Building Safer Workplaces: Five Ways Health Systems Are Supporting Nurse Retention

At a glance

Healthcare leaders highlighted five practical ways to make nurses’ day-to-day work safer and more sustainable:

• Building coordinated safety programs with input from frontline employees
• Using reporting and incident data to identify risks and guide action
• Strengthening physical environments with practical safeguards
• Providing tools and training to help employees manage difficult situations
• Responding visibly after incidents so employees know their concerns matter

Safety shapes the nursing experience

Workplace safety in healthcare is more than a security concern. It has increasingly become a workforce concern. As health systems work to retain nurses and sustain frontline care, more attention is turning to the conditions that shape whether employees feel safe coming to work.  

A recent Wall Street Journal article, Nurses Are in High Demand but They’re Quitting in Droves, reported that 2.4% of nursing staff in Press Ganey’s national hospital sample were attacked last year, a 26% increase from 2017. Press Ganey’s State of Healthcare Safety 2026 found that of the top 10 drivers of employee engagement, seven are tied directly to safety culture, and a negative view of the organization’s safety culture makes employees 1.74 times more likely to leave.  

Together, these findings show how workplace conditions can shape engagement and retention. 

During panel sessions at the Qualivis Roundtable and Aya Ideas Retreat, leaders from Allina Health, Oregon Health & Science University (OHSU) and VCU Health System shared how their organizations are responding to this growing issue. Ashley Xavier, director of violence intervention and initiatives at the Virginia Hospital and Healthcare Association (VHHA) Foundation, added a statewide perspective based on her work with hospitals across Virginia. 

Build a coordinated safety program 

Health systems are bringing together security, nursing, human resources, occupational health, risk management, quality and frontline employees to address workplace violence as an organization-wide concern.

OHSU created a frontline-led safety and security task force and added a dedicated workplace violence manager within occupational health. “We’re designing this process with them and not for them,” said Claudia Aime, OHSU’s vice president and chief nursing officer.

VCU’s violence prevention committee includes 40 to 50 representatives from across the organization. Allina has hospital-level committees that include nurses, nursing assistants, environmental services employees, safety leaders and union representatives.

The VHHA Foundation extends that team-based approach across Virginia by convening hospital safety, security, clinical and risk leaders to share effective practices and discuss common barriers. Those conversations help health systems learn from one another instead of developing safety strategies in isolation.

Use data to identify risk

Health systems are improving how they track incidents, injuries, near misses and time away from work. The goal is to understand where violence occurs, what contributes to it and which interventions are working. 

VCU uses its existing occupational injury reporting system to track workplace violence, giving leaders a clearer view of incidents, injuries and time away from work. The organization also conducts post-assault huddles to document what happened, identify follow-up needs and connect supervisors with the people responsible for supporting the employee and addressing risks. 

OHSU is using employee reporting to better understand what employees are experiencing and where leaders need to focus their response.  

“Right now we’re actually seeing an increase in reporting, which is what we want to see. We want our employees to tell us what’s happening,” said Aime.   

Strengthen the physical environment

Health systems are reviewing the spaces where employees work to identify vulnerabilities and reduce opportunities for violence. Changes can include: 

• Badge access and visitor management 
• Weapon detection and cameras 
• Improved lighting and clearer signage 
• Ballistic glass and walls 
• Door barricade devices 

Allina has invested in badge access, emergency department weapon detection, cameras and active shooter training. OHSU conducted a comprehensive site survey, added weapon detection at all entrances and converted its emergency department entrance to ballistic glass and walls. 

Following an incident in 2023 , VCU expanded weapon screening to 22 entry points with 27 detector sets.

Give employees practical tools and training

Health systems are pairing duress technology with training that helps employees respond to escalating situations. 

Allina is expanding real-time locator and duress devices across its hospitals. OHSU activated panic alarms on existing badge communication devices. VCU moved its emergency alert system from opt-in to opt-out so employees are automatically enrolled. 

Training is becoming more practical, too. VCU offers unit-specific verbal de-escalation training. Allina added “disengagement” training, which teaches employees not to rush into a room when a patient is agitated but not actively harming anyone.  

“If they’re in the room and they’re yelling and swearing or throwing a cup, we actually started training our staff to just disengage,” said Tracy Kirby, vice president of patient care services and system workforce management and staffing at Allina Health. The approach gives employees more room to use their judgment and avoid unnecessary risk. 

Xavier said some Virginia hospitals are also creating behavioral response teams that bring together security officers, social workers and de-escalation specialists. “When you just do training, it’s good. But if you don’t have a team to support somebody, you’re bringing in a whole new skill set,” she explained. These teams can step in when a patient’s behavior begins to escalate, giving clinical staff support instead of leaving them to manage high-risk situations alone. 

Respond visibly after incidents

Workforce safety depends greatly on what happens after an incident. Employees need to know that reports lead to action and that the organization will support them afterward. 

“I think the biggest part of [the reporting process] is listening to what is reported and responding to it in a way that’s visible to the employees so they know that we’re committed to making it safer,” said Aime. 

VCU works closely with law enforcement to improve emergency communications and conducts after-action reviews to examine what happened and how the response could improve. The organization’s approach reflects a broader point from the panel: Visible follow-through can build trust, strengthen reporting and show employees that their safety is being taken seriously. 

A safer workplace supports retention

No health system can eliminate every risk. But the examples from Allina Health, OHSU, VCU Health System and the VHHA Foundation show what it looks like to treat workforce safety as a priority. The strongest efforts combine employee input with better reporting, physical safeguards, practical training and visible follow-through. 

As Taylor Greene, director of enterprise security at VCU Health System, noted, “It’s not this one magic system or process that is going to change the game.” 

Health systems cannot recruit their way out of unsafe working conditions. The organizations most likely to retain nurses will be the ones that treat safety as a daily condition of work, not a response after something goes wrong.