By Bo Mitchell, Contributing Writer

The numbers surrounding violence in healthcare facilities are staggering. 

Healthcare workers are five times more likely to experience workplace violence than other occupations, according to the U.S. Bureau of Labor Statistics. Nearly 82 percent of nurses experienced some form of workplace violence in 2023, according to a 2024 survey by National Nurses United. The annual financial burden on hospitals due to violence, including treatment costs and lost productivity, is estimated at $18.27 billion, according to the American Hospital Association. 

The real-life results of these actions are often shocking. In February 2025, in Pennsylvania, a husband upset with the care his terminally ill wife was receiving became verbally abusive with hospital staff. He was ejected by hospital security officers and returned the next morning, shooting and killing six people, including a police officer. 

Many forms of workplace violence 

Active shootings are the most egregious form of workplace violence. Healthcare facilities managers involved in efforts to prevent and plan for such emergencies need to understand that workplace violence takes many forms. 

The U.S. Department of Justice reports there are 2 million instances annually of workplace violence in all workplaces, including healthcare facilities. Other forms of workplace violence include bomb threats, child abuse, civil disturbance, hostage taking, rape, suicide, suspicious packages and persons and verbal threats. 

Analysis of these incidents reveals connections among these many forms. For example, everyone who is bullied turns into an active shooter. But every active shooter was bullied at work, at school or in their neighborhood — in many cases, all three. The Pennsylvania shootings were forewarned by the threats the night before. 

Also, research grows yearly that active shooters — anyone perpetrating workplace violence in any form — often telegraph their intentions to commit violence repeatedly before they commit the actions. 

Complexities and preparation 

If the above scenarios define the problem, what is the solution regarding readiness for an active shooter and other types of workplace violence in healthcare facilities?  

Equipment and systems — panic alarms, easy-locking doors for lockdowns, security officers armed or trained in de-escalation — certainly can aid readiness. But they are only a start. One axiom from my drill sergeant in the U.S. Army was, “For every complex problem, there’s a simply solution that’s always wrong.” 

The most effective solutions are sophisticated emergency response planning and master level training for all employees. 

Executives in healthcare facilities often automatically declare that their organizations have an effective emergency plan. Yet when an independent, outside assessment of their planning and training is conducted, it is common that they fail to comply with the letter and spirit of all established standards in healthcare. They do not have an emergency action plan that complies with the Joint Commission, CMS, OSHA, NFPA, state and city fire codes, FBI, U.S. Secret Service, the Access Board, ASIS and other standards-issuing agencies, all of which apply to healthcare facilities. 

Too many healthcare facilities believe their monthly fire drills or fire-response simulations cover their bases. Most have not addressed their fatal flaws in their active shooter and workplace violence response. 

Fatal flaws 

What are the common flaws in healthcare emergency planning regarding active shooters and workplace violence? 

We often see a poster or a page on the practice of run/hide/fight. But there is little if any direction, training or exercise on: how to alert 100 percent of personnel, clients and patients instantly; whether to stay with or abandon clients or patients if they cannot run; how to hide; how to communicate with the emergency response team; and how to prepare to fight. 

Active shooters and workplace violence perpetrators almost always telegraph their actions. But healthcare employers become fixated on active shooters, thereby ignoring the many forms of workplace violence that often serve as precursors to active shooters. Few healthcare facilities, train all employees in behavioral assessment or promote a culture of recognition and of reporting signal behaviors that often precede workplace violence. 

Healthcare employers also pay no attention to other potentially lethal weapons beyond firearms, including knives, baseball bats and thrown projectiles. The response procedures and training for weapons that are not firearms are very different for the healthcare facilities staff compared to those for responding law enforcement. Few facilities deploy de-escalation procedures that healthcare employers can train and implement to be enthusiastically used by employees when a firearm is not involved. 

Bo Mitchel is president of 911 Consulting, which creates emergency, disaster recovery, business continuity, crisis communications and pandemic plans, as well as training and exercises for organizations.