As nurse leaders, we have invested in resilience programs, wellness initiatives, recognition programs, and professional development strategies, all designed to help nurses manage the extraordinary demands of the profession. While these efforts are important and are valuable, they aren’t addressing one of the most fundamental reasons that nurses leave: they don’t feel safe.
Key Takeaways
- Workplace safety is one of the most powerful and underutilized retention strategies available to healthcare leaders.
- What looks like burnout is sometimes the cumulative effect of repeated exposure to violence, inadequate organizational response, and environments where aggression has become normalized.
- Retention is shaped by whether nurses feel supported and safe as they deliver care.
- A culture of safety is not the same as a workplace violence policy. The difference is whether nurses believe their organization recognizes risk, responds when they ask for help, and acts on what they report.
Research Shows Nurse Retention is Tied to Safety
A study published in JAMA Network Open found that nurses who experienced workplace abuse or violence during the previous 12 months had 39% higher odds of planning to leave the nursing profession within the next year. Higher emotional exhaustion was associated with more than three times the odds of planning to leave.
The same study found that nurses who rated their clinical setting's safety as excellent were significantly less likely to plan to leave, underscoring that safety is not just a moral obligation. It is a retention lever. Another study found that nurses with higher psychological safety were also less likely to leave within a year and reported higher patient safety ratings.
These studies make it clear that safety is not only a security issue, but it’s also a workforce strategy.
The Impact of Workplace Violence Doesn’t End with the Incident
Workplace violence isn’t contained to just a single event. It has a ripple effect that impacts staff, units, and patients. But it usually starts with an individual nurse and their experience.
As an example, let’s say an ED nurse is assaulted on Tuesday. They finish their shift, complete an incident report, and go home. On Wednesday, the same nurse shows up to work and begins caring for patients. Operationally, the incident is over. For the nurse, there may be lingering feelings like fear or anxiety about what happened. Now imagine that happening repeatedly over the course of a career. Each new instance builds on the one before. Over time, this impacts not only their ability to care for patients, but their overall well-being.
The question the nurse asks themselves eventually shifts from: "Can I handle this?" to: "Why should I continue working somewhere where this is considered part of the job?"
That shift matters, because it signals something more specific than burnout. When nurses work in environments where threat and aggression have become routine, where organizational responses fall short, and where nothing seems to change after an incident is reported, the question stops being about resilience and starts being about whether staying is worth the cost.
The Nurse Retention Cascade
One instance of workplace violence creates a cascade that begins with a single exposure to aggression and ends with staffing instability that puts the nurses who remain at even greater risk:
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Exposure to aggression or violence leads to feeling unsafe at work, which drives heightened vigilance and emotional exhaustion. That erodes trust in the organization, reduces engagement and psychological safety, and ultimately leads to intent to leave, then turnover, then staffing instability and loss of experience, which increases workload and risk for the nurses who remain.
And then the cycle begins again.
This is why workplace safety and workforce stability cannot be managed as separate strategies.
Safety is More Than Preventing Violence
Workplace violence prevention strategies need to look beyond the incident to create an environment that recognizes risk and works to prevent it. This means providing an end-to-end system designed to prevent violence before it happens, while also offering support and further measures to protect staff if it does.
This means providing:
- Tools to act early and request help even before aggression is overt
- Help that arrives quickly when it’s asked for
- Leadership responses and ongoing support after an event
- A means to change protocols or update policies if needed when violence does happen
That is the difference between having a workplace violence policy and creating a culture of safety.
Technology, including wearable duress solutions, can be an important part of that infrastructure by reducing the distance between recognizing danger and mobilizing assistance. But technology alone can’t solve the problem. It requires a strategy that commits to recognizing risk earlier, enabling intervention, rapidly summoning help, responding effectively, learning from incidents, and supporting staff afterward.
Nurse Retention Happens Before the Resignation Letter
Healthcare organizations often begin retention interventions when nurses show signs of disengagement or when turnover metrics start moving in the wrong direction. But the moments that shape retention happen long before those signals appear.
Perhaps, most importantly, retention is influenced by what happens when that nurse comes back to work believing their organization listened, responded, learned from what happened, and is committed to making the workplace safer.
We cannot ask nurses to become more resilient while leaving unsafe conditions unchanged. Resilience helps nurses navigate adversity. Prevention changes the conditions creating it.
When nurses feel safe, they are more likely to stay. Workplace safety is not simply an employee benefit. It is a retention strategy and a visible commitment that an organization values and protects the people who care for its patients.
Read Why Psychological Safety is a Patient Safety Strategy
Building the infrastructure to support your staff takes more than good intentions. Read how psychological safety empowers staff to speak up, feel more supported, and provide better patient care.
