Workplace violence in healthcare settings: Does preventive training and education affect prevalence?

Objective: Workplace violence is an ongoing concern in healthcare settings. Patient-initiated violence toward healthcare workers impacts employees physically and emotionally and may affect the quality of care delivered to patients. Healthcare organizations must promote safety through appropriate policies, procedures, and educational practices. The purpose of the study was to examine potential gaps in education and preparedness to manage violent patient situations and to evaluate whether workplace violence training is associated with the prevalence of patient-initiated violence. 
Methods: A cross-sectional correlational design was used, including a survey with Likert-type items and open-ended questions. The survey was distributed via snowball sampling through social media and professional email listservs. Two hundred fifty-six respondents from the United States participated in the study. Quantitative data were analyzed using chi-square tests and exploratory logistic regression, and qualitative responses were analyzed to identify common themes. 
Results: More than half of the respondents (66.01%) reported experiencing patient-initiated violence within the past six months. Although 82% of participants reported completing workplace violence training, no statistically significant association was observed between training and the prevalence of patient-initiated violence. Exploratory multivariate analysis adjusting for years of experience, clinical setting, and employment status yielded similar findings. Clinical setting was a significant predictor of violence exposure, indicating variability across practice environments. Qualitative responses highlighted concerns regarding training adequacy, frequency, organizational support, and emphasized the need for changes in hospital policy, procedures, and unit-level environments. 
Conclusions: Patient-initiated violence toward healthcare workers remains a significant issue in healthcare. Findings from this study suggest that training alone may be insufficient to reduce violence exposure and that organizational and environmental factors play a critical role. Interventions such as enhanced scenario-based training, implementation of de-escalation teams, and stronger enforcement of policies and procedures at the organizational level may better support healthcare workers in recognizing and managing escalating situations.