communicate more effectively, and participate in improvement efforts. Safety culture and care quality are not separate pursuits; they reinforce each other directly.
Referenced Vistelar Resources:
The following Vistelar blog posts and resources are referenced throughout this article: